Other therapeutic joint injections
Elbows, wrists, thumbs, shoulders, hips, ankles, bursae, tight muscle knots — and a longer-acting steroid option for arthritic knees. Every joint, tendon and bursa injection at ARV Centers is performed by a physician under live imaging, so it lands where it’s meant to. Not near it. In it.
Typically covered by insurance No referral or prior authorization needed for your initial consultation
Maybe it’s the elbow that lights up every time you pick up a grocery bag. The thumb that can’t open a jar anymore. The hand that goes numb at 3 a.m. and wakes you. The knot behind your shoulder blade that no massage reaches.
Maybe you already had a shot for it — in a busy office, placed by feel, over in ninety seconds — and it did nothing. So you filed “injections” under tried that.
Before you close that file: where the needle actually went matters more than most people are ever told.
How injections work here
A knee is a big target. The joint at the base of your thumb is not. Neither is the AC joint on top of your shoulder, the tunnel your wrist nerve runs through, or a tendon the width of a pencil. In a published review of injection accuracy across the major joints, the biggest gains from image guidance were in exactly these smaller joints — the hand and the foot — where a needle placed by feel most often lands beside the target instead of in it.1
So every joint, tendon and bursa injection at ARV Centers is guided by live imaging and performed by a physician. We see the joint, the tendon, or the bursa on the screen; we confirm the needle is in it; then the medicine goes in. That’s the difference between an injection that treats the problem and one that treats the tissue next to it. It’s also gentler — when the needle goes where it should and nowhere else, there’s less soreness and less bruising afterward.
And we’ll be honest about the limits. Steroid injections calm inflammation; they don’t rebuild a joint or repair a tendon. Relief is real, but it’s usually measured in weeks to months, not years — and if you keep needing the same shot, that’s information, not failure. It means it’s time to talk about the next option, and we have several.
What we treat with injections
Most of these use a small dose of steroid with numbing medicine. Some are candidates for PRP instead. Every joint, tendon and bursa injection is guided by imaging; all are performed in the office, and you walk out the same day.
Elbow · tendon
Pain on the outside (tennis) or inside (golfer’s) of the elbow where the forearm tendons anchor to bone — gripping, lifting a coffee cup, shaking hands. A guided injection calms an inflamed tendon attachment; the needle goes into the tendon itself, not just near it.
Tendon injections ache more than joint injections — we’ll tell you that up front. For elbow tendons that keep flaring, PRP is often the better long-term conversation.
Wrist · nerve
Numb, tingling fingers — often worst at night — from a nerve squeezed inside the wrist. A guided steroid injection into the carpal tunnel eases the swelling around the nerve. It can be a real treatment on its own, and it also tells us something: if the injection helps, the diagnosis is confirmed.
Imaging matters here. The nerve and its neighboring tendons sit millimeters apart, and we want the medicine around the nerve, never in it.
Hand · joint
Arthritis at the joint where the thumb meets the wrist — the one that makes jars, keys and pinching hurt. It’s a small, crowded joint, which is exactly the kind where an injection placed by feel most often misses. Under imaging, it doesn’t.
Steroid is the covered choice here. Gel injections in the thumb aren’t covered by insurance, so we offer them only if you’d rather pay out of pocket for one.
Shoulder top · joint
The small joint on top of the shoulder where the collarbone meets the shoulder blade — painful reaching across your body, sleeping on that side, or from an old separation. It’s a narrow target; a guided injection lands in the joint space and confirms it before the medicine goes in.
Not the same as the main shoulder joint. If your pain is deeper in the shoulder, start with our shoulder pain page.
Ankle · joint
Arthritis in the ankle, or an ankle that never fully settled after a bad sprain or fracture. A guided injection into the joint calms the inflammation driving the pain, and imaging confirms it went into the joint space itself — which is harder than it sounds in an ankle that arthritis has narrowed.
Outer hip · bursa
Pain on the bony point of the outer hip — worst lying on that side at night, climbing stairs, or getting up from a chair. It’s the cushion over the hip bone, not the hip joint itself, and it’s one of the injections we do most. A guided injection puts the medicine in the bursa, not the muscle over it.
Bursitis that keeps coming back has a next step here too — see our hip pain page.
Shoulder · bursa
Pain reaching overhead, behind your back, or lying on the shoulder — from the inflamed cushion between the rotator cuff and the bony roof of the shoulder. A guided subacromial injection calms it. Another of our most common injections, and one where imaging keeps the needle out of the tendon and in the space above it.
If the shoulder is stiff as well as painful, read our frozen shoulder page first.
Inner knee · bursa
A tender spot on the inner side of the knee, a couple of inches below the joint line, where three tendons share a small fluid-filled cushion (a bursa). It’s often mistaken for knee arthritis pain — and treating the wrong one is why some knee injections “didn’t work.” A guided injection treats the bursa itself.
If your knee pain is the joint rather than the bursa, our knee page lays out the whole ladder.
Muscle · neck, shoulders, back
Tight, tender knots in muscle that ache locally and often refer pain somewhere else — the neck knot that gives you the headache, the shoulder-blade knot you can’t reach. A small injection of numbing medicine into the knot releases it. Quick, and usually more than one spot in a visit. These are the one injection here placed by exam rather than imaging — a trigger point is found by feel, and that’s how it’s treated.
Not a spine procedure. We don’t do epidurals or other spinal injections.
Other joints and tendons are decided case by case. If we’re not the right people for it, we’ll say so and point you toward who is.
For arthritic knees
Most people know the cortisone story — wonderful for a couple of weeks, then gone. Zilretta is the same steroid, packaged differently, and it’s the one exception to the “cortisone fades fast” rule worth knowing about.
What it is. Zilretta is triamcinolone — the same steroid in an ordinary cortisone shot — loaded into tiny dissolvable microspheres. Instead of flooding the knee and washing out into the bloodstream within days, the microspheres release the steroid slowly, inside the joint — tiny doses over the following months instead of one big dose on day one. It is FDA-approved specifically for osteoarthritis pain of the knee, and it’s given as a single injection.2 Because it’s a knee-only, knee-specific product, we’ve kept it here rather than crowding it onto our knee page — but if your knee is the joint in question, this section is for you.
What the research shows — plainly. In the pivotal trial — 484 patients with knee arthritis, followed for 24 weeks — patients who got Zilretta reported their average daily pain dropped by about three points on a ten-point scale by week 12, roughly half of where they started, and significantly more than the saline placebo group.3 It beat placebo on every secondary measure too, including cumulative pain relief through week 24.3 Side effects were mild and no more common than with the other injections in the trial.3
Now the part a sales brochure would skip. The trial also compared Zilretta head-to-head with an ordinary cortisone shot. On the main pain measure at 12 weeks, the difference between the two was not statistically significant.3 On several other measures — function, and quality of life — Zilretta came out ahead,3 but the primary comparison didn’t clear the bar, and we won’t pretend it did. That’s also the reason a few insurance plans still balk at covering it.
What we see. In our experience, Zilretta is simply the better steroid option for an arthritic knee — for nearly every patient, not just a few. Because it doses the joint slowly rather than all at once, the relief we see typically runs three to six months instead of a couple of weeks. That’s clinical experience, not a trial result, and we’re telling you which is which. If you’ve had a cortisone shot that helped and then quit on you, this is the version worth asking about.
If you have diabetes, this matters more. Ordinary steroid injections push blood sugar up for a few days — enough that many diabetic patients have been told to avoid them. In a small randomized study of 33 patients with type 2 diabetes and knee arthritis, average blood sugar over the three days after injection rose about 15 mg/dL with Zilretta versus about 34 mg/dL with a standard cortisone shot.4 That is the whole point of the slow-release design — keep the steroid in the joint and out of the bloodstream — and it’s why, for our diabetic patients, Zilretta is the steroid we recommend for the knee.
Can it be repeated? The FDA label says the safety and effectiveness of repeat injections haven’t been formally demonstrated.2 A follow-on study of 208 patients who received a second Zilretta injection 12 to 24 weeks after the first found the second worked about as well as the first, with no sign of harm to the joint on X-rays a year later.5 In practice it can be repeated as often as every three to four months, but we prefer to be conservative — about once every six months — and the right interval depends entirely on you and your knee.
Where it fits. Zilretta calms inflammation for longer. It doesn’t replace the fluid an arthritic knee has lost — that’s the job of gel injections, which some patients receive alongside it at different times. And when injections of any kind stop doing the job, genicular artery embolization treats the inflamed lining of the knee itself, and doesn’t depend on how much cartilage is left. Injections close no doors here.
Zilretta is covered by most insurance plans. A few plans don’t cover it, and some ask for prior authorization first, which we handle for you. Our complimentary benefits check tells you exactly where you stand before anything is scheduled.
Sources: 1. Saha P, Smith M, Hasan K. Accuracy of intra-articular injections: blind vs. image-guided techniques — a review of the literature. J Funct Morphol Kinesiol 2023;8:93. 2. ZILRETTA (triamcinolone acetonide extended-release injectable suspension) U.S. prescribing information, revised 11/2024. 3. Conaghan PG, Hunter DJ, Cohen SB, et al. Effects of a single intra-articular injection of a microsphere formulation of triamcinolone acetonide on knee osteoarthritis pain: a double-blinded, randomized, placebo-controlled, multinational study. J Bone Joint Surg Am 2018;100(8):666–677 — 484 patients, 24 weeks; superior to saline at week 12 (p<0.0001); not statistically superior to standard triamcinolone on the primary pain measure. 4. Russell SJ, Sala R, Conaghan PG, et al. Triamcinolone acetonide extended-release in patients with osteoarthritis and type 2 diabetes: a randomized, phase 2 study. Rheumatology 2018;57(12):2235–2241 — 33 patients; +14.7 vs +33.9 mg/dL (p=0.045). 5. Spitzer AI, et al. Safety and efficacy of repeat administration of triamcinolone acetonide extended-release in osteoarthritis of the knee: a phase 3b, open-label study. Rheumatol Ther 2019;6:109–124 — 208 patients, single-arm.
A word about cortisone
A steroid injection is a good tool for the right job: calming a flare, getting you through a stretch you can’t afford to lose, or confirming that a joint or tendon is really the source of the pain. What it isn’t is a plan. Repeated steroid over and over isn’t kind to tendon or joint tissue, so we space injections out — commonly no more often than every few months — and we don’t keep repeating a shot that has stopped helping.
That’s not a limitation of this practice; it’s the reason for the rest of it. Tendons that keep flaring can be candidates for PRP. Arthritic knees have gel injections, Zilretta, and GAE. Shoulders, hips and heels have embolization options of their own. If we recommend an injection, it’s because it’s the right next step — and we’ll tell you what comes after it, in the same visit.
Your care team
Every injection here is a physician procedure. A visit is short: an exam, a look at any imaging you’ve brought, the guided injection, and a few minutes to make sure you’re comfortable. You drive yourself home.
Lisa D. Persyn, M.D.
Board Certified · Physical Medicine & Rehabilitation
Performs your injection
Meredith Reynolds, MSN, ACNP-BC
Board Certified · Acute Care Nurse Practitioner
Exams & care through your visit
Injections at ARVC are performed by Dr. Persyn — board-certified in physical medicine and rehabilitation, a specialty devoted to restoring function without surgery — who has performed more than 100,000 knee injections. Meredith Reynolds is typically part of your care as well, whether she’s examining you or assisting with the procedure — so the team in the room already knows you. Meet the whole team →
After your injection
Plan on going easy on the treated area for 24 to 48 hours — no extreme exercise. Some soreness at the site is normal, and a steroid occasionally causes a short flare of aching in the first day or two before it settles; ice and an over-the-counter pain reliever handle it. If you have diabetes, check your blood sugar a little more often for a few days after a standard steroid injection. Questions afterward? You call, we answer. And if something ever feels urgent after hours, our phone line has an emergency option that rings the on-call doctor’s cell phone directly.
Straight answers
Typically, yes — steroid and numbing-medicine injections into joints, tendons, bursae and trigger points are routine, covered care under most plans, including Medicare. Zilretta is covered by most plans too; a few don’t cover it, and where a plan wants prior authorization first, we handle it. Either way, our complimentary benefits check tells you where you stand before anything is scheduled. PRP is the exception on this page — it is not covered by insurance, and we say so plainly.
No. You can call us directly — no referral or prior authorization is needed for your initial consultation. If you already have X-rays, an MRI or notes from another doctor, bring them; if not, we’ll get what we need.
A straight answer: it depends on where the injection goes. We freeze the skin first with a numbing cold spray, and for most joint injections the stick is quick — pressure more than pain. Tendon injections, like tennis elbow, genuinely ache for a few moments, because a tendon has no open space to receive fluid. We’d rather tell you that now than have it surprise you. Dr. Persyn has performed more than 100,000 knee injections, and that kind of practice shows up in your comfort. If needles genuinely scare you, say so — we’ll take it slow.
Because small is the point. In a review of injection accuracy across the major joints, the biggest improvement from image guidance was in the small joints of the hand and foot — the ones a needle placed by feel most often misses. A big knee is forgiving; a thumb joint, an AC joint or a wrist tunnel is not. Imaging turns “probably in” into “confirmed in” before the medicine goes anywhere. (The one exception is trigger points, which are found and treated by feel — that’s the correct technique for a muscle knot.)
We space them out — commonly no more often than every few months in the same spot, and for Zilretta we prefer about once every six months — because repeated steroid isn’t kind to tendon or joint tissue over time. If you find yourself needing the same shot again and again, that’s useful information: it means it’s time to talk about the next option rather than re-buying the same few weeks of relief.
Zilretta is the same steroid as a regular cortisone shot, packaged in slow-dissolving microspheres so it stays in the knee and releases over months instead of days. It’s FDA-approved for arthritis pain of the knee. In its main trial it clearly beat placebo, but on the primary head-to-head measure against ordinary cortisone the difference wasn’t statistically significant — we won’t oversell that. We’ve used it here for about seven years, and in our experience it is simply the better steroid option for an arthritic knee: it doses the joint slowly, and the relief typically runs three to six months instead of a couple of weeks. The full discussion is above.
Usually, with a plan. A standard steroid injection raises blood sugar for a few days, so we’ll ask about your control and suggest checking more often afterward. For the knee, Zilretta is the steroid we recommend for diabetic patients — it was designed to keep the steroid in the joint and out of the bloodstream, and in a randomized study of diabetic patients it raised average blood sugar much less than a standard cortisone shot. Tell us you’re diabetic at your consultation and we’ll choose accordingly.
No. Trigger point injections treat muscle knots, not the spine, and we don’t perform epidurals or other spinal injections. We do treat SI joint pain with image-guided injections and radiofrequency ablation, and spinal compression fractures with kyphoplasty — those have pages of their own.
Then you’ve learned something, and so have we. Sometimes it means the pain has another source, and the exam and imaging point us there. Sometimes it means the joint or tendon has moved past what a steroid can do — and that’s exactly where the rest of this practice comes in: PRP for stubborn tendons, gel injections, Zilretta and GAE for arthritic knees, and embolization for shoulders, hips and heels. Injections close no doors here.
Yes. These are office injections with a numbing spray — no sedation, no driver needed. Plan on a quiet day or two, and you’re otherwise free to get on with things.
Free patient guide
Our free knee arthritis guide explains what’s actually causing your pain, every treatment option — injections, Zilretta, gel, embolization and surgery — and the questions worth asking any doctor, including us. Written by our physicians. No appointment required, and no follow-up phone call unless you ask for one.
We’ll email your guide plus occasional patient education. Unsubscribe anytime. Privacy policy.
Bring any imaging or notes you have from other doctors. You’ll leave knowing what’s driving the pain, whether an injection is the right next step for it, which one, and what your plan covers — and if an injection isn’t the answer, we’ll tell you that too. Call us directly, or send this form and we’ll call you to schedule.
210-405-1335Closed on major holidays.
3212 Napier Park, San Antonio, TX 78231
Stand-in image (Map © OpenStreetMap) — the live site embeds the interactive Google map here
No referral or prior authorization needed for your initial consultation.
Rather book by phone? Call (210) 405-1335.