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Corticosteroid (Intra-articular / Soft Tissue)

Triamcinolone Acetonide 10–40mg (Kenalog)

Brand names: Kenalog, Adcortyl (intra-articular)

Adult dose

Dose: Large joints: 40mg. Medium joints: 20–30mg. Small joints: 10mg. Soft tissue (plantar fascia, De Quervain's, tennis elbow, carpal tunnel): 10–40mg.
Route: Intra-articular or periarticular soft tissue injection
Frequency: Single injection; repeat after minimum 3 months
Max: 40mg per injection site; 80mg total per session (two sites)
Triamcinolone has longer duration of action than methylprednisolone acetate (6–8 weeks vs 3–4 weeks). Kenalog preferred by many practitioners for knee OA and soft tissue injections. Same aseptic technique and exclusion of infection required.

Paediatric dose

Route: Intra-articular
Frequency: Specialist-guided
Max: JIA: up to 1 mg/kg per large joint (max 40mg); triamcinolone hexacetonide preferred for JIA
Concentration: 10 mg/mL, 40 mg/mL N/A/ml
Triamcinolone acetonide used in JIA — triamcinolone hexacetonide is preferred where available due to longer efficacy. Specialist paediatric rheumatology only.

Dose adjustments

Renal

No dose adjustment required for intra-articular use

Hepatic

No dose adjustment required for intra-articular use

Clinical pearls

  • Longer duration than Depo-Medrone — preferred for patients needing prolonged symptom relief (e.g., OA awaiting arthroplasty, frozen shoulder)
  • Plantar fasciitis injection: 10–20mg with 1–2mL lidocaine at medial calcaneal tubercle — effective short-term; risk of plantar fascia rupture with repeated injections
  • Tennis elbow (lateral epicondylitis): 10–20mg at maximum tenderness point — good short-term response; long-term outcomes similar to physiotherapy
  • Carpal tunnel syndrome: 10–25mg injection: effective short-term, may defer need for surgery
  • Document: site, dose, lot number, consent, and injection date in clinical notes

Contraindications

  • Suspected septic arthritis or joint infection
  • Bacteraemia
  • Prosthetic joint
  • Overlying skin infection
  • IV route (never give IV — for intra-articular and IM use only)

Side effects

  • Post-injection flare (less common than with methylprednisolone)
  • Skin depigmentation and subcutaneous atrophy (inject into joint cavity, not superficially)
  • Transient hyperglycaemia (diabetics)
  • Joint infection (rare)
  • Facial flushing (24–48h — systemic absorption)

Interactions

  • Hypoglycaemic agents — transient hyperglycaemia
  • NSAIDs — additive effect on blood pressure and fluid retention with systemic absorption

Monitoring

  • Blood glucose (diabetics, 24–72h post-injection)
  • Signs of post-injection infection
  • Soft tissue appearance (fat atrophy, depigmentation at injection site)

Reference: BNFc; BNF; NICE NG226 (Osteoarthritis); BSMS and BSRA Joint Injection Guidelines; BMJ Best Practice. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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