I have a patient for whom I do cervical ESIs and caudal ESIs when needed. She states that she has experienced multiple joint pain after a few of the injections, although not every time. Usually pain in hips, knees, ankles. Not severe. Onset shortly after the injection, and resolves by the next morning, and did not affect her sleep. The last time however, the pain was more severe, affected her sleep, to the extent she thought about going to ER. It did resolve by the next evening, but longer duration of pain compared to prior. The pain does resolve, but concerned that this could be a sign she is at risk for AVN or maybe already has some degree of AVN? I have not had any other patients tell me they experience joint pain like this after steroid injections. I did however have a patient in the past with multiple joint AVN (shoulders, hips, knees) that she attributed to multiple steroid injections done by another physician. Should I tell the patient that she should avoid steroids as much as possible? Should ESIs be considered contraindicated for her? Should I consider MRI of at least one of the affected joints (maybe hip) to see if there is any sign of early AVN?