Chronic pain of the facet and other joints is very common in the elderly population. Joint pain, which occurs mostly secondary to age-related degeneration and without effective treatment, can have a major impact on their overall quality of life. Intra-articular injections may be performed for both diagnostic and therapeutic purposes. Imaging guidance improves the accuracy of needle placement and potentially reduces inadvertent injury of vital structures around the joint. Depending on expertise and equipment availability, fluoroscopy, ultrasound imaging, and computed tomography are used to provide real-time guidance for intra-articular needle placement. Given the high success rate and low complications, image-guided injection is safer and more effective than “blind” injections.