When they set it. Made the bad decision to decline the pain med because the needle was 6” and was going to be pushed through the bone. Sounded like a bad idea to me. But when the guy had to muscle the bone back in place I screamed the whole time. When he he finished I said I was glad that was over and maybe I should have taken the shot. He said he was only half done and proceeded to do that again. The staff called me John Wayne, but I did not feel that brave at the time.