Injection therapy

Injection therapy

Below you can find all the useful information you may require prior your treatment.
  • Ultrasound Guided Hyaluronic Acid (HA) Injections
  • Corticosteroid Injections

 

What is Hyaluronic Acid (HA) Injection?

HA is a natural component of synovial fluid. HA injections help to increases the synovial fluid viscosity, restore the joint lubrication and acts as a shock absorber hence controls the joint/tendon symptoms.

How many Injections do I need?

A course of 3 injections are recommended for the best results. However, this varies from severity of the problem, type of HA preparation (Some HA injections have significantly larger particles than other HA injections). Some patients benefited from one injection, others benefited from 2 to 3 injections per year.

How long HA injections work?

We offer HA injections with large particles. Larger particles stay longer in the joint. If your body responds well to the treatment, you should see the benefits in few days and lasting for few months.


In very few cases HA injections may not be effective.

Are there any side effects and risks?

HA injections have very few side effects. Some may experience slight allergic reaction, temporary flare up of symptoms, swelling. Infection is a rare complication. All our injections are Ultrasound guided. Hence, avoids injecting into the blood vessels.

Post injection care?

You may require 2 days of relative rest in case of developing bruising pain from the injection needle.
Also try avoiding any strenuous activities for 2 weeks after injection.
If feels unwell or shows signs of infection (swelling, redness, increased temperature, feeling unwell, painful movements) visit your GP or A and E immediately. However, Infection is a very rare complication.

How does HA injections for TENDON work?

HA’s lubricating ability improves the gliding and reduces the stickiness of the tendon fibres. HA also blocks pain receptors and hinders inflammatory mediators. Overall it helps to restore the normal tendon features.

What is Corticosteroid/steroid injection?

Corticosteroid/steroid injection is an anti-inflammatory medication, is used for many of the 
inflammatory and arthritis conditions to relieve pain and improve function.
 Corticosteroids are not the same as used by body builders.

Why should I have a corticosteroid injection?

Precisely injected small amount of corticosteroid injection can greatly help to relieve inflammatory signs, such as pain, swelling, stiffness and function. These may in turn help you to start your exercises and return to normal activities or hobbies.

Why do I need an ultrasound guided injection?

Ultrasound helps to visualise the problem on the screen, so the needle can be guided in to the
 problematic area and injected accurately for the best possible treatment outcome. Ultrasound guided injections are also used when non ultrasound guided cortisone injections have failed to control the pain.

What are the risks?

Most of the times corticosteroid injections are entirely safe. Sometimes you may experience one or many of the following problems:

• Allergic reaction.
• Flushed face for few hours to days after the corticosteroid injection.
• Steroid flare-up: Pain gets worse before it gets better.
• Temporary bruising and/or bleeding, especially if you are on blood thinning medications.
• Temporary raise in blood sugar levels for few days to weeks, in case of diabetic.
• Temporary raise in blood pressure.
• Fat atrophy and depigmentation: thinning of the fat at the site of injection and discoloration of the skin.
• Transient feeling of fainting or dizziness.
• Temporary light vaginal bleeding or irregular menstruation cycle.
• Injection may not work. Sometimes it can be a partial success or temporarily successful, where another injection needs to be considered.
• Weakening / damage to the tendons
• Nerve damage (for nerve block injections)

Rare:
• Infection. Very rare (about 1 in 10,000). If the injected area becomes swollen, painful and hot for more than 2-3 days, or if you become generally unwell, you must contact your GP or Accident & Emergency (A&E) department without a delay.

When should I not consider the injection?

• Infection either at the site of injection or elsewhere in the body.
• If you are taking antibiotics due to active infection.
• If you are allergic to steroids /local aesthetic drugs.
• If you are on anticoagulant therapy and you INR is too high.
• Feeling unwell.
• Metal at the site of injection.

Are there any other alternatives?

• Physiotherapy /Rest.
• Pain medication.
• Avoid exposing the activities caused the injury.
• Non steroidal injections. Such as : Hyaluronic Acid, Plasma rich Platelet (PRP)
• Surgery: speak to your GP or specialist.

Consent

Before the procedure we will explain to you the potential side effects, risks and benefits. You will be given an opportunity to discuss any other questions and concerns you may have. If there are any changes in your health or circumstances you must inform the clinician, before the injection.

Inform the clinician if you are allergic to either steroid / local anaesthesia / particular type of plaster.

Written consent will be obtained from you, prior to the injection.

What happens during the procedure?

Injection site will be cleaned with aseptic and gently introduced a needle to the target site using ultrasound guidance. Plaster is applied (if not allergic to the plasters) to the injection site to keep it clean.

Will it hurt?

Pain from the needle insertion is kept to minimum by using the local anaesthesia.

What happens after the Injection?

If the local anaesthesia is used you may start feeling pain free for 2hours approximately, after that you may start experiencing the pain again until steroid starts working for you. During this period, you can continue with your regular pain medication prescribed to you. Also, ice packs can be used for 10min each time for 2 to 3 times /day over the injection site to control pain and swelling.

Steroid injection can take from 2-3 days to 2 weeks before you feel better. Though it is not possible to estimate how long the steroid injection works for everyone, usually is effective for 3 to 6 months and some times longer.

Do I need to stay in the clinic/home after the injection?

You may leave clinic or your home after the injection, if you feel well. Otherwise we will treat you if you develop allergic reaction. If you experience an allergic reaction at a later stage, you must attend Accident and Emergency or contact Emergency services – this is very unlikely to happen.

Driving after steroid injection:

Your driving insurance may not be covered if you drive immediately after the injection. You may be able to drive after 2-3hours. Check with insurer or make alternate arrangements.

What happens later?

Driving is not recommended for the rest of the day. First two days, avoid carrying out any activities that makes pain worse. Two weeks of relative rest is recommended, especially when weight bearing joints are injected.

If the injected area is swollen or painful, apply ice packs to the injection site for 10 minutes each time, twice a day, by wrapping in a clean towel.

Alcohol:

There is no particular reason to avoid alcohol after steroid injection.

Breastfeeding /pregnancy:

Though there is no harm with single steroid injection, it is your responsibility that you speak to your doctor before the injection.

Do I need a follow-up appointment?

You may have a follow-up appointment with your referrer or with a clinician who injected you. In some cases you may need another injection. More than 3 injections to the same area for same problem are not recommended.

Please visit Versus Arthritis for further information and reference.

Files

Please feel free to download the relevant PDF files.