An anti-inflammatory medication. It is a steroid medication. A bit like using simple oral anti-inflammatories (ibuprofen and naproxen). Cortisone injection is injected directly to the point on inflammation.

Injections are normally used for inflamed tissues. Particularly, helpful in persons with night pain, resting pain, inflamed and thicken tissue seen on ultrasound, osteoarthritis flare-ups, to manage pain in people who cant have surgery. Injections can be helpful in the short term to facilitate physiotherapy exercise.

Generally cortisone injections are a very low risk procedure. Small risks exist with any injection procedure surrounding infection, but again very low with the aseptic technique used. There is some evidence that too many injection over time may have joint and tissue risks, but in particular a single injection would not present with this repetitive use risk. When injecting very superficial tissue structures there is a chance of skin depigmentation (link), this risk is very low. Post injection pain for a few days after the injection is also a low risk reported, but most likely no more than the pain already being experienced with an inflamed structure.

Aspiration is very similar to an injection in that the same needle is used, the structure is normally injected with some local anaesthetic and then swelling or fluid is removed by withdrawing (sucking it out). This might be used for conditions like Bakers or Ganglion Cysts, or very effused (swollen) joints.

Normally people who seek a private injection procedure have some understanding of its use, possibly they have had one before, their GP or consultant has advised it as an option. People with arthritis flare ups understand that injection can reduce the flare up but not cure the osteoarthritis itself. Other conditions like frozen shoulder, trigger finger and carpal tunnel can be caused by flare ups in metabolic conditions such as diabetes, cholesterol, cardiovascular disease, thyroid and other medical treatments, in such cases injections can be used to better control the pain while a certain time factor is involved in the resolution of the condition. Essentially injection are considered and used dependent on condition and after simple conservative management, time and adequate healing opportunity has been owed for.

Injections seem to work differently for different people, dependent on severity of inflammation, stage of condition being treated, ability of the person to avoid aggravating factors after injection, other metabolic contributory factors, repetitive use of injections. Sometime people are happy to accept an injections short term benefit for a break from the pain for a number of weeks, in other conditions such as trigger fingers and bursitis injections can be very effective and completely resolve the condition.

One way to look at Injections are that they are designed primarily to manage inflammatory pain, one reason for doing this is to allow for and promote normal movement and exercise, essentially injections when combined with physiotherapy often give the best results. The consult and management involves advice on how physiotherapy and exercise should be utilised after the injection. Different condition require different physio prescription. After the injection information and advice is given from a physiotherapy and rehab perspective on how best to move forward with the diagnosed condition. In most cases after the injection a 5-7days are give to allow the injection to work (sometimes up to 2-3weeks). Then advice would be to slowly build back into exercise, movement and normal function after this. The main point being to give a few days to allow the injection to calm and reduce inflammation.

One way to look at Injections are that they are designed primarily to manage inflammatory pain, one reason for doing this is to allow for and promote normal movement and exercise, essentially injections when combined with physiotherapy often give the best results. The consult and management involves advice on how physiotherapy and exercise should be utilised after the injection. Different condition require different physio prescription. After the injection information and advice is given from a physiotherapy and rehab perspective on how best to move forward with the diagnosed condition. In most cases after the injection a 5-7days are give to allow the injection to work (sometimes up to 2-3weeks). Then advice would be to slowly build back into exercise, movement and normal function after this. The main point being to give a few days to allow the injection to calm and reduce inflammation.

There is technically no limit, but repetitive use isn’t advised and they tend to be ineffective with repetitive use. Evidence from the literature found that in the past people who continued to use multiple injections per year over a number of years caused damage to the joint. Like any drug too much, and frequent use could have adverse effects. Evidence suggest not having more than 3-4 injections per year, but even this number isn’t really sustainable in the long term. Ideal the goal would be to only use 1 or 2 injections to try and manage the inflammation and use other conservative measures in combination to manage the condition. Its not that a person cant have any more injections, its more than with over use of injection they seem to become less effective. If they are used for pain that is not inflammatory they tend to be less effective. Ideally in an arthritic joint one might use injections once every 1 or 2 years to manage flare ups and possibly utilise for short term relief.

Online assessment form needs to be filled out. Ideally your GP is aware of you plan to consider an injection? Your GP details are requested that we can update them on the assessment and injection procedure

Whilst a person can have joint, tendon, nerve and muscle pain it may not always be suitable that an injection is carried out. Ideally , the reason we request a GP referral and the online assessment information is to try (to the best of our ability) screen persons as to their suitability for an injection. It may be that we suggest you don’t have an injection and in which case only be charged for the MSK assessment, diagnostic ultrasound report and advice on most suitable management option. A lot of the time injections suitability is termined by waying up the risks and benefit to an injection, all information, from what the person says, to the physical exam to the ultrasound exam is considered and information and advice on injection suitability given. Ultimately once the person understands the pros and cons of the injection…patient choice is at the heart of the final decision, but clinician safety and best practices and opinion is always documented and made clear.

A lot of evidence based practice suggests primarily managing tendon pathology with exercise and appropriate loading, particularly in younger people who are playing sport. That being said there are different types of injections that do not contain steroid that maybe suitable in certain circumstances. Tendon pathology in other persons not in competitive sport have other options.