Guide to injection therapy

 

All injections are performed by Dr Kulothungan who has over 15 years of experience in interventional procedures. 

 

You do not need a GP referral to be seen but it is usually helpful to have a referral from your GP whenever this is possible. We will seek your permission to inform your GP of any treatment or advice given. This is done in your best interest to optimise the care given.

 

Most local injections given into or around joints, tendons, muscles and ligaments are very well tolerated and the risks of adverse (side) effects and complications are very rare.

 

Dr Kulothungan performs all procedures under ultrasound guidance to optimise accuracy.

 

Some injections may need to be repeated for optimal therapeutic effect (maximise benefit) while others need to be used sparingly.  

 

The information given below is to give you a balanced view of the benefits and risks associated with the procedures.

Dr Kulothungan will discuss all treatment options during the consultation and explain the merits, limitations and risks associated with each procedure. You will be fully involved in the decision making of any treatment.

Certain treatments may not always be appropriate for your specific condition either due to the risks or poor outcome. If in doubt please ask prior to booking.

Please note that certain procedures may not be covered or only partially funded by your insurance policy. Please check with your medical insurance provider before booking. If you are in doubt please discuss with Dr Kulothungan.

 

 

Steroid injections

 

Cortisones (corticosteroids) are anti-inflammatory particles produced in the human body by the adrenal glands. Injectable corticosteroids are synthetically produced in a high dose to be used  as a local injection to help relieve pain and inflammation.

 

It is used in tendons, joints, ligaments and muscles to treat pain, swelling and inflammation. They are also widely used to treat allergies, asthma and inflammatory arthritis.

It is advised to reduce the load on the joint or limb for 1-2 weeks before commencing rehabilitation. You should be able to do your day to day activities without much restriction. Strenuous physical activity should be avoided until rehabilitation is commenced and advised to do so in a gradual manner.

The injected joint or limb may feel numb after the treatment, which can last up to 4 hours. We advise patients to arrange transport home after treatment, as driving could be unsafe. 

Cortisone, generally offers relief within a week after treatment though occasionally it might take longer.  

Pain relief may last for weeks to months depending on the severity of each case. 

There are occasional side effects and risks following steroid injections which include:

1. Allergic reaction or intolerance which is usually associated with the local anaesthetic (LA) that is included in the injection. If you have had previous reactions to LA please discuss this prior to the procedure.

2. Joint infection (septic arthritis) or soft tissue infection: the risk is very low and aseptic non-touch technique is used to further minimise the risk. If you are taking any medication to reduce your immunity or taking antibiotics or feeling unwell (ongoing infection) please discuss this during the consultation.

3.  Tendon rupture: steroids very rarely cause the tendon to rupture, however, following an injection due to reduced pain levels patients can forget that the injured tendon is still very weak. By using the affected limb beyond the capability of the tendon to withstand the forces can sometime result in the existing tear to worsen. This is why managed loading program (physiotherapy) is advocated after steroid injections.

 

4. Bleeding is a very rare complication in healthy people following injections. However, if you are on blood thinning medication (e.g.,warfarin, clopidogrel, rivaroxaban) or a hereditary condition (haemophilia) can cause increased bleeding under the skin (bruising) or into the joint. Please bring your current medication to the consultation. 

5. Nerve damage/irritation: Occasionally a small nerve can be irritated during the procedure but the symptoms will usually settle after a few days.

 

6. Steroid flare can be an annoying side effect which could present either as local pain and irritation or generalised flushing. The latter is more common in women. These also last a few days and self limiting. Occasionally it can present as period disorders in women. 

 

7. Raised blood pressure is uncommon however if you are on medication to reduce BP please discuss during the consultation

 

8. Raised blood sugar levels can be seen in diabetes especially when taking insulin and this needs to be discussed during the consultation

 

9. Skin depigmentation and pitting is a rare cosmetic side effect when superficial injections are performed particularly in darker skin types. These changes usually resolve after 6-12 months.

10. Gastro-intestinal side effects: Nausea and Vomiting are rare side effects among other possible side effects.

Pregnancy and breast feeding: There are no known risks to mother or baby when steroids and LA are used locally. However the usual advice is to avoid any procedure unless the benefit outweighs the potential side effects and risks.

Please see further information in the links below.

Reference 

1. Kenalog:           https://www.medicines.org.uk/emc/files/pil.6748.pdf

2. Depo-Medrone: https://www.medicines.org.uk/emc/files/pil.8957.pdf

3. Lidocaine:        https://www.medicines.org.uk/emc/files/pil.2798.pdf

4. Marcain:         https://www.medicines.org.uk/emc/files/pil.876.pdf