There are a number of injections we can perform at Wandsworth physiotherapy, including steroid injections into joints, tendon sheaths, and bursa.
We use either Depo-medrone or Kenalog, and these are usually combined with a local anaesthetic. We use 1% lidocaine, which is a shorter acting anaesthetic that can last two or three hours, or we use 0.5% bupivacaine, which takes a little longer to work, but can last for six or seven hours after the injection providing relief from discomfort.
There are numerous conditions, for which we will use a steroid injection, these include inflammatory conditions, such as arthritis of the knee, hip, shoulder or smaller joints, such as the fingers and toes. We also inject bursa, including quite commonly, the shoulder bursa and less commonly the hip bursa, and we also inject tendon sheaths for tenosynovitis. There are a number of injections where we need to remain cautious. This includes injections into the load-bearing tendon sheath around the foot and ankle. If you have a steroid injection into one of these tendons you may need to wear a Aircast boot for two weeks afterwards as the effect of steroid may potentially lead to a tendon rupture. There are also conditions that we no longer use steroid injections for such as into tendons themselves. We do not inject tennis elbow into the common extensor tendon as this has been shown to cause long-term harm. injections into load-bearing tendon such as the patella or Achilles tendon are also not recommended anymore.
With any injection it can be uncomfortable, but the local anaesthetic will help to reduce any discomfort for several hours. But it is not unusual to be in a little bit of pain for one or two days after an injection. Simply using some ice and paracetamol can help to alleviate this discomfort. Some people suffer from what is termed a steroid flare, this is where there is a reaction to the steroid injected that can cause a few more days of pain, but this will normally spontaneously resolve. The main problem that we are keeping an eye out for with any invasive procedure including injections is an infection. We use a sterile technique and sterilise the skin and this significantly reduces the risk but cannot eliminate the risk of infection. We believe that the risk of infection is anywhere between one in 50,000 to 100,000 injections.
There are also some side-effects from injections such as a little white spot where the injection was performed. This is called skin de-pigmentation, and also a small dimple where the injection was performed. This is called fat atrophy. Steroid injections can lead to some transient changes in mood, increased blood sugar, increased blood pressure, facial flushing, and menstrual irregularities.
There are reasons in which we certainly would not perform a steroid injection, this includes whether you are allergic to any steroid medication, or it’s ingredients, whether you are pregnant or if you are taking any antibiotics for a recent infection. There are also reasons why we need to be cautious delivering a steroid injections including in people with diabetes (as steroid injections increased blood sugar), those taking blood thinners (anticoagulants), and those with glaucoma.
At Wandsworth Physiotherapy we deliver all our steroid injections under ultrasound guidance. This means we can visualise the structure we want to inject, we can see the needle and we can deposit the steroid in exactly the correct place. Ultrasound guided injections have been shown to be more effective, accurate and more cost effective.
