When joints become painful this is generally because of inflammation (swelling) and due to long term overuse or short-term intensive projects.
The joint swelling stretches the capsule (balloon like structure surrounding the joint) which causes increasing and chronic pain. This can lead to weakened muscles groups and decreased use of the joint and limb involved.
There are a number of options at PHP to help support these problems:
- Stretching of muscles and tendons surrounding the joint, increasing range of movement.
- Massage therapy
- Physiotherapy with manual therapy, ultrasound and / or exercise prescription
- Steroid joint injection with further health treatment support
- Steroid joint injections are the use of anti-inflammatory medication, generally with local anaesthetic (short term numbing / pain relief), directly injected with a needle into the specific joint. This works by reducing the inflammation and improving the movement.
- The medication is called a corticosteroid and can caused side effects, hence getting this into the local area of need is of great importance. The different types of steroid are: hydrocortisone, methylprednisolone and triamcinolone. Hydrocortisone is the weakest of the above and generally either methylprednisolone or triamcinolone are used.
- Injecting with the steroid and local anaesthetic can give initial / straight away improvement in the symptoms. However, the long-term improvements can take 2-4 weeks to really take effect and gently restarting your previous activities is strongly advised. Resting the treated area for a few days is also advised.
- You may suffer from a steroid crystal reaction in the first 24-48 hours with increased pain due to the steroid being absorbed by the joint, this is normal but still only happens a small number of cases.
- The doctor giving these injections will have extensive training either as a specialized GP or GP with a surgical training background. The injection will be given in the clinic and you will be able to return home after this.
- Steroid medication can reduce the bodies ability to fight off infection. It is therefore advised to take it easy for a few days and monitor the injected area. At this time, all patients must also be aware that this means the risk for COVID 19 infections also increase. The current scientific evidence suggests that other risk factors (male, over 65, chronic diseases) are much more important than the injection itself. If you fall into one of these categories you may wish to avoid the addition risk of a steroid injection. However, if you are likely to benefit greatly from the steroid injection or are not in the above category, you may choose to proceed.
- If you have any doubt you may wish to discuss this with your doctor or with your family / friends prior to attending.
- Of note is that the effects of the injection generally wear off after a few months. This means that continuing other treatments (Physiotherapy, Pilates, Massage, Osteopathy) will help in ensuring that the pain does not return. The pain relief can last from 3 weeks up to 3 or 4 months which can sometimes allow you to engage better with the above treatments.
- If the pain does return you may be able to have a repeat injection, although this is limited to 2 or 3 maximum per year with increase in the risks to damage to your joint with each new injection.
Joint injection sites:
- Acromioclavicular joint
- Elbow (tennis/golfers’ elbow)
- Wrist / Carpal tunnel / De Quervain’s tenosynovitis
- Trigger Finger
- Thumb base for osteoarthritis
Preparing for a steroid injection:
Let your doctor know about any medicines you’re taking. If you take a medicine that thins your blood (for example, an anticoagulant such as warfarin), your risk of bleeding into the joint is higher. So, you may need to have a blood test before a steroid joint injection to check how well your blood clots. For a similar reason, it’s important to let your doctor know if you have a health condition that affects the way your blood clots – for example, haemophilia.
It’s also important to let your doctor know if you have diabetes. This is because a steroid joint injection may raise your blood sugar for several days.
You don’t usually need to make any other special preparations before you have a steroid joint injection. It’s best to wear comfortable clothes that allow easy access to the joint that you’re having injected.
Check with your doctor or healthcare professional if you’ll be able to drive after your joint injection. It’s a good idea to ask friends or family for a lift home. If you have a local anaesthetic, your joint area might feel numb so it might be difficult to drive.
Also, be prepared to rest the affected joint for a day or two afterwards. Make sure you get everything you need and stock your fridge in advance.
Your doctor or healthcare professional will discuss with you what will happen before, during and after your procedure, and any pain you might have. If you’re unsure about anything, just ask. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You’ll be asked to do this by signing a consent form.
Complications to be aware of:
- An infection within the joint or the tissues surrounding it
- Damage to the cartilage within your joint or tendons around it – this may be more likely the more injections you have
- Thinning or change in the colour of skin around the injection site – this tends to happen more often with stronger repeated injections; it improves with time
- Irregular periods in women or vaginal bleeding even if you are past the menopause
- Changes in your mood – you may feel really good or really low
PHP will contact you post injection to ask you a few questions regarding the outcome of your injection and your overall satisfaction with the outcome.
If you are unsure about anything please ask – being fully informed will help you feel more at ease.