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Injection Under Ultrasound Guidance

Injection therapy is carried out by highly experienced physiotherapists who have undergone extensive training and clinical practice.

All of our injections are performed as standard under ultrasound guidance. This is the gold standard for musculoskeletal injections, whether we are using corticosteroid or Ostenil. There is an overall body of evidence that using ultrasound to guide injection therapy results in enhanced pain relief that lasts for longer compared to blind injections used traditionally. There is also a evidence that by using the ultrasound to guide the injection causes fewer adverse events such as trauma or needle misplacement which results in ultrasound guided injection being a much safer option, especially when dealing with more intricate areas. Our injecting physiotherapists have received advanced training in addition to their injection therapy qualifications in all ultrasound guided techniques.

Both Becca and Lucinda are experienced injectors and able to carry out both Corticosteroid and OSTENIL® injections.

Corticosteroid Injections

Steroid injections (also known as corticosteroid injections) are types of anti-inflammatory medicines. They are used to treat a wide range of conditions.

Corticosteroids are synthetic versions of hormones naturally produced by the adrenal glands. Administering corticosteroids through joint or muscle injections has the potential to alleviate inflammation in the targeted area, subsequently diminishing pain and stiffness.

In the context of pain relief, steroids are commonly paired with a local anaesthetic, Lidocaine. This combination ensures not only the long-term anti-inflammatory effects of corticosteroids but also provides immediate pain relief that typically lasts for a few hours.

 

What can steroids be used for?

 

Osteoarthritis: knee, shoulder, ankle, elbow, wrist, thumb and fingers, toes, foot

Soft tissue issues: tennis elbow, rotator cuff problems, plantarfaciitis

Bursitis

 

Benefits of corticosteroids:

 

Corticosteroids are generally safe and well tolerated.

They do not carry the same risks as oral steroids.

They also have fewer side effects and are not as high risk as non-steroidal anti-inflammatories which overtime cause problems for example kidney  damage.

Injecting corticosteroids directly into an injured area targets the issue more effectively without having an effect on the whole body.

 

Who cannot have a steroid?

 

If you have had a recent steroid within 6-12 weeks, or had two within the last year

Have had an allergic reaction to one before

Have a current injection

Have had or will have any vaccinations within 3 weeks either side

Are pregnant or breastfeeding

 

What are the risks of corticosteroids?

 

Pain and discomfort around the site

Facial flushing for 12-24 hours

A loss of skin pigmentation or loss of fat in the area

Very rarely an infection can happen

A risk of tendon rupture

If you are diabetic your blood sugars can rise slightly

I you take warfarin you may be told to miss the dose before the injection

Exceptionally rare is an anaphylactic reaction (we have adrenaline present)

OSTENIL® injections

OSTENIL® is a treatment for the symptoms of osteoarthritis. It can be used in the knee, or in any of the other joints in the body that are classified as ‘synovial’ such as shoulders, toes, elbows and more

What is OSTENIL® (sodium hyaluronate)?

Sodium hyaluronate (also known as hyaluronic acid or hyaluronan) is a natural substance. It is present in the body wherever moisture is stored or lubrication between layers of tissue is required to eliminate friction.

Examples are the vitreous body of the eye itself, the tear film, the joint cartilage, the synovial fluid in the joints, all the mucous membranes of the body, but also the basic substance of the skin which consists of up to 55% sodium hyaluronate.

 

Sodium hyaluronate takes on a variety of functions:

Storage: it absorbs and stores moisture in enormous quantities

Lubrication

Transport medium for nutrients

Filter for inflammatory molecules.

 

Sodium hyaluronate is an essential component of the synovial fluid. It enables the fluid to act as a lubricant, a shock absorber and a filter controlling the movement of cells and large molecules within the joint

How does OSTENIL® work?

OSTENIL® is a solution containing sodium hyaluronate (for more information on sodium hyaluronate. It is injected into the space in the joint that contains synovial fluid and works by restoring the normal balance between the breakdown and production of sodium hyaluronate. This procedure is known as ‘viscosupplementation’, and the effect of OSTENIL® means that it can decrease pain and stiffness and improve the other symptoms of osteoarthritis.

The sodium hyaluronate in all versions of OSTENIL® injections is very pure and is manufactured using a process called fermentation. It contains no animal proteins, which means that it is very unlikely to cause an allergic reaction. OSTENIL® has been given to thousands of patients and has not been found to cause any serious side effects. The exact make-up of the sodium hyaluronate in OSTENIL® has been carefully chosen so that it is as effective as possible in treating osteoarthritis

Effects of OSTENIL® :

  1. An injection of sodium hyaluronate increases the viscosity of the synovial fluid, restoring its lubricating, shock-absorbing and filtering properties
  2. In addition, it re-establishes the protective coating of hyaluronan over the inner surface of the joint and increases the scavenging of free radicals
  3. As a result of these changes, sodium hyaluronate reduces inflammation of the synovial membrane

 

The direct effects of OSTENIL® whilst results in immediate lubrication, additional shock absorbing effect, cannot account for its long-term benefits, as it is cleared from the joint within a few days. Instead, research shows that the OSTENIL® over time restores the ability of the joint to produce its own hyaluronan/synovial fluid, and thus returns it to a state of homeostasis (i.e. stable condition) that persists for several months.

Evidence also exists suggesting that exogenous hyaluronan may slow the destruction of cartilage

What are the side effects?

Very rarely there is a possibility of infection

OSTENIL® TENDON

OSTENIL® TENDON is used for the treatment of pain and reduced mobility due to tendon disorders such as tendinosis/tendinitis.

It is injected around the affected tendon or into the tendon sheath. A single injection offers rapid symptomatic relief and improved function. Due to its lubricating and visco-elastic properties OSTENIL® TENDON supports both tendon gliding as well as the regeneration process.

Traditionally steroid has been injected around tendons to treat them, however, there are several risks associated with this, mainly the risk of rupture of the tendon. Ostenil ® TENDON can be injected without the same risk factors.

How does OSTENIL® TENDON work?

The lubricating characteristics of sodium hyaluronate increase tendon gliding and reduce agglutinations (stickiness). The tendon can work again as if well-oiled. Furthermore, sodium hyaluronate blocks pain receptors, hinders inflammatory mediators, and is a good transport medium for nutrients. OSTENIL® TENDON ensures a harmonisation of the tendons and the surrounding structures, reduces pain and increases joint function.

Examples of what Ostenil ® TENDON can treat are:

Achilles tendonitis

Plantarfaciitis

Tennis elbow

Patella tendonitis

Any other soft tissue issues

Most of the time one injection is sufficient to resolve the issue, however is possible you may require a second injection within one month of the first for more persistent issues.

  • "Lucinda consistently addresses a variety of injuries I pick up and enables me to keep competing despite all of these."

    Henry T (GB power lifter)

  • "After many years of chronic back pain and a variety of specialists, I was referred to Lucinda and within 6 sessions I was amazed at the reduction in my symptoms and the increase in my movement."

    Liz G

  • "Thank you Lucinda for teaching me some simple yet very effective back exercises which have kept me pain free for over a year now, they have made a tremendous difference to my quality of life."

    Linda M

  • "Lucinda has consistently demonstrated her in depth knowledge and treatment skills in managing my neck pain following a long-term whiplash injury and each time quickly rectifies any difficulties in a few sessions."

    Adam P

  • "Lucinda’s physiotherapy background helps immensely with her approach to Pilates and she is able to work through injuries and enable me to exercise when I was too worried to."

    Mike S

  • "Lucinda was recommended to me following major surgery for a knee ligament injury. She was able to get me back to my pre-injury level of semi professional rugby, which at the time seemed unlikely."

    Paul W

  • "Following a severe lower back problem which was affecting my work and personal life a friend recommended Lucinda Davies. Lucinda’s initial diagnosis identified the cause of my pain and her treatment, guidance, advice and support have been invaluable in my recovery. The benefit of Lucinda’s treatment has been immense and I really appreciate all she has done for me."

    Iain

  • "Lucinda has seen me through a multitude of injuries over the years and kept me running competitively despite these, including a PB half marathon shortly after a significant tendon injury."

    Matt B

  • "Fantastic service with high level of knowledge and expertise demonstrated throughout, would highly recommend Lucinda."

    Annabel E