Treatment: Ultrasound-Guided Injections

If you having a corticosteroid injection, this explains the benefits, risks and alternatives of the procedure as well as what you can expect when you come to the centre. If you have any further questions, please speak to a doctor, nurse or radiographer caring for you.

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Ultrasound scan

An ultrasound machine sends high frequency sound waves (ultrasound) into the body via a handheld probe placed on the skin. Lubricating jelly is placed on the end of the probe to ensure good skin contact. The probe detects the sound that is bounced back from different structures in the body and produces an image on a monitor. The image produced provides real time pictures so body structures and movement can be assessed. An ultrasound scan can detect needles inserted into the body and therefore can be used to guide needles to specific positions.

Corticosteroid injection

Corticosteroids are a group of medicines that reduce inflammation, and therefore can reduce swelling and pain caused by inflammation. Corticosteroids can be used to treat a range of problems such as joint pain or tendon inflammation. Common steroids given are hydrocortisone, triamcinolone and methylprednisolone. These are used with local anaesthetic, which will temporarily numb the area affected. In some cases, a corticosteroid injection can aid in diagnosing your condition if it is not clear which is the particular area that is causing your pain.

How to prepare for your treatment

Is there anything I need to do before my appointment?

No specific preparation is required for this procedure. However, you will not be allowed to drive or cycle for 24 hours after the procedure, so you may need to arrange for someone to take you home.

What happens during the procedure?

The procedure will be performed by a doctor who is a specialist doctor trained in performing image-guided procedures. The doctor will explain the benefits and risks of having the injection and will answer any questions you may have. You will be positioned on the ultrasound couch. The doctor will perform an ultrasound to identify the area requiring an injection. The skin is cleaned with a sterile solution.

Using the ultrasound probe, the needle is guided gently to the affected area and the medication is injected. The needle is removed and a plaster or dressing is applied. The procedure usually takes 10 to 15 minutes.

Will I feel any pain?

The injection of corticosteroid and local anaesthetic will involve a small needle and will be like a blood test. The injection may cause stinging briefly before the area becomes numb. There may be a pressure sensation or tightness for injections into joints.

Risks

1.Infection (occurs in approximately 1 in 10,000 procedures). If the area injected becomes red, hot and swollen, and/or you feel feverish, it is important to seek medical advice immediately.

2.Bleeding into a joint or soft tissue. This is usually only a concern for people taking warfarin or similar anticoagulation (blood-thinning medicine).

3.Allergic reaction to the local anaesthetic.

4.When the area around a tendon or ligament has been injected, there is an extremely low risk of tendon rupture/tear. This most likely occurs due to overuse after the injection will assess the state of the tendon using the ultrasound scan before deciding whether to proceed with the injection.

Please bear in mind that your doctor has recommended you for this procedure because he/she believes that the potential benefits of the injection outweigh any potential complications. If you have any questions or concerns please do not hesitate to speak with your doctor.

What are the alternatives?

Alternatives to the injection include lifestyle changes, physiotherapy and oral pain relieving medication. Surgery may be an alternative option, which would need to be discussed with your specialist.

After your appointment

What happens after the procedure?

Immediately after steroid injection, you may feel that your pain has gone or is significantly reduced. This is due to the local anaesthetic and the effect will last for a few hours. The steroid usually starts to work in three to four days but may take longer. The effect of the steroid injection varies from person to person, and a few people may not experience any benefit. Symptoms can be relieved for a few weeks to a few months.

What do I need to do after I go home?

You are advised not to drive or cycle after your injection for 24 hours.

If you are having other medical treatment or dental procedures within six weeks, you should tell the clinician treating you that you have received a corticosteroid injection.

Will I have a follow-up appointment?

You may be asked to attend a follow-up appointment with your referring doctor or physiotherapist six to eight weeks after your injection to check your progress.