In the right situation steroid injections can be a very powerful treatment and give rapid pain relief to normally stubborn painful conditions. Here are 5 key factors that we believe are important to ensure you get the best result and why you should choose our Complete:
1. Obtain the correct diagnosis
Before we perform any injection, we carry out a detailed clinical assessment and a diagnostic ultrasound scan. The scan is included in the price of the initial consultation.
We do it because we want to gain as much information about your condition before we carry out an injection. The information we discover on ultrasound can influence where we inject. Combining the clinical assessment together with the scan information at one appointment by the same practitioner, is the most effective way of ensuring we get the correct diagnosis and treatment. This ‘one stop’ clinic approach has been shown to be highly effective and is very convenient for our clients.
By ensuring we get the correct diagnosis we will then be able to identify the pain sensitive structure, be it a joint, tendon, nerve or bursa. A targeted intervention such as a steroid injection carried out under ultrasound guidance, directed at this pain sensitive structure, is likely to have a positive outcome.
2. Accuracy of the injection
All our injections in the clinic are ultrasound guided using a high specification ultrasound machine. Research has shown that the accuracy of the injection is very important. Often the target tissue that requires injecting is only 1-2mm in thickness and it is essential the injection is carried out with ultrasound guidance to ensure the desired effect.
If you have had a previous ‘unguided’ injection, sometimes known as a ‘blind’ injection i.e. without an ultrasound machine to guide the needle, and you have had no or minimal improvement in your symptoms we would advise any further injections are carried out with ultrasound guided. We have had many patients over the years who have not responded to an ‘unguided’ injection but have had an excellent result from a guided injection.
3. Rehabilitation after the injection
Most steroid injections should not be done as a stand-alone treatment and should be followed up with a course of physiotherapy. Trigger finger, carpel tunnel and DeQuervains tenosynovitis injections are exceptions to this. This ‘treatment package’ is very important for you to get the best outcome from the injection.
Following an injection If you just go back to doing the activity or sport that was causing the pain in the first place it is likely the pain will return and you may then require a repeat injection. We see a steroid injection as a great opportunity to reduce inflammation and pain but also to provide a ‘window of opportunity’ to strengthen the muscles and/or tendons to ensure the pain does not return. This ‘treatment package’ (injections plus physiotherapy) is why we believe we get the best results from our steroid injections.
4. Experience of the clinicians (number of injections)
At Complete, all injections are carried out by either Chris Myers or Dave Baker, who are both highly experienced Extended Scope Physiotherapists (ESP’s) with over 10 years of injecting under ultrasound guidance. They are both dual trained physiotherapists and musculoskeletal sonographers, aswell as independent prescribers. An independent prescriber can prescribe the local anesthetic and steroid for the injections.
They have both spent many years working in NHS Trusts carrying out hundreds of injections each year. This experience is invaluable in perfecting the skill of an ultrasound guided injection. They both still carry out an NHS ultrasound guided injection list as well as working in private practice.
They also both teach clinicians nationally and internationally on diagnostic ultrasound and ultrasound guided injections. Chris runs the Sports Medicine Ultrasound group (SMUG) (www.ultrasoundtraining.co.uk) and Dave is Chairman of the Association of Chartered Physiotherapists in Orthopedic Medicine & Injection Therapy (www.acpomit.co.uk) and specialist advisor to the National Institute of Health and Care Excellence (NICE) Interventional Procedures Programme.
5. Cost
Carrying out an ultrasound guided injection takes years of training and also requires expensive equipment. The cost of an injection varies in London but in other clinics it can cost up to £1000 for exactly the same procedure. Our fee includes the assessment, the ultrasound scan and the guided injection.
If you have any questions about this blog or would like to find out whether an ultrasound guided steroid injection is appropriate for your condition please email us at info@complete-physio.co.uk