Injections: getting you comfortable enough to do the work

What a corticosteroid injection does

It calms the inflammation around an irritated joint, tendon sheath or bursa. For a lot of people that means a large drop in pain, and the relief can run from several weeks to several months depending on the structure and the problem.

We mix the steroid with local anaesthetic. That gives you comfort within minutes rather than days, and it tells us something useful. If the pain settles straight away, we have confirmed we were in the right structure.

What the injection does not do is rebuild tissue. It buys you a period of comfort, and what you do inside that period is what decides whether the result holds. That is why the rehabilitation is planned at the same appointment rather than left for later.

A prescriber on site, so nothing waits

Jamie is an independent prescriber. In most clinics an injection means being assessed by one person, sent to a GP or consultant for the prescription, then booked in again somewhere else. Here it happens in one visit.

You are assessed, scanned if the scan would change the decision, and treated the same day. For a painful shoulder that is keeping you awake, the difference between today and six weeks from now is not a small one.

Guided, in plane, into the structure we mean

Every injection we give is placed under ultrasound. We use an in-plane approach, which means the needle is watched along its whole length as it travels, so the medication goes into the structure we intended and not the tissue beside it.

That matters most where the targets are small and close together. The wrist, the rotator cuff and the tendons around the hip are all places where a blind injection is an educated guess.

In de Quervain's of the wrist, a network meta-analysis of thirty randomised trials found the treatments that included an ultrasound-guided steroid injection ranked top for pain relief, and concluded that an injection with a short period of splinting should be first-line care.

What to expect afterwards

Most people feel the local anaesthetic working within minutes. That wears off after a few hours, and the steroid itself takes anywhere from two days to a fortnight to reach full effect.

Some people get a flare in the first day or two before it settles. Keep the rest of that day light, then go back to normal activity. You do not need to rest it for a week.

We will book the rehabilitation to start while the comfort is there, usually inside the first two weeks, and give you a realistic picture of what to expect for your particular problem before you decide anything.