Conditions and Advice
If you are considering an injection, particularly for soft tissues rather than joints, it is advisable to aim to have 2 days rest and 2 weeks relative rest after the injection, so try to plan this into you schedule.
Shoulder impingement/Rotator Cuff Injuries/Bursitis
Tendonitis of the rotator cuff muscles is common. This can happen with repetitive movements of the shoulder, particularly with the arm raised, such as a plasterer/painter/decorator. The tendons, run under the acromial arch and can get pinched (impingement). Injuries can also happen with a wrenching type of action. The bursa (sack of fluid, there to protect the tendons) can also become inflamed. Inflammation of these structures cause pain and inflammation, particularly when lifting the arm.
In combination your body may try to ‘help’ and you end up with a dropped shoulder that sits a little forward than it should, this sadly aggravates, rather than helps the condition.
Injections can be extremely useful for these conditions, generally an injection is placed under the acromial arch and it bathes all the tendons and bursa. Occasionally, a single tendon needs a specific injection. All this will be assessed by Jo and discussed prior to injection.
The most important thing is that postural exercises are undertaken after the injection to ensure the best possibly outcome.
Shoulder Glenohumeral Joint/Capsulitis/Arthritis/Frozen Shoulder
Many of our joints have a capsule around them, these are like bags containing the fluids within and around the joints. In the conditions named above, the capsule becomes inflamed and tight. The cause can come on for no reason, injury and arthritis, frozen shoulder/capsulitis is more common in diabetics. There is a reduction in the shoulder range of movement, mainly in the range of lifting the arm, hand behind back and less noticeable to most, rotating your arm outwardly.
Generally, you will feel pain in the top section of your arm, sometimes running down to the hand in more severe cases. Generally, the earlier the injection is done in the condition, the better the results, the more severe the symptoms and more chronic the condition, the less effective and another injection or two may be needed. Careful stretching of the capsule without pain, is needed after, progressing from simple pendular exercises to progressing to stronger passive stretches and finally a strengthening and stabilising programme when range of movement (ROM) has returned.
If, after 2/3 injections the movement has not returned, I would recommend a referral to a shoulder surgeon, for consideration of hydrodilation, which is when a steroid along with a large volume of water is injected, therefore stretching the capsule.
It should be noted that if the capsulitis is as a result of osteoarthritis then it is unlikely that the hydrodilation will be enough and it maybe that a shoulder replacement maybe considered.
This the little joint on top of your shoulder where the collar bone joins the spine of the shoulder blade. You tend to feel the pain specifically over the joint and it is sore to take your arm across your upper chest.
It is a small joint and if there is arthritis maybe quite tight but an injection can be beneficial.
Golfers and Tennis elbow
These are tendonitis of the long forearm muscles that lift your wrist up (tennis) or down (golfers). The tendons become inflamed generally from over use at the wrist, throwing actions or trauma, you do not have to play tennis or golf to suffer! Careful diagnosis is needed as there are various conditions that can mimic tennis elbow. There have been reports to suggest that injections no always help. This is not my experience and I think maybe, the unsuccessful ones, may have other aspects to them such as nerve irritation or misdiagnosis, amongst other things.
Advice on tennis elbow:
Advice on golfer’s elbow:
Hand, Fingers and Thumb
Trigger fingers or thumb, is when you feel a locking and unlocking. The locking often feels like it is coming from the first joints of your digits. It is actually, the long flexors tendons of the digits as they run under a ligament on the palm side of your knuckle joints. The tendons get inflamed and develop a swelling, which then catches under the ligament, causing catching, locking, triggering and pain.
The injection reduces the inflammation and then in time the size of the swelling, thereby stopping the triggering. It can be a sharp injection and if local anaesthetic is used, can give you a tingling numbness in the digit for a couple of hours after. It usually takes a couple of weeks before you will feel an improvement and splinting can help in the interim.
Osteoarthritis of thumb and wrist joints respond well to steroid injections but may need to be repeated from time to time, if the joints become inflamed again.
The thumb needs to be assessed carefully as there is a tendonitis condition called:
De Quervains which is felt at the base of the thumb and is common in new mothers who pick up their babies with a hand either side and thumbs to the front, as this strains the extensor and abductor tendons at the base of the thumb. The good news is these too, respond well to steroid injection.
Hip/Trochanteric Bursitis/Gluteal tendonitis/Greater Trochanteric Pain Syndrome (GTPS)
Pain is felt on the outside of the hip, especially is bad at night if you lie on it, or when the leg drops forward if lying on the other side. It can be painful when walking. The tendons tend be felt a little further to the back and have to be injected carefully to avoid rupture. Bursitis is caused by irritation of the bursa (sacks of fluid we have all around our bodies to protect tendons). Bursitis often comes hand in hand with tendonitis.
There can often be a biomechanical issue, ie. Flat feet, a weakness in the gluteal muscles or being overweight. It is VERY important that these issues are addressed before, if possible, but definitely after the injection. They do well with injection but are likely to recur if these things are not addressed.
Osteoarthritis is the wear and tear type of arthritis. There are three parts of the knee joint, the inside (medial) and most common, the outside (lateral) and the front or kneecap (patella-femoral) which also felt at the back of the knee. If you are getting ‘bandy’ legged, it is likely to the inside part of your joint that is worn. If you are getting ‘knock kneed’ it is likely to be the outside part of the joint and if you have problems going downstairs, downhills and have a feeling of giving way, it is more likely to be your patellofemoral joint.
As with the shoulder, the knee has a capsule around it, holding the fluid of the knee joint. I will aim to put the injection into the least painful side as this tends to have the largest space and therefore is less uncomfortable.
Don’t worry though, because of the capsule, the steroid or hyaluronic acid gets to all parts of the joint. To get the most out of the injection it is really important to keep your thigh muscles strong to support the knee.
Both joints can cause a restriction in your range of movement and cause pain around your ankle. Jo will assess to see which part is affected. They tend to respond well to injections but may need to be repeated.
This is pain at the base of your heel and underside of your heel pad. It is worse first thing in the morning when you get out of bed. It is generally caused when we get older and start to lose the arch in the foot or are overusing, such as running. The injection can be painful but is usually successful so long as there is rest afterwards and insoles are used in all footwear. It is better not to walk around barefooted.
Big Toe/Bunion/1st MTP joint
This is arthritis of the big toe joint and sometimes the big toe comes in forming a bunion (Hallux Valgus). Sometimes the toe has good alignment but a reduced range of movement (Hallux Rigidus). Both do well with injections.
There are other problems around the body that can benefit from injection. Call Jo with any queries.
These areas are best injected under radiological guidance(x-ray/ultrasound/CT) in a hospital and Jo does not offer these injections. However Jo can administer an injection into your buttock whcih can help alleviate some of the inflammation in your body.
Recommended Physiotherapy Clinics
For pre- and post- injection care, Jo can offer some exercise and aftercare advice but for some conditions more formal treatment is recommended.
Heatons Physiotherapy Clinic
The Coach House, 162 Heaton Moor Road, Heaton Moor, SK4 4HS
26 Nevill Road, Bramhall, Stockport SK7 3ET
Complete Physio & Rehab
The Avenue, Sale, M33 4PB