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Hip Pain

Hip Pain: a joint that often gets over looked.

The hip is a weight bearing joint and is affected by degenerative changes and inflammation. But despite these common and shared problems with the knee joint, treatment for hips is more limited.
Whilst there are some GP’s that will provide knee injections and day case surgery for knee arthroscopy’s is widespread practice; injections and surgical intervention for the hip joint is much more difficult to access.
This is mainly due to the depth of the joint and the costs involved with guided injections performed in Theatre .

However, with appropriate diagnosis and modern ultrasound scans the hip joint does not need to be a poor relation to the knee.

Hip injection by ultrasound guidance
There are two key areas that can benefit from injections; the Trochanteric Bursa and the joint capsule. Both these areas can be visualised on ultrasound scans and allow for accurate guided needle placement. The worry of touching a nerve or deep vascular structure is gone, because they are clearly visible.
Secondly, hip injections are relatively painless. In the Journal of Arthroscopic Surgery 49 out of 50 patients preferred ultrasound guided injections over x-ray guided. Most people comment ‘is that it’. The worry of the injection is typically far worse than the injection itself!

Hip joints also have a large number of surrounding muscles and therefore with appropriate exercises the mechanical stability of the joint can be improved.

The key to all muscle and joint related problems remains the same: Improve the joint chemistry by decreasing inflammation or adding joint lubrication and then optimise the movement pattern and supporting muscle strength.
If you feel you may benefit from a clinical examination and ultrasound scan of your hip joint and surrounding tissues then please phone 0114 267 1901 to check on appointment availability.

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Pain Scores: are they damaging us?

Are ‘Pain’ scores damaging the public’s health!

person in pain

Ever been asked to score your pain out of 10?

Ever been asked to describe your pain and even draw a picture of where it is?

Ever wondered why?

We are taught to believe that a description of our pain and its intensity will help us to find out what’s wrong. This approach has grown in popularity, in part fuelled by a trend in cultural expectations that we should be pain free. In part driven by commercial practice that attempts to sell a ‘pain free’ lifestyle. It is both tempting and financially lucrative.

So does this approach work?

No. The number of people with long term pain is rising, mental ill health associated with pain is rising, the financial cost for the management of long-term pain is increasing and the health of the nation is decreasing. 

So why is it that a standard medical consultation spends time discussing a persons experience of pain and how it affects them?

There are several reasons, the key ones include:

  • All NHS contracts in orthopaedics stipulate that outcome measures based on pain scores are put in place as part of service contracts. Consequently, the clinicians have to ask and patients have to score high in order to gain access to care.
  • It is cheaper to talk about pain than it is to investigate.
  • Many clinicians are taught to ask about pain and there is trend in becoming more empathetic as opposed to diagnostic. ‘How do feel’ has gained priority over ‘this is what’s wrong’. 

Is this pain discussion really that bad?

At its current level, yes. As a consequence of our focus on ‘pain’, our time and financial resources are being spent on ‘pain’ driven pathways instead of appropriate investigation and medical intervention. The focus on ‘pain’ is like having focus on the noise a fire alarm makes. The alarm is not the real problem, the alarm is a warning. It is the resultant investigation that determines if there is a problem and if so, where it is and how big it is.

Side note: Veterinary practitioners have the luxury of avoiding the whole pain score and pain discussion because animals don’t speak. Veterinary clinics have ultrasound scans, x-rays, some even have MRI’s. Many have blood laboratories on site and as a result our pet animals have immediate focus on ‘what is wrong’. 

So, if we don’t measure ‘pain’ what should we measure?

With regard to muscle and joint pain we should investigate and measure mechanical strength, alignment and movement patterns. We should observe the true status of tissues and look for tears, ruptures, levels of degeneration and damage. We should measure chemistry to ensure our blood, hormone and endocrine systems are normal and check our temperature. 

The image (on the right) shows a partial tear to a patients rotator cuff tendon. The left image is normal. This person had several treatments and discussions about their pain before visiting InjectionClinic. Once we established a diagnosis treatment could then focus on the condition, not just the ‘pain’ experience.
rotator cuff tear ultrasound scanFollowing investigation we should also acknowledge ‘normal’ findings as a process of exclusion. We should understand that not all pain arises because of damaged tissue, pain can occur because of irritation without damage. Most back pain for example occurs because of poor posture and patterns of movement, not medical pathology. We should therefore measure our improvements in mechanical and chemical terms if we really want to improve our health. The ‘pain alarm’ will then turn itself off.

Is it really that simple?

Yes and no. Yes, because best mechanical function and best chemistry are key to making us healthy.

No, because nationally this would require a significant shift in financial resources and a change in the current model of healthcare. We would need frontline clinicians with appropriate diagnostic skills, the time to diagnose and access to investigations.

It is however simple on an individual level, because it is easier for one person to elicit change than a national organisation.

If you are in pain but don’t know what tissues are damaged or irritated, then a physical examination enhanced by ultrasound is a great place to start. It costs £75.

Book your initial consultation including ultrasound scan 

www.injectionclinic.co.uk/sheffield/

The error of chasing pain!

All too common problem
The error of chasing pain !
For over two years this person visited their GP with knee pain. Injections and physiotherapy did not improve the symptoms or the persons mobility.
The x-ray below shows the painful knee joint. There are no major changes seen on the x-ray, but because the experience of the pain remained around the knee, so did this persons treatment.
By staying focused on examining how joints and tissues are performing and not chasing the pain, we observed the whole person and in particular examined the joints above and below the knee.

The examination of the hip revealed significant changes. A loss of movement was quickly apparent and further investigation with x-ray highlighted the severe degenerative changes (bottom picture).

Its not uncommon for an experience of pain to mislead both patient and practitioner and therefore it is important not to be lead by an experience of pain alone.

Remember that an experience of pain is your body’s alarm, it is an essential warning mechanism, but the detail of your pain experience is not a reliable indicator of what the true nature of the problem is.

If in doubt get the problem checked out!

Examination and ultrasound scan to assist diagnosis £75. When indicated x-rays and MRI scans can be arranged.

No photo description available.
No photo description available.

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Shoulder Pain

 
What does shoulder pain look like?
Shoulder pain and ‘pain’ in general cannot be seen. What can be seen are changes to the tissues that make up our shoulder joints.
Shoulder Bursitis
Common problems include shoulder bursitis, which is the inflammation of a fluid sac within your shoulder joint. This can be seen on the ultrasound image below (see the darkened band pointed to by the white arrow) . It is a common painful condition that responds very well to ultrasound guided cortisone injections..
 
 
Next picture shows a needle directed into the bursa. Note the measurement ‘A ‘(3.6mm). This is the size of the bursa after injecting with cortisone. To ensure accurate needle placement when the tissues are so small requires ultrasound guidance.
 
guided ultrasound injection into subacromial bursa shoulder
Rotator cuff tendon tear
Another common shoulder problem is a tear within the rotator cuff tendon. The image below shows a comparison between a normal supraspinatus tendon (left image) and a torn supraspinatus tendon (right image). This problem is not for injection, but requires surgical consideration and appropriate rehabilitation.
rotator cuff tear ultrasound scan
Acromio-clavicular joint inflammation
A common and often over looked problem is inflammation of the acromioclavicular joint (ACJ). The image below shows an inflamed ACJ which again responds really well to injection therapy.
 
 
If your shoulder is painful then first establish a diagnosis and then select the right treatment for your problem.
Call Active Healthcare Sheffield on 0114 2671901 and ask about an ultrasound scan and injection therapy.

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