Injections Archives - Injection Clinic Sheffield Barnsley

coVID-19 and injection therapy

Information on how coVID -19 is affecting clinical practice.

Please could read the following. It contains information about Injection Therapy and the latest changes surrounding coVID-19.

Firstly, it has become standard practice to ask people with any symptoms to self isolate. The symptoms relate to fever, persistent cough and a sore throat.

Anyone who has recently travelled or been in contact with someone who may be infected is also advised to self isolate.

Ultrasound scans to help confirm your diagnosis will continue as normal. There are however some restrictions on the use of Corticosteroids. Please phone for a telephone chat prior to booking to make sure you are suitable for steroid injection.

The use of injections such as Ostenil to assist with joint lubrication continues as normal. Please mention to the reception staff if you are considering Ostenil, just to make sure we have enough in stock.

What about the use of steroid injections

The use of Cortico-steroids does however need a bit more understanding. Cortico-steroids have a minimal effect on suppressing a persons immune system. This effect is not normally a problem, but with coVID-19, people at risk are having a difficult time in fighting off the viral infection. Therefore any compromise to their immune system is not advised.

The high risk group includes people:

Over the age of 70 years.
Any immunosuppressant disease; such as Lupus, Inflammatory Bowel Disease and Type 1 diabetes.
People with breathing problems such as Chronic Obstructive Pulmonary Disease (COPD) or asthma.
And anyone with cardiac problems such as hypertension (high blood pressure) or angina.

Consequently the Injection Clinic in conjunction with ActiveHealthcare advise against the use of steroid injections in this group of people for the time being.

Now could actually be a good time to correct your muscle and joint problem.

The coVID-19 problem is now having a dramatic impact on health and finance.

It is difficult to find any positives, but if you are stuck in isolation then it does provide an opportunity to work on correcting your posture, strength and your movement pattern for daily tasks.

As with all problems, Injection Clinic recommends you first establish a diagnosis. Whether your fixing a car or your body, if you first identify whats wrong, your time in correcting the problem will be reduced.

Remember, shoulder and knee pain is not a diagnosis; shoulder impingement with bursitis or patella tendinopathy is!

To find out your diagnosis please book an appointment with Chris for a consultation and ultrasound scan. Then start your rehabilitation.

Spinal Injections

What are Spinal Injections?

The term injection refers to the how medication or supplements are introduced into the body.
Most medication is administered via tablets or drinkable liquid formulas. There are however other ways to administered medication and this includes 'injections'.
Some injections are designed to go directly into the blood stream, others need to be injected into muscles or joints.

A Spinal Injection therefore refers to medication that is injected into the spine.
The key issue to understand is that there are many different medications that can be injected and many different spinal areas into which these injections can be administered to.

What are the most common Spinal Injections?

There are three main spinal injections; an epidural, nerve root block and facet joint injection.

Epidural

This is an injection administered into the spinal canal, the central part of the spine which protects the spinal cord and lumbar spinal nerve roots.
The injection can be administered at the base of the spine or between vertebral bones around the mid-lumbar region.
Typically used for pain management of the lower limbs during surgery, pregnancy and for symptom relief of spinal stenosis (narrowing of the spine around the nerves).

These injections should be administered in hospital and research indicates that the steroid should be a non particulate solution in order to further minimise the risk of clots and damage to vascular tissue within the spine.

The forgotten facet joint injection

Facet joint injections often get over looked. One potential reason is the public's and healthcare workers perception that 'bad' back pain and 'referred pain' must arise from a 'trapped nerve' or a 'slipped disc'.
The reality is that as we get older the likelihood of back / leg pain from a facet joint irritation increases year on year.

Over time, with normal ageing , the discs between our vertebral bones loose height. This then positions the facet joints closer together and at risk of exposure to increasing compression. This mechanical force transmitted through facet joints is a very common cause of back and leg pain.

Facets joints are bony joints, just like any other joint in our body and like an arthritic knee, for example, they can respond well to injections of cortico-steroids.

Nerve Root Blocks

Nerve root blocks are often considered when the persons pain is thought to be attributed to the irritation of a specific nerve. For example a right sided L5 nerve root block is a consideration if someone has 'radicular' pain down their leg and into their foot.
An MRI scan can further provide some insight into the likelihood of nerve irritation based on the observation of a nerve being surrounded by displaced tissue or being deviated (moved) from its normal pathway.

A nerve root injection is more difficult to perform and again it is recommended that the injection is performed in a hospital setting under x-ray or CT guidance.

So what does the Injection Clinic think to Spinal Injections?

Firstly, at the Injection-Clinic we only perform facet joint injections. These are safe to administer under ultrasound and with the same medication as we use for all other joint injections.

The success of the injections varies from life changing to no effect. The main reason for this is due to the individuals specific diagnosis.
If the facet joint is inflamed and the chemical inflammatory changes are causing pain then a facet injection will have a good outcome. If the pain is due to mechanical compression on a nerve then the injection will have little benefit.

The problem is that we never fully know the complete diagnosis and consequently injections are administered for the purpose of diagnosis as much as they are administered for treatment.

Priced appropriately so you can find out.

An important consideration when thinking about spinal injections is the cost. There is no guarantee of the injection working, but because most spinal injections are administered in a hospital setting the cost is very high.
At the Injection Clinic, whilst the procedure is more complex than injecting a knee or shoulder joint, we do not charge a premium.
Facet joint injections are £80 each. Dependent on the findings from physical examination, a client normally has either two or four facet joint injections.

Platelet Rich Plasma PRP

What is blood made from?

All mammals have a fluid called 'blood' that is pumped around their bodies in a network of blood vessels (arteries /veins).

Blood is made up of many different cells and a fluid called plasma.

Most people have heard of red and white blood cells. The red cells carry oxygen which is an essential element in energy production. White cells help us produce antibodies to fight infection. There are however other bits floating around in the blood plasma which are much smaller. These are called platelets.

What are Platelets?

Platelets contain many different 'factors'. These can plug areas of damage to the blood vessels and prevent leakage; they also stimulate growth and repair. Consequently, to improve healing potential Growth Factors have to be present.

Plasma itself, whilst mostly water, contains many different proteins, electrolytes, vitamins and nutrients such as glucose and amino acids. These too are needed to grow new tissue and generate tissue repair.

Platelet Rich Plasma could therefore be described as a collection of the 'bits' of blood needed for tissue repair.

Do we heal faster if we have more platelets at the site of tissue damage?

Firstly, we don't heal at all if Platelets are not present. So to make sure we heal as good as possible it would stand to reason that there exists a 'best amount'; an optimal level.

But what is this level and how do we know what our own level is?

It is unlikely that we will know our platelet count or what our levels of folate, B12, zinc and magnesium (just to name a few) are. But if we take what we have and concentrate it, then the levels in that sample will be higher.

Always remember to eat well and ensure your diet contains these essential nutrients!

Does the research support the use of PRP?

One of the largest research advice centres in the UK is the National Institute for Health and Care Excellence (NICE). NICE provides guidance to the National Health Service (NHS) with regard to which treatments it should deliver.

The current information provided by NICE states that "the evidence on platelet-rich plasma injections for knee osteoarthritis raises no major safety concerns. However, the evidence on efficacy (its success) is limited in quality."

Chris Creaghan has trailed the use of PRP in early to moderate degenerative joints. The patient feed back is favorable.

Not all PRP injections are the same and over the years Chris has found the best results are attained following a double spin method and the use of an Platelet activator.

Like all treatments, first a diagnosis must be established and the treatment administered needs to be appropriate for the condition.

So what does the Injection Clinic think?

Number one: eat well and make sure you have a diet that contains all the essential ingredients, as mentioned in the last blog 'Body Chemistry'.

Number two: move well. If you don't move well then you will continually irritate the tissues that need chance to repair.

Number three: normal and appropriate healing takes time. When cooking food it is not best practice to put everything on full heat; some things just take longer. Be patient.

Number four: When prepared correctly, PRP can boost your own healing capabilities. There is growing support from Injection Clinic patients that PRP is an effective treatment in the long term management of OA joints.

Treatment for Knee Osteoarthritis

Knee osteoarthritis is not just mechanical wear and tear, it also involves cellular and chemical changes. These changes affect all the tissues that make up a knee joint (cartilage, bone, joint capsule, ligaments and muscle).

In the event of trauma and/or age related changes, the body will attempt to repair damaged tissue. However this process does not replace like for like. Consequently tissue repair can result in changes that further affect the normal function of the joint.

It is therefore essential that both mechanical and chemical changes are minimised.

Mechanical Factors

In order to decrease abnormal mechanical stress on the knee joint there are three keys factors that a person should identify. Their joint alignment, strength and functional movement.

The photograph shows a typical valgus alignment of the left knee and the x-ray shows what lays beneath the skin. You can clearly see the erosion of the left side of the knee joint. In this situation mechanical correction by surgery and a joint replacement is likely to provide the best outcome.

Most are not that bad!

Fortunately, most knees with osteoarthritis are not that bad and therefore mechanical improvements can be made via exercises. The video shows good technique for a wall squat. You don’t have go very deep into the squat but it is important to get your hips, knees and feet in good alignment. The squat will improve knee joint strength.

https://youtu.be/rBohxX3q70g

Chemical Changes

The chemical changes within a knee joint can also vary. Many arthritic joints have inflammatory flare ups and at times the fluid within the joint needs to be aspirated. Other chemical changes include Gout. The video shows the technique for joint aspiration.

https://youtu.be/O2OitCv1Gu0

Chemical changes are not simply achieved by taking excessive fluid out, improvements can also be made by injecting medication directly into the knee. A common injection is a Corticosteroid. This will directly decrease inflammation and can often decrease the persons experience of pain.

Other injections can also be considered. These include viscosupplementation, such as Ostenil and Platelet Rich Plasma (PRP). Please click the button for more information on the different types of joint injection.

Diagnosis is critical for best treatment

For any treatment to be effective it must be tailored to the specific requirements of the individual. There are many other factors that affect knee osteoathritis including problems with the hip joint, foot and ankle. The pain experience itself is not diagnostic, it simply informs the person that they have a problem.

New patient examination and ultrasound scan £75

Please remember that the Injection Clinic provides a high quality service for all your joint aches and pains. Please visit the website for full details.

Platelet Rich Plasma (PRP) injections

The search for best treatment of joint degeneration and OA changes continues.

A growing number of people are hearing about Platelet Rich Plasma (PRP) injections, but what are they and do they work?

All mammals, and that includes us, have cells within their blood. Different cells do different jobs. Most people have heard of red blood cells as these help carry oxygen and white blood cells that help fight infection.

There are however lots of other ‘bits’ within our blood and these are called ‘platelets’. Platelets are fragments of cells that originate in bone marrow cells. These fragments contain many different proteins and are most commonly associated with ‘plugging’ a hole in any damaged tissue. They form a blood clot and prevent excessive bleeding, but they also initiate the process of repairing tissue and some of the proteins within platelets are referred to as Growth Factors.

The idea behind PRP injections is that you take a persons blood and separate the red bloods cells away from the platelets. You then have a higher concentration of proteins and growth factors which you inject into the area of damaged or degenerate tissue. This is essential as you do not want red blood cells inside joints or ligaments as this can cause a further inflammatory response (red blood cells should not be in these places).

platelet-rich-plasma-prp

The aim is to stimulate new cellular growth and therefore boost the repair process. Sounds good, but does it work?

Like most things there is no clear answer. Research is a mixed affair with animal dissection after injections showing an improvement in the surface of joint cartilage. We don’t tend to be that cruel to humans, so most outcomes in people are based on pain and disability scores. Research tries to compare the benefit of PRP to exercise and/or other medication. The results are not conclusive but there is a trend and as the use of PRP has grown there has been more widespread acceptance of PRP as a valid treatment option. It is now acknowledged by the NHS and in some areas of the UK offered as a treatment.

One big advantage of PRP is that it is safe and there are no long term side effects. The physiological basis has merit, mainly because usually platelets have difficulty reaching ligament, tendon and cartilage tissue. Consequently, I tend to refer to PRP as a fertiliser to aid healing and ensure the best outcome. It is not however a miracle cure or a stand alone treatment. Its needs to be used in conjunction with corrections to strength, alignment and patterns of movement.

If you wish to discuss your problem further or arrange an appointment for PRP treatment please visit with main website and book an appointment.

Further information can be viewed in the article written by Arthritis Health.

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. For a new patient examination and ultrasound guided cortisone injection the cost is only £150.

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.

Book an appointment

Frozen Shoulder

Frozen shoulder is a common shoulder problem; it typically starts without any trauma and last for around 18 months. Quite often it affects the persons non dominant arm and after a period of several weeks it can cause the shoulder joint to loose its range of movement. Washing hair, fastening bras, putting on jumpers etc all become problematic.

Diagnosis is established by the presenting loss of movement and ultrasound scans can further ensure there is no tissue damage. A frozen shoulder on both ultrasound scan and x-ray will look normal.

Due to the high level of pain and limited movement, the condition has a significant impact on a persons life. Whilst treatments such as gentle exercises and soft tissue massage to the surrounding muscles can benefit, the main change in symptoms and movement is provided for by injection therapy.

Guided corticosteroid injections help reduce inflammation and in so doing decrease the pain experience. Hydro-dilitation or distention helps to stretch the shoulder joint capsule from the inside and can provide immediate improvement in joint range of movement.

It must be noted that all injections have to be administered under guidance. The joint space is relatively small and can be as deep as 6cm on some individuals. For Hydro-dilitation, the use of ultrasound scan enables a clear image of the expanding joint capsule.

Guided injections work well to suppress excessive inflammation. This can often improve night time rest, enabling better sleep.

To book an appointment with Injection Clinic and find out if you could benefit from a guided injection please ‘click here’.

Shoulder Pain

What does shoulder pain look like?

INJECTION CLINIC·SUNDAY, 17 FEBRUARY 2019

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.

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-diagnosis-of-shoulder-problem

Acromio-clavicular joint inflammation

A common and often over looked problem is inflammation of the acromioclavicular joint (ACJ). When inflamed the joint 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.

coVID-19