Ultrasound Guided Injection Service
We offer ultrasound guided injections, including steroid injections, hyaluronic acid injections (Durolane), Ostenil and hydrodilatation. Currently, these are performed by Tony Gill. Tony is the only Bristol Physiotherapist qualified as an ultrasonographer, prescriber and injection therapist combined. Please contact us to inquire about pricing.
Bristol Physio are able to offer an ultrasound guided injection service. These include Steroid and Hydrodilatation injections. All injections are done using ultrasound as guidance (rather than anatomy guided) this ensures the target area is identified and treated. Injections are mainly used for shoulder complaints, but are available for all joints.
You will usually have an initial assessment with Tony or another team member to assess your suitability for an ultrasound guided injection. All of our staff are trained to recognise when to refer for a guided injection, however Tony has the last say. His experience, including his knowledge as a private presciber (and how the medications react to others you may be taking), influences whether a guided injection is the correct treatment for you. It may be that it is too soon in your rehabilitation program. An ultrasound guided injection is usually a last resort treatment, either to provide a window of opportunity for strengthening and mobility, or to provide an interim before surgery. Occasionally the guided injection is the treatment modality that solves the issue and keeps the joint pain free.
The Ultrasound Guided Injections are usually the correct treatment for shoulder, hip, knee, wrist and foot complaints. See here for more on back pain and Tony's blog on back pain here. The shoulder in particular has been shown to respond well to ultrasound guided steroid injection and hydrodilatation, see here for articles on the evidence. The injury can vary from Frozen shoulder/adhesive capsulitis to more acute ACJ strains or impingement. Read more below on the benefits behind each guided injection and whether it could be right for you.
STEROID INJECTIONS
Cortico-steroids are the body's natural anti-inflammatory products. We offer steroid injections for joint and tendon problems with a focus on pain reduction and increased mobility. The body naturally produces many steroids, such as Cortisone, to reduce inflammation and promote healing. The injection gives a targeted dose of steroid into the affected area. Subsequently, the inflammation within the joint space, tendon or bursa takes 2 - 10 days to reduce after the direct injection. A single injection may be sufficient to alleviate your pain, however some chronic conditions can require multiple injections. Steroid injections are always used in conjunction with exercise rehabilitation. Once the pain has been alleviated, retraining and normalising movement & power is key to long term success. The steroid allows a window of opportunity for rehabilitation and exercises. There is also the added benefit of pain relief which can help with mobility, sleep quality, mental health and ability to do the exercises. Click here for published research on steroid injections. Steroids can slightly compromise the immune system, so it is important to discuss with us and your GP before opting for this type of injection. Alternatives are available and we will be able to advise you.
HYDRODILATATION
Additionally, we offer hydrodilatation injections (including large volume hydrodilatation) with reports of great success. The patient will usually feel immediate relief in pain in the shoulder and have more movement in a short period afterwards.
Hydrodilatation is most often administered to treat 'frozen' shoulders. The research behind frozen shoulder is still a little unclear but it is thought the shoulder gets 'sticky'. Eventually this leads to a very stiff and painful shoulder that you struggle to raise. This condition can last from a few months to a few years without hydrodilatation. Click here to read more on shoulder injury and diagnosis.
Hydrodilatation is a mixture of sterile saline solution, local anaesthetic and steroid and is injected into the shoulder to increase joint movement and to reduce pain. To read more on the published research on hydrodilation success follow these articles.
HYALURONIC ACID
Hyaluronic acid injections are also available. These medicated injections are most appropriate for conditions such as mild osteoarthritis or tendinopathies. We commonly use these injections for knee pain caused by osteoarthritis. The injection is chemically similar to natural joint lubricant and replicates some of the shock absorbing properties. The injection is usually repeated a few times, in weekly doses. For an introduction to the research behind the effectiveness of Hyaluronic Acid Injections click here.
Recently we have started using a product called Durolane, which is a 1 injection treatment for mild OA. See more here. Bioventus have also created a great patient information booklet here.
Image and Booklet used with permission from Bioventus
Prescriptions for the guided injections can only be made after an initial consultation with Tony, who will then decide if an injection is required and prescribe the appropriate medication. All injections are administered by Tony in a follow up session.
To book your initial assessment click here.