Consultant Rheumatologist Dr Stephanie Kaye-Barrett explains how injections for patients suffering from painful joint conditions, including frozen shoulder, hip pain and and plantar fasciitis, can provide immediate and lasting relief for patients
Will an injection help a painful shoulder?
A careful history and examination by a specialist in bones and joints is essential prior to deciding on a corticosteroid injection. You may have experienced pain for a very long time, related to a previous injury or sometimes there is no history of trauma. If you have pain during everyday movement, or when a doctor or therapist manipulates the part of the body that’s causing trouble (such as when a doctor gently circles your arm during an examination), this shows there are signs of impingement (catching of the tendons under the bony ridge with pain on movement). Perhaps there is also a history of night pain.
Treatment for a frozen shoulder
A joint injection can be very helpful for shoulder pain. Often it relieves 75 to 100 percent of the pain. It may also help with a frozen shoulder - where all movements are restricted. The skin is cleaned with an alcohol wipe. Following this, the skin around the point of entry and shoulder is so that you should feel very little or no pain when the needle is inserted. The injected steroid is usually Depomedrone or triamcinolone together with another local anaesthetic, Lignocaine. The amounts used in the injection are harmless to the rest of the body. Obviously, it’s essential that the area is very clean and no infection is introduced at that time. However, joint injections are carried out everyday within surgeries or consultants' rooms. Following the injection you should feel immediate relief from the local anaesthetic, lignocaine. The corticosteroid gradually ‘kicks in’, and you will feel minimal or no pain. The aim is to completely alleviate night pain, which can be one of the worst symptoms, from impingement or subacromial bursitits.
What's causing your hip pain?
Lateral hip pain, which is often misdiagnosed as osteoarthritis, may be due to a number of problems. One of the most common is trochanteric bursitis. This gives pain that mimics sciatica and osteoarthritis of the hip. People often visit an orthopaedic surgeon first and are discharged if the diagnosis of osteoarthritis is not present to substantial degree. However people are still left with the pain! On careful examination, the diagnosis of trochanteric bursitis can be made by a consultant rheumatologist. People have often suffered for many months with severe hip pain, that has been attributed to osteoarthritis or sciatica. The key to this diagnosis is in the presence of night time pain when the person lies on the side of the painful hip. This may cause dramatic sleep disturbance.
A steroid injection for trochanteric bursitis
Again, the problem may be solved by a corticosteroid and lignocaine injection. The skin is repaired in same way as previously mentioned, and it's also numbed using a local anaesthetic before the needle is inserted with the corticosteroid and lignocaine.
The issue may be due to hypermobility - which causes the feet to over-pronate (this term refers to when flat feet inwardly roll when they land on the floor). Your doctor should always examine your gait - you may be referred for gait analysis and possible orthotics to correct the problem. Other tissue abnormalities around this area, the lateral hip, may be gluteous medius tendinosis. This is treated in very much the same way as trochanteric bursitis.
Otherwise known as policeman’s heel, this very painful condition presents as immediate pain under the heel when you first stand up in the morning. As time goes on, you may have more pain whilst walking and sometimes at night. The underlying problem is related to inflammation of the tendons that lie under the heel and midfoot. The tendons are also linked up to the Achilles tendon at the back of the ankle. The underlying problem is a gait (walking) abnormality. Again, the feet roll (pronation), causing loss of the medial arch, worsening the condition. The solution to this is a corticosteroid injection using local anaesthetic spray to numb the pain before the needle is inserted and local anaesthetic called lignocaine which is mixed in with the steroid, Depo-medrone. People are often are often very afraid of steroid injections as they feel pain from the injection. As we use a local anaesthetic spray on the skin before inserting the needle and a steroid plus local anaesthetic, you’ll feel very little pain with our careful techniques.
Further treatment for plantar fasciitis
Following the injection, it is most important to be referred to a podiatrist for gait analysis and balancing of the feet with orthotics and exercises. Very rarely, people require further treatment with one one more injection. Usually the combination of injection, cushioning of heels, gait analysis and orthotics is enough to address the problem. Further treatment with shockwave therapy can be offered if the plantar fasciitis is resistant to the initial injections. There is a high success rate with this combination of treatment and management as described above.