Patient Information 

Information for patients receiving Hyaluronic Acid (HA) Injections: Sinovial ® Products including Sinogel® & Ostenil® ______________________________ What Are Hyaluronic Acid Injections? Hyaluronic acid (HA) products are sterile gels injected into joints or around tendons to help reduce pain, stiffness and symptoms associated with osteoarthritis and some soft-tissue conditions. These products are manufactured without animal proteins and have a very low risk of allergic reaction. We Provide injections with the following products: Sinovial One Sinovial HL Sinogel (contains chondroitin, which may not be suitable for individuals with shellfish allergy) Ostenil & Ostenil Mini Ostenil Plus Ostenil Tendon _______________________________ How Do They Work? In painful or arthritic joints, the natural HA in the synovial fluid becomes thinner and less effective. Injected HA helps restore lubrication and shock absorption within the joint or around a tendon. Benefits may include: •Reduced pain & Stiffness •Improved joint movement & Increased tolerance to activity For most people, improvements last 6+ months. You will require repeat injections, depending on symptoms and response around this time frame. Current UK evidence and clinical experience indicate no known long-term tissue harm from repeat HA injections when appropriately administered. _______________________________ Before the Injection Your clinician will: •Check your medical history and medications •Confirm suitability •Explain risks and benefits •Obtain written informed consent If you take anticoagulants (e.g., warfarin), your clinician may confirm your INR is within a safe range. HA injections are usually avoided during pregnancy unless your GP specifically advises otherwise. They are considered compatible with breastfeeding. _______________________________ During the Injection •The area will be cleaned and prepared using an aseptic no-touch technique •All Injection procedures are ultrasound guided •A small dressing will be applied for 24 hours •Most procedures take only a few minutes. ______________________________ After the Injection •If local anaesthetic is used, it may cause temporary numbness that wears off within 1–2 hours •The benefit of HA normally begins over several days, sometimes up to several weeks •Avoid strenuous exercise for 2–3 days •You may prefer not to drive immediately afterwards if numbness is present _______________________________ Possible Risks or Side Effects Most people have no problems Common •Injection discomfort •Post-injection pain flare (20–30%) lasting 24–48 hours •Temporary swelling or heat around the joint Less Common •More prolonged flare lasting up to a week •“Pseudo-sepsis” – significant pain and swelling without infection o(rare, requires medical assessment) Very Rare but Important •Infection (approx. 1 in 50,000) oSymptoms: worsening pain, heat, redness, fever, feeling unwell oSeek urgent medical review (A&E) if these occur •Allergic reaction / anaphylaxis (approx. 1 in 500,000) oSymptoms: faintness, wheezing, fast heartbeat, confusion, collapse oYou will be observed in clinic for 15–20 minutes after injection Specific to Sinogel® •Contains chondroitin, which is derived from shellfish. •Patients with shellfish allergies should not receive this product. _______________________________ Repeat Injections If helpful, the injection may be repeated. Usually every 6 months. Many clinicians use HA injections to create a “window of opportunity” for rehabilitation, strengthening, and improving joint function. _______________________________ Aftercare A report will be provided for you, we advise you make your GP aware, so your medical record is updated. _______________________________

Information for patients receiving High Volume Injections Local Anaesthetic + Sterile Saline for Patellar or Achilles Tendon Regions _______________________________ What Is a High-Volume Injection? A high-volume injection (HVI) involves injecting a larger volume of sterile saline (sodium chloride for injection) mixed with local anaesthetic into the space between the tendon and nearby fat pad. It is not injected into the tendon itself. It is commonly used for: •Mid-portion or insertional Achilles pain •Patellar tendon pain The aim is to reduce pain thought to relate to neovascularisation and irritation of adjacent fat tissue. _______________________________ How Does It Work? The combination of saline and anaesthetic may: •Disrupt sensitive small nerve and vessel ingrowth •Reduce local tissue irritation •Improve pain to allow rehabilitation loading •Aid return to activity or sport Benefits often occur within days to weeks when combined with physiotherapy-led loading programs. _______________________________ Before the Procedure Your clinician will: •Review your symptoms and scan findings •Confirm that the injection is suitable •Discuss risks and expected outcomes •Obtain written consent Anticoagulant use and relevant medical history will be checked. _______________________________ During the Injection •The skin is cleaned and prepared aseptically •Ultrasound guidance will used •The injection is placed at the fat pad–tendon interface, not into the tendon •A small dressing will be applied The procedure usually takes around 10-15 minutes. _______________________________ After the Procedure •Local anaesthetic may reduce pain temporarily for 1–2 hours •The area can feel bruised or heavy for 24–48 hours •Avoid strenuous activity for 48 hours •A structured rehabilitation plan will be provided _______________________________ Risks and Possible Side Effects Common •Temporary discomfort or heaviness •Bruising at the injection site •Pain flare for 24–48 hours Less Common •Short-lived increase in symptoms lasting up to one week Rare •Infection - 1 in 50,000 very rare oSeek urgent help if redness, heat, swelling, or fever occur •Allergic reaction / anaphylaxis - 1 in 500,000 extremely rare oSymptoms: faintness, wheezing, fast heartbeat, confusion, collapse oYou will be observed in clinic for 15–20 minutes after injection Tendon Rupture An important point for patients: •Because the injection is not placed into the tendon, the procedure does not weaken the tendon. •However, if a patient loads the tendon too aggressively too soon, there is a small risk of rupture. •Following the rehabilitation plan and graded loading advice is essential. This aligns with current UK practice guidelines _______________________________ Rehabilitation Successful outcomes depend heavily on structured loading after the procedure. Your clinician will provide an individualised program.

Information for patients receiving a corticosteroid injection What Is a Corticosteroid Injection? Corticosteroid injections reduce inflammation and pain in joints, bursae, and soft tissues. They can provide rapid symptom relief, creating a valuable opportunity to progress rehabilitation. _______________________________ How Do They Work? Steroids act locally to reduce inflammatory chemicals within the injected area. Effects may be felt within a few days, with benefit lasting from several weeks to several months depending on the condition. Cortico-steroid injections are not effective for every patient; a minority of patients may experience no relief. NICE and Arthritis UK recognise steroid injections as useful short-term treatments for many inflammatory or degenerative musculoskeletal conditions. _______________________________ Before the Injection Your clinician will: •Check your medical history •Review medications including anticoagulants •Discuss risks and benefits •Obtain written consent •You will be given an opportunity to ask any questions prior to consenting for the procedure. •Steroid injections are generally avoided during pregnancy unless essential. •People with diabetes should be aware that blood glucose may rise temporarily. _______________________________ During the Injection •The area is cleaned using aseptic technique •This will be an ultrasound guided procedure •A Local anaesthetic may be added for comfort •A dressing is applied for 24 hours _______________________________ After the Injection •Pain may improve within several days •Avoid strenuous exercise for 2–3 days •A steroid flare (temporary increase in pain) may occur within the first 24–48 hours _______________________________ Possible Risks and Side Effects Common •Brief stinging or pressure during injection •Steroid flare: (2-5%) temporary worsening of pain for up to 48 hours •Mild facial flushing Less Common •Skin or fat atrophy (a small indentation or lightened skin) at the injection site •Temporary rise in blood glucose (especially in people with diabetes) •Temporary increase in blood pressure Rare but Important •Infection (1 in 50,000), seek urgent care if redness, heat, swelling or fever occur •Allergic reaction - Anaphylaxis (extremely rare 1:500,000) •If injected around a tendon, repeated steroid injections can weaken tendon tissue over time (

Information for patients receiving a Hydro-Dilatation Procedure Adhesive Capsulitis / Frozen Shoulder _______________________________ What Is a Hydro-dilatation Procedure? Hydro-dilatation is an ultrasound-guided injection used to treat adhesive capsulitis (frozen shoulder). It involves injecting a mixture of: •Local anaesthetic •Corticosteroid •Sterile Saline (sodium chloride for injection) The fluid gently stretches and distends the tightened joint capsule to improve movement and reduce pain. This procedure is supported by UK practice guidelines and is commonly recommended when shoulder stiffness and pain significantly affect daily function. _______________________________ How Does It Work? Frozen shoulder occurs when the joint capsule becomes inflamed and tight. Hydro-Dilatation aims to: •Reduce inflammation (via the corticosteroid) •Reduce pain (via local anaesthetic) •Stretch the joint capsule (via saline distension) •Improve range of movement •Facilitate progress with physiotherapy Many patients experience meaningful improvement within 2–6 weeks when combined with appropriate rehabilitation. _______________________________ Before the Procedure Your clinician will: •Review your symptoms and diagnosis •Confirm suitability for Hydro-Dilatation •Discuss risks, benefits, and alternatives •Review medical history and medications, including anticoagulants •Obtain written consent People with diabetes should be aware that corticosteroids may temporarily raise blood glucose. This injection is generally avoided during pregnancy unless specifically discussed with your GP. _______________________________ During the Procedure •Ultrasound is used to accurately guide the injection •The skin is cleaned using aseptic technique •Local anaesthetic is used to numb the area •A mixture of steroid and saline is injected to stretch the joint capsule •You may feel a sense of pressure as the joint fills — this is normal •A small dressing is applied for 24 hours Total procedure time is usually 10–15 minutes. _______________________________ After the Procedure •The shoulder may feel numb for 1–2 hours •Mild aching or “fullness” is common for 24–48 hours •Avoid strenuous activity for 48 hours •Start or continue physiotherapy as advised — this is essential for the best outcome Pain relief may begin within a few days, but improvements in movement typically build gradually over several weeks. _______________________________ Risks and Side Effects Common •Temporary discomfort or pressure during the procedure •Bruising or mild swelling •A steroid flare (temporary increase in pain for 24–48 hours) •Short-term numbness from local anaesthetic Less Common •Dizziness or feeling faint •Shoulder soreness lasting up to one week Rare •Infection (1 in 50,000), seek urgent care if redness, heat, swelling or fever occur •Allergic reaction - Anaphylaxis (extremely rare 1:500,000) •Temporary rise in blood glucose (people with diabetes) •Skin or fat atrophy at injection site (uncommon with ultrasound guidance) _______________________________ Expected Benefits Most patients experience: •Reduced pain •Improved ability to sleep •Gradual improvement in shoulder mobility •Ability to progress with rehabilitation Hydro-Dilatation may be repeated, if necessary, although many patients only require one treatment. Aftercare _______________________________ A summary document of your procedure will be provided; it is advised to make your GP aware so they can update your medical records.

Information for patients receiving a Fenestration Procedure Tennis Elbow – Ultrasound-Guided Needle Fenestration Procedure _______________________________ What Is Needle Fenestration? Needle fenestration is an ultrasound-guided technique used to treat lateral epicondylitis (tennis elbow). It involves: 1.Local anaesthetic injection 2.Multiple controlled passes of a needle into the degenerated tendon tissue to stimulate healing 3.A repeat session two weeks later This technique does not cut the tendon — it creates controlled micro-stimulation to encourage a normal healing response. Fenestration is widely used in UK musculoskeletal practice when symptoms persist despite physiotherapy. _______________________________ How Does It Work? Tennis elbow involves small degenerative changes in the tendon rather than inflammation. Fenestration aims to: •Stimulate local healing •Break down abnormal tissue •Increase blood flow •Reduce pain over time •Improve grip strength and function Results typically build gradually over 6–12 weeks, especially with guided rehabilitation. _______________________________ Before the Procedure Your clinician will: •Confirm the diagnosis through assessment and ultrasound •Review your medical history and medication •Explain the procedure and obtain consent •Discuss rehabilitation requirements People taking blood thinners may require additional checks. _______________________________ During the Procedure •The skin is cleaned using aseptic technique •Local anaesthetic is injected to numb the area •Under ultrasound guidance, the needle is passed repeatedly through the degenerative tendon tissue •You may feel pressure or vibration rather than sharp pain due to the anaesthetic •A small dressing is applied The procedure typically takes 10 minutes. A second session is performed two weeks later to maximise effectiveness. _______________________________ After the Procedure •The area may feel bruised or sore for 24–72 hours •Ice can be used if recommended •Avoid gripping and heavy lifting for 48 hours •Start your staged rehabilitation program as instructed Complete recovery typically depends on commitment to tendon-loading exercises. _______________________________ Risks and Side Effects Common •Post-procedure soreness for several days •Bruising •Temporary weakness Less Common •Pain flare lasting up to one week •Mild swelling or stiffness Rare / Extremely Rare •Tendon injury or partial tear (following the loading program reduces this risk) •Infection (1 in 50,000), seek urgent care if redness, heat, swelling or fever occur •Allergic reaction - Anaphylaxis (1:500,000) •Temporary nerve irritation Fenestration does not weaken the tendon long-term — healing responses strengthen it over time. _______________________________ Two-Session Treatment Plan •Session 1: local anaesthetic + tendon fenestration •Session 2 (after 14 days): repeat fenestration if symptoms/tendon appearance indicate benefit Rehabilitation progresses between and after the two sessions. _______________________________ Rehabilitation A structured strengthening programme is essential and may include: •Isometric exercises •Slow heavy load exercises (as tolerated) •Gradual return to gripping tasks and sport Your clinician will provide a personalised plan. _______________________________ Aftercare A report will be provided for you and it is advised to let your GP aware so they can update your medical records.