Patient Information 

How do Corticosteroid injections work? Corticosteroid (steroid) drugs are a man-made version of hormones usually produced by the adrenal glands. They can be used to treat pain and inflammation, and certain types of arthritis. They can be given as an injection, at low doses, and are helpful in treating many joint and soft tissue problems. A local anaesthetic is often given at the same time, which helps to reduce the discomfort for few hours and often helps with diagnosis. Most people report improvements in their symptoms within 24-48 hours. However, it can take up to a week for it to work in some individuals. The anti -inflammatory effect last approximately 3-6 weeks so patients may have a reduction in pain lasting several weeks to months and sometimes longer-term relief. Unfortunately, no treatment will be effective for every patient and whilst most patients will experience at least partial benefit, a minority of patients may experience no relief. Possible Risks or Complications with this procedure •Infection (very rare 1:50,000) •Post injection flare of pain (2-5%) – this is reduced with rest for 24hours •Skin discolouration (improves with time) •Subcutaneous fat atrophy •Bruise / Bleeding (rare) •Soft tissue calcification with repeated injection at the same site •Joint injury, cartilage damage: avoid repeat injections – max 4 per location per year •Tendon atrophy and rupture (less than 1%) •Avascular necrosis •Facial flushing •Temporary impairment of diabetic control •Menstrual disturbances •Vasovagal reaction •Anaphylaxis (extremely rare 1:500,000) Steroid therapy may not be suitable for you if you have •Heart failure •Recent trauma to the joint being treated •The presence of local or systemic infection or you are taking antibiotics •A known allergy e.g. local anaesthetic, Latex •A tendency to bleed more (due to medical conditions or various medication) particularly if you have an unstable INR •Surgery pending in the joint to be injected •Current or recent treatment with certain medication e.g. oral steroids, HIV medication •Severe fear of needles •Received a vaccination or have one planned within 2 weeks of your injection •We are not able to offer steroid therapy in Pregnancy The Injection Procedure The clinician will ask you some questions to ensure you are suitable and can proceed with the procedure. They will discuss the risks and benefits of treatment and gain your informed written consent. You will be given an opportunity to ask any questions prior to consenting for the procedure. The clinician performing your injection will choose the most appropriate steroid and dose for your condition. Most injections are quick and easy to perform, the clinician will usually inject the steroid directly into the area that is inflamed, such as into the joint or around the soft tissue, where the pain is felt. The clinician will use an ‘aseptic no touch technique’ and place a dressing over the treatment area which is to stay in place for 24 hours. After The Injection Procedure It is best practice to rest for a while following the procedure especially if it is your first injection. You will be asked to take a seat in reception for 20minutes following the injection to allow observation of possible adverse reaction. If you have an injection that involves a local anaesthetic it may cause some numbness, you may also have some discomfort or pain, so it is advised you do not drive for a few hours after the injection. You may wish to arrange alternative transport home; you are welcome to bring a friend or family member along to the appointment. If you have local anaesthetic, you may feel some pain relief within minutes, but this will normally wear off after a few hours. You should try and rest the area and avoid strenuous exercise for a few days after the injection, if you are having an injection around a tendon you may wish to avoid heavy loading impact activities for up to 2 weeks. Advice will vary according to your condition so please discuss this with your clinician. You may notice a worsening of symptoms over the following 24-48 hours which may be related to a steroid flare, this can be treated with over-the-counter pain medication such as paracetamol. If pain is severe or increasing after 48 hours or you experience any problems that cause you undue concern, please contact your clinician, alternatively contact your GP or A&E department if you consider the problem to be urgent. If the joint becomes more painful, hot, red, and swollen, you are unwell or nauseous you should seek medical attention immediately (A&E) and inform the medical professional examining you that you have recently had a corticosteroid injection into your joint as they may need to give you antibiotics. Further injections If you find the injection helpful and other treatments are unsuitable or haven’t helped, the injection may be repeated. However, injections are most often used to provide a window of opportunity to engage in exercise and rehabilitation. Once your pain is better controlled, the need for injection should be reduced. Guidelines suggest limiting to a maximum of 3 steroid injections into the same area in a 12-month period. Aftercare Whilst we do not require a doctor to refer you for an injection, we will supply you with a report after the procedure which we suggest you forward to your GP for your medical records.

How does Ostenil plus work? Ostenil Plus is a solution containing hyaluronic acid. It is injected into the space in the joint that contains synovial fluid and works by restoring the normal balance between the breakdown and production of hyaluronic acid. This effect of Ostenil Plus means that it can decrease pain and stiffness and improve the other symptoms of osteoarthritis. The hyaluronic acid in Ostenil Plus is very pure and is manufactured using a process called fermentation. It contains no animal proteins, which means it is very unlikely to cause an allergic reaction. The addition of Mannitol (a simple sugar derivative) to Ostenil Plus allows the Hyaluronic Acid to work for longer and more efficiently in the joint, enabling effective symptom reduction with a single injection. Ostenil Plus has been extensively tested and has not been found to cause any serious side effects. Hyaluronic acid (HA) injections can give a reduction in pain of osteoarthritic joints. These improvements usually last around 6-9 months. Some patients may require a series of injections and some injections can be delivered on a one-off basis. If you find the hyaluronic acid injection helpful, and other treatments have been unsuitable or have not helped, the injection may be repeated. There is currently no research evidenced to suggest any long-term harm to tissues from having repeat injections of hyaluronic acid. The Injection Procedure The clinician will ask you some questions to ensure you are suitable and can proceed with the procedure. They will discuss the risks and benefits of treatment and gain your informed written consent. You will be given an opportunity to ask any questions prior to consenting for the procedure. The clinician performing your injection will choose the most appropriate dose for your condition. Most injections are quick and easy to perform, the clinician will inject the Ostenil plus directly into the joint or around the tendon, where the pain is felt. The clinician will use an ‘aseptic no touch technique’ and place a dressing over the treatment area which is to stay in place for 24 hours. After The Injection Procedure If you have a local anaesthetic your pain may be relieved within minutes, but the effect will usually wear off after an hour or two. It usually takes several days (even up to couple of weeks) for the effect of the HA to become apparent. You might wish to arrange alternative transport home after your injection, especially if you are having a local anaesthetic, which may cause some numbness and make it difficult to drive. If you are having an injection into a joint, you may be advised to avoid strenuous exercise for two or three days afterwards due to potential post-injection discomfort. Possible Risks or Complications with this procedure Most people have HA injections without any side effects. The Injection can be a bit uncomfortable at the time, but many people find that they are not as bad as they initially feared. A Post injection flare for 24-48 hours can occur in some patients (20-30%). A smaller proportion may have a more significant level of pain which will last for up to a week. Very rarely patients experience a more severe pain and swelling (known as pseudo-sepsis) which requires medical review to ensure no infection. Very rarely (approximately 1:50,000) you may get an infection in the area of the injection. If the joint becomes more painful, hot and swollen, and/or you are feeling hot, nauseous and unwell you must seek medical attention immediately e.g., go to your local accident and emergency department (A&E). You should inform the medical professional examining you that you have recently had a hyaluronic acid injection into your joint as they may need to give you antibiotics. Anaphylaxis It is extremely rare to have an allergic reaction to hyaluronic acid or local anaesthetic (1:500,000). This would usually happen within the first few minutes of an injection and requires immediate medical attention. Very rarely the allergic reaction can be delayed. The symptoms you might experience are feeling lightheaded or faint, breathing difficulties (such as fast, shallow breathing and/or wheezing), a fast heartbeat, clammy skin, confusion and anxiety, collapsing or losing consciousness. You will be asked to remain in the clinic for 20 minutes following the injection to allow observation of possible adverse reactions. You can take other medications alongside the hyaluronic acid injection. There are no known significant drug interactions that occur with hyaluronic acid. However, if you are taking a blood thinning drug, such as Warfarin, you may need a blood test to make sure that your blood is not too thin to have the injection. This is because of the risk of bleeding into the joint at the time of the injection. You, therefore, must tell the physiotherapist giving the injection, if you are taking an anticoagulant as they may need to discuss this with your GP before giving you the injection. We are not able to offer hyaluronic acid injection to patients who are pregnant without receiving specific consent from their GP. There are currently no known associated risks to having HA injection whilst breastfeeding, although you might still wish to discuss with your GP first. There are very few other reported side effects that have been linked with the use of hyaluronic acid. Further injections If you find the injection helpful and other treatments are unsuitable or haven’t helped, the injection may be repeated. However, injections are most often used to provide a window of opportunity to engage in exercise and rehabilitation. Once your pain is better controlled, the need for injection should be reduced. Aftercare Whilst we do not require a doctor to refer you for an injection, we will supply you with a report after the procedure which we suggest you forward to your GP for your medical records.

How does Traumeel work? Traumeel is a safe and natural alternative for conventional anti-inflammatory injections such as corticosteroids. These injections contain multitarget homeopathic components that support and accelerate healing, shorten the inflammation interval without blocking the process, reduce pain and provides sustained recovery from injury. Traumeel Injection Solution is indicated for the treatment of symptoms associated with inflammatory and degenerative processes such as muscle, tendon, ligament injury, bursitis and joint pain associated with arthritis. It is particularly popular in the management of sports injuries to reduce recovery time following injury. Are there any side effects? Traumeel is well tolerated and is a safe choice and consists of 14 plant extracts and minerals, it has no known drug interactions. It is registered and manufactured under homeopathic conditions but contains considerable quantities of active ingredients which have demonstrated efficacy, so patients will be receiving a clinically effective dose. Studies evaluating Traumeel in a variety of conditions have demonstrated effectiveness compared with placebo, NSAIDs and conventional therapy. It is contraindicated in the case of allergy (hypersensitivity) to one or more of the ingredients. The active ingredients are: Achillea millefolium Calendula officinalis Hypericum perforatum Aconitum napellus Echinacea Matricaria recutita Arnica montana Echinacea purpureaMercurius solubilis Hahnemanni Atropa bella-donna Hamamelis virginiana Symphytum officinale Bellis perennis Hepar sulfuris The Injection Procedure The clinician will ask you some questions to ensure you are suitable and can proceed with the procedure. They will discuss the risks and benefits of treatment and gain your informed written consent. You will be given an opportunity to ask any questions prior to consenting for the procedure. The clinician performing your injection will choose the most appropriate dose for your condition. Most injections are quick and easy to perform, the clinician will inject the Traumeel combined with a local anaesthetic directly into the joint or around the tendon, where the pain is felt. The clinician will use an ‘aseptic no touch technique’ and place a dressing over the treatment area which is to stay in place for 24 hours. After The Injection Procedure If you have a local anaesthetic your pain may be relieved within minutes, but the effect will usually wear off after an hour or two. It usually takes several days for the effect of the Traumeel to become apparent. You might wish to arrange alternative transport home after your injection, especially if you are having a local anaesthetic, which may cause some numbness and make it difficult to drive. If you are having an injection into a joint, you may be advised to avoid strenuous exercise for two or three days afterwards due to potential post-injection discomfort. Possible Risks or Complications with this procedure Most people have Traumeel injections without any side effects. The Injection can be a bit uncomfortable at the time, but many people find that they are not as bad as they initially feared. A Post injection flare for 24-48 hours can occur in some patients (20-30%). A smaller proportion may have a more significant level of pain which will last for up to a week. Very rarely patients experience a more severe pain and swelling (known as pseudo-sepsis) which requires medical review to ensure no infection. Very rarely (approximately 1:50,000) you may get an infection in the area of the injection. If the joint becomes more painful, hot and swollen, and/or you are feeling hot, nauseous and unwell you must seek medical attention immediately e.g., go to your local accident and emergency department (A&E). You should inform the medical professional examining you that you have recently had a Taumeel and Local Anaesthetic injection into your joint as they may need to give you antibiotics. Anaphylaxis It is extremely rare to have an allergic reaction to Taumeel or local anaesthetic (1:500,000). This would usually happen within the first few minutes of an injection and requires immediate medical attention. Very rarely the allergic reaction can be delayed. The symptoms you might experience are feeling lightheaded or faint, breathing difficulties (such as fast, shallow breathing and/or wheezing), a fast heartbeat, clammy skin, confusion and anxiety, collapsing or losing consciousness. You will be asked to remain in the clinic for 20 minutes following the injection to allow observation of possible adverse reactions. You can take other medications alongside the Traumeel injection. If you are taking a blood thinning drug, such as Warfarin, you may need a blood test to make sure that your blood is not too thin to have the injection. This is because of the risk of bleeding into the joint at the time of the injection. You, therefore, must tell the physiotherapist giving the injection, if you are taking an anticoagulant as they may need to discuss this with your GP before giving you the injection. Further injections Traumeel require a series of injections once weekly for three weeks totalling three injections to provide optimal benefits. If you find the injection helpful and other treatments are unsuitable or haven’t helped, the injection may be repeated. However, injections are most often used to provide a window of opportunity to engage in exercise and rehabilitation. Once your pain is better controlled, the need for injection should be reduced. Aftercare Whilst we do not require a doctor to refer you for an injection, we will supply you with a report after the procedure which we suggest you forward to your GP for your medical records.