Musculoskeletal Ultrasound Scans:
Ultrasound is a medical technology that allows clinicians to look inside the body using only the waves of sound. Simply, a probe is held against the skin to deliver sound waves into a body part and receive reflections. Then a computer lets us look at the reflected pictures. Just like clinicians would look at a baby scan, we can look at muscle, ligament, tendon, and other soft tissue. We can’t look inside joints, but we can see around the outside and this can partially inform us about what is happening inside a joint.
Some other types of scans, such as x-rays, use radiation to capture pictures but ultrasound only uses sound - this means, scanning is much safer. In most cases, using ultrasound, the process of capturing images of a body part is much quicker than other types of scans, such as MRI. Additionally, there is no need to sit still or lay down in a narrow magnet chamber because the great thing about ultrasound is that we can take live pictures and capture the movement of muscle, joint and soft tissues – this allows a wonderful dynamic evaluation of a problem structure.
In our clinic we use an ultrasound machine to assist diagnosis of pain and dysfunction affecting muscles, ligaments tendons, joints, and other related structures. We ask you to reveal only the region to be scanned, apply a little water-based jelly onto the skin and take between 10 and 20 pictures depending on the body part. Then we write a medical report based on the findings from the pictures and send this report to your GP or referring clinician. We can store these pictures onto a memory stick for you to take away if you wish.
Corticosteroid Injections:
Steroid injections are a process of delivering powerful anti-inflammatory medication into a joint or soft tissue. An injection is generally safer than taking anti-inflammation medication by mouth. Steroids can help reduce an inflammation and pain. They are generally used to assist and promote a rehabilitation process. Please note, these are not muscle building steroids. Local anaesthetic may also be used during the procedure (like the dentist). This medication wears off after 20-30 minutes. The steroid begins to work approximately 48 hours after injection and is expected to have a therapeutic effect for up to 6-12 weeks.
Hyarulonic Acid Injections:
Hyaluronic acid injections are a type of therapeutic injection where a gel-like substance, hyaluronic acid, is injected into a painful joint or soft tissue such as the knee or a tendon sheath. Hyaluronic acid is a naturally occurring substance found in joints that acts as a lubricant and shock absorber. In people with joint pain, the level of hyaluronic acid may be reduced, causing increased friction and pain. By injecting hyaluronic acid into the affected joint, the joint can be lubricated, reducing pain and improving mobility. This treatment is commonly used for osteoarthritis and is known as viscosupplementation. It is usually given as a series of injections over the course of several weeks.
Risks:
The possible side effects of the injection are rare and include:
- 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 significant relief.
- Flushing of the face for a few hours.
- Small area of fat loss or change in skin colour around the injection site.
- A temporary increase in pain after the injection. With a steroid injection this may last 24-48 hours. If you experience increased pain for a longer period then please contact us for advice.
- Hyarulonic Acid injections may very rarely gives rise to a more prolonged post injection flare lasting for several weeks.
- Patients with increased blood pressure (hypertension) may notice a temporary increase in blood pressure. If your blood pressure is unusually high, unstable or you have recently changed blood pressure medication please notify your clinician prior to any injection.
- Patients with diabetes may notice a temporary increase in blood sugar levels. If you have diabetes, you are advised to check your blood sugar levels for 7 days post-injection.
- Temporary bruising or bleeding in the injected area, especially if you are taking antiplatelet medicines (such as aspirin) or anticoagulant medicines (such as warfarin). Please advise the team if you are taking any blood thinning medicines.
- Infection: If the area becomes hot, swollen, and painful for more than 24 hours, or if you feel generally unwell, you should contact your clinician immediately. If they are unavailable, you should seek advice from your GP or Emergency Department (A&E).
- For injections in and around tendons there is a small risk of tendon damage or rupture
- Slight vaginal bleeding/menstrual irregularities.
- Allergic reaction or severe allergic reaction (anaphylaxis) to the drug: This will usually happen immediately so you will be asked to wait for a short time after your injection to check for any reactions.
- Very rarely loss of consciousness, respiratory depression, respiratory or cardiac arrest.
- For ladies who are breastfeeding; Studies have shown the amount of steroid and local anaesthetic that passes to breastmilk is safe at the doses we use.
Advice after an ultrasound guided injection:
- Local anaesthetic used during the procedure (like the dentist) wears off after a few hours and some mild pain may occur. If tolerated, analgesia can be used to moderate this discomfort.
- Steroid begins to work approximately 48hours after injection and is expected to have a therapeutic effect for us to 12weeks.
- There is generally no need to cease daily activities but if you have post-injection pain, analgesia medication and sensible activity modification should be considered.
Clinical follow up after an ultrasound guided injection:
We will arrange a follow-up message & telephone review appointment with you 2-4 weeks after your injection to assess your progress.
Consenting for any procedure:
The next slide will ask you for a digital signature. At your next clinic visit, following a full consultation, physical examination and diagnostic ultrasound scan your precise treatment plan and risks vs benefits will be discussed. Once your individual needs have been discussed your consent form will be formed with this digital signature allowing you time to read in full and for your clinician to answer any questions.