Joint Injection Request

Joint Injection Request

Please fill in this form to request a joint injection. If you have never had one before, you will be asked to book an appointment with a clinician first. If your request is too soon, you will be asked to request again at a later date.
Name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Phone number*
Email
example@example.com
Please read this booklet:

Versus Arthritis steroid injections information booklet
Which joint do you need the injection for?
What is the reason?
When did you last have an injection into this joint?
Who carried out the injection? Was it here at Harborne Medical, or in hospital?
Is it on the left or the right?

LeftRightBoth
Are you on any blood thinning medication? If so, what?
Do you have any allergies?
CONSENT FORM

The purpose of this document is to provide written information regarding the risks, benefits and alternatives of joint injections. It is important you fully understand this information so please read this document carefully.

Reasons for injections include:

• Tendonitis

• Bursitis

• Rheumatoid arthritis

• Psoriasis

• Gout

• Osteoarthritis

The Procedure:

After the skin surface is thoroughly cleaned, the joint is entered with a needle attached to a syringe. Joint fluid can be obtained and sent for appropriate laboratory testing or medications can be injected into the joint space. Joint injections are given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout and occasionally osteoarthritis. Steroids are anti-inflammatory agents that slow down the accumulation of cells responsible for producing inflammation within the joint space. Commonly injected joints include the knee, shoulder, ankle, elbow and small joints of the hand and feet.

Benefits:

You might receive the benefit of relief from pain and swelling with this procedure, but this cannot be guaranteed. Only you can decide if the benefits are worth the risk.

Risks:

No procedure is risk-free. The following risks are well recognised, but there may also be risks not included in this list that are unforeseen

• There may be allergic reactions to the medicines injected into joints, to tape or the chemicals used to clean the skin for instance.

• There may be infection, although this is extremely rare.

• You may develop ‘post-injection flare’ which is joint swelling and pain several hours after the corticosteroid injection. This only occurs in approximately one out of 50 patients and usually subsides within several days.

• Joint damage may result from frequent corticosteroid injections. Generally, repeated and numerous injections into the same site should be discouraged.

• De-pigmentation (a whitening of the skin).

• Local fat atrophy (thinning of the skin) at the injection site.

• Rupture of a tendon located in the path of the injection if inadvertently injected.

• Pain may be associated with this procedure and the healing process.

Alternatives to injections:

• Oral anti-inflammatory drugs such as brufen or naporoxen.

• Do nothing

If you have any questions regarding the procedure, risk, benefits or alternatives, ask your doctor before signing this consent form.
Sign below if you consent to have the procedure

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