This innovative clinic is designed to simplify the patient journey. It is for people affected by conditions of the upper and lower limbs. This includes joint, tendon, ligament, muscle and bursa conditions of the shoulder, elbow, wrist, hand, hip, knee, ankle and foot. The clinic is run by Stewart Kerr who is an Advanced Practice Physiotherapist and qualified Musculoskeletal Sonographer. In your consultation you will have the opportunity to discuss your problem, have a thorough clinical examination and if indicated a diagnostic ultrasound scan can be undertaken. Once the examination process has been completed you will then be offered advice on the best treatment and management options for you. This may include a joint or soft tissue injection, rehabilitation and management advice. This can all be undertaken in the same session.
Diagnostic ultrasound is an excellent imaging modality for tendon, muscle, ligament and joint structures. The high quality machine at Life Fit means that superb resolution images can be obtained thus improving the ability to assist in diagnosis.
Ultrasound offers several advantages over other forms of imaging such as x-ray and MRI scans. Firstly, ultrasound is very safe as it uses sound waves rather that emitting radiation. It also provides a ‘real time’ image allowing the sonographer to evaluate structures as they move and in different positions. The other great advantage of ultrasound is that of Doppler imaging which allows the clinician to determine the presence of extra blood flow often associated with inflammation.
These factors combine to make ultrasound a very valuable form of musculoskeletal imaging. When combined with a thorough clinical examination, scans can assist in accurate diagnosis and help you and the clinician make the best treatment decisions for your presentation.
Most injections can be performed under ultrasound guidance. This means that the clinician will be able to directly visualise the needle ‘real-time’ like watching something happen live on TV. This has been shown to improve the accuracy of the injection meaning that the substance being injected (injectate) is directed exactly at the intended location.
Common conditions that may be conducive to injection therapy include:
- Trochanteric bursitis (lateral hip pain)
- Ishcial bursitis (base of pelvis / ‘sit bone’ pain)
- Knee osteoarthritis
- Pre-patellar and infrapatellar bursitis
- Pes anserine bursitis
- Iliotibial band bursitis
- Ankle osteoarthritis
- 1st metatarsalphalangeal joint (big toe / bunion) arthritis
- Morton’s neuroma
- Retrocalcaneal bursitis (back of heel)
Hand & Wrist
- Carpal Tunnel Syndrome
- Trigger finger
- Tenosynovitis of the thumb and finger tendons (inflammation of the tendon sheath)
- Base of thumb arthritis
- Finger arthritis
- Tennis elbow (lateral epicondylitis)
- Golfers elbow (medial epicondylitis)
- Olecranon bursitis
- Subacromial pain / bursitis
- Acromio-clavicular (AC) joint pain
- Frozen Shoulder (adhesive capsulitis)
- Glenohumeral joint (shoulder ball & socket joint) arthritis
What is a corticosteroid injection?
Corticosteroids are naturally produced within the adrenal glands in the body. They are a strong anti-inflammatory hormone and help to regulate our body’s healing response amongst many other roles.
Corticosteroids (sometimes called ‘cortisone’) have been manufactured to be injected directly into the tissues that are causing your symptoms. In many respects it is a safer alternative to taking anti-inflammatory medication by mouth.
It acts primarily in the area injected and is not the same as the steroids taken by bodybuilders or athletes.
What are the benefits?
Why should I have a corticosteroid injection?
The injection can help to relieve swelling, pain and stiffness caused by inflammation. This may in turn help you to start your rehabilitation and return to normal activities sooner by ‘breaking the cycle’ of pain and inflammation.
It can also be helpful to aid in the diagnosis of your condition if it is not clear which structures are responsible for your pain. You may also have a local anaesthetic injected at the same time, which allows for temporary pain relief.
Frozen Shoulder Treatment
Shoulder Hydrodistention / Hydrodilitation / High Volume Injection
Hydrodistension, (also known as hydrodilatation or High Volume injections) is primarily used in the treatment of Frozen Shoulder. The procedure is performed under ultrasound guidance with the aim of precisely depositing anti-inflammatory steroid, local anaesthetic and saline to give pain relief whilst also deliberately stretching the lining of the joint (joint capsule). This procedure has been shown to be effective in the majority of patients by giving pain relief and also helping them to regain movement. These injections can give rapid and effective reduction in pain and inflammation; when coupled with immediate stretching exercises the effects can be maximised.
What happens during the hydrodistention procedure?
The clinician who will be performing your injection will choose the most appropriate steroid medicine and overall volume dose for your condition and symptoms. You will normally be lying down for the injection with the joint exposed. The clinician will inject under ultrasound guidance directly into the joint. Most injections are quick and easy to perform. Some patients opt to have a smaller dose steroid injection immediately after there hydrodistension injection into an area around the joint known as the ‘bursa’ – there is some research to support that this gives significant amount of further pain relief. Having this additional procedure can be discussed with you’re treating clinician on the day.
What happens after the injection?
Due to the local anaesthetic, some of your pain may be relieved shortly after the injection but will probably wear off after a few hours. It usually takes several days for the effect of the steroid to fully begin to work.You may wish to arrange transport home after your injection as we would not recommend for you to drive immediately after a hydrodistension procedure as some people may experience some post-injection discomfort due to the stretching of the joint. Occasionally patients may feel a little lightheaded immediately afterwards. We recommend patient’s stay in the waiting area for 20-30 minutes following the injection.You should try to avoid strenuous exercise for 3-5 days after the injection but try to perform some regular stretches as advised at the time of the procedure from 24hours after your injection.
Will I need another injection?
Most people only need one procedure. If you find the injection helpful, and you feel further injections are required, this may be repeated. We usually recommend a period of 1 month between these injections. We usually recommend no more than 3 injections into any one location within a 12 month period. Injections are most often used to provide a period of reduced pain in order to engage in exercise and rehabilitation.
Hyaluronic Acid Injections
Sodium hyaluronate (also known as hyaluronic acid or hyaluronan) is a natural substance. It is present in the body wherever moisture is stored or lubrication between layers of tissue is required to eliminate friction. It is found in synovial joints and acts as a shock absorber, lubricant and molecule filter.
The sodium hyaluronate in synovial fluid does not stay there for a whole lifetime, but is continuously broken down and replaced. Normally, there is an exact balance between the breakdown of old sodium hyaluronate and the production of new sodium hyaluronate. In osteoarthritis, however, this balance is disturbed and breakdown happens faster than production. As a result, the synovial fluid becomes more watery and stops working properly.
Due to the change in the synovial fluid – and for other, more complex reasons – the cartilage in the joint may gradually become affected. The thinning of the synovial fluid and impact on the cartilage can lead to the symptoms of osteoarthritis, which include pain, stiffness and swelling.
OSTENIL® plus is a treatment for the symptoms of osteoarthritis. It can be used in the knee, or in any other synovial joints.
OSTENIL® Plus is a solution containing sodium hyaluronate. 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 sodium hyaluronate. The effect of OSTENIL® Plus means that it can decrease pain and stiffness and improve the other symptoms of osteoarthritis.
The sodium hyaluronate in OSTENIL® Plus is very pure and is manufactured using a process called fermentation. It contains no animal proteins, which means that it is very unlikely to cause an allergic reaction. OSTENIL® has been given to thousands of patients and has not been found to cause any serious side effects. The exact make-up of the sodium hyaluronate in OSTENIL® Plus has been carefully chosen so that it is as effective as possible in treating osteoarthritis.
What to Expect
If you decide to have treatment with OSTENIL® Plus, it will be injected directly into the joint affected by osteoarthritis. This can be performed as a single injection. Some other products require multiple injections over a set period, however this is not the case with Ostenil® Plus. You will probably not notice any benefits immediately after the injection, but you should gradually start to feel less pain and stiffness over the next few weeks. The improvement in your symptoms should last for several months. Once the effects of the first injection wears off, you can, if you choose, have another.
Hyaluronic Acid Injections
OSTENIL® TENDON was developed to treat pain and restricted mobility in tendon disorders caused, for example, by overuse or inappropriate biomechanical stress. It is highly concentrated sodium hyaluronate (2%).
Tendinopathy is a disorder of the tendon caused mostly by issues related to loading the tendon. Tendons connect muscle to bones, so when they become irritated, people can experiences issues when trying to move or sustain load through a joint. Tendinopathy is sometimes referred to as tendinosis or tendinitis. Essentially these terms describe irritation and often changes to the normal structure of the tendon. Hyaluronic acid is normally found around tendons to facilitate movement and reduce friction. In tendinopathy it is thought that this does not happen to the same extent.
OSTENIL® TENDON injections can provide some symptomatic relief from tendinopathy by providing hyaluronic acid at the site of irritation to facilitate lubrication. It also helps to block pain receptors and facilitates local tendon nutrients. The injection is administered under ultrasound guidance to place it most accurately where is is needed.
High Volume Tendon Injection
High volume tendon injections can be used mainly for Achilles and Patellar tendon problems that have not responded to rehabilitation and other forms of conservative management and treatment. In chronic tendon problems, extra blood vessels and nerve endings form in and around the affected portion of the tendon and it is thought that this may contribute to ongoing pain.
High volume tendon injections, or stripping, helps to disrupt these vessels and nerve endings to facilitate recovery.
Prior to the procedure a thorough clinical examination and diagnostic ultrasound scan is undertaken to ensure the suitability of the procedure. The injection is undertaken under ultrasound guidance to ensure accuracy. The procedure consists of injecting local anaesthetic followed by a high volume of salt water (saline) into the surrounding border of the tendon but not into the tendon itself.
Further details can be found here.