Steroid Injection Therapy and Hyaluronic Acid

Injection with Corticosteroids and Hyaluronic Acid

 

At Core Body Clinic in Swansea we will be providing injections using Corticosteroids and Hyaluronic Acid.

 

Corticosteroid is a controlled drug and requires prescription which we will be able to provide. Hyaluronic acid is not a controlled drug and requires no prescription - NB both have their merits and they are administered based on your injury status.  This means the service is a one-stop service where you can have your diagnosis and treatment at one location.  Because we are one of the few clinics in the area to provide Ultrasound diagnosis we can assess you, perform a point of contact scan to assist in diagnosis and clearly identify your eligibility for an injection. 

You should contact the clinic 1st to check you are eligible for an injection and you would normally undertake an initial physiotherapy with ultrasound assessment prior to having the injection to ensure you are appropriate and to ensure that you will benefit.  All patients are carefully screened by telephone prior to having an injection to ensure also that the prescription is safe for use. 

 

What are the injections? 

Corticosteroids: 

Cortisone is the name of a group of medicines that are very strong anti-inflammatories. Corticosteroids are naturally occurring hormones already present within the human body, they are very different to anabolic steroids as used by some bodybuilders. Cortisone can help reduce the pain of a tendon, joint or nerve that is inflamed.

What us Hyaluronic Acid?

Hyaluronic acid occurs naturally in the body meaning injections are very safe.  These injections can be used for painful joints like arthritis or where you have degenerative changes in the joint and you are not able to perform exercise.  Using these types of injections is sometimes preferrable to cortisone for joints because they are less aggressive.  There are different injections available with hyaluronic acid. It depends if you will benefit from a series of injections vs a single treatment.  Depending on your condition, the treating clinician will assist in helping you find the right solution. 

 

How are injections given?

Cortisone can be taken by mouth but an injection is usually more effective as the medication is placed exactly where it is needed, meaning smaller doses can be used. Typically they are placed around a chronically inflamed tendon or into joint. Both Hyaluronic acid and cortisone are delivered via a needle and syringe.

 

What conditions are treated with cortisone?

Hyaluronic acid is for the treatment of joint conditions that are of a degenerative nature. 

Most painful tendons can be treated effectively with cortisone injections. Inflammatory joint pain from osteoarthritis can be rapidly reduced with cortisone, as can nerve inflammation such as carpal tunnel syndrome.  Some of the common conditions include: 

  • Tendon Pain
  • Frozen Shoulder
  • Joint pain
  • Nerve Pain
  • Carpel Tunnel Syndrome
  • Tennis Elbow

 

Is cortisone a cure or a temporary fix?

  • Cortisone can be a cure for any pain that is entirely due to an inflamed structure such as frozen shoulder and tenosynovitis.
  • Cortisone can also be a temporary fix for any pain that is due to a minor injury, but the patient is unable to take the required time for the injury to heal itself. For example, with Golfer’s elbow in elite sports players who are required to continue with their sports activities.
  • Hyaluronic Acid can last anywhere between 6 and 9 months. 

 

How frequently can cortisone be given?

  • There are no lifetime limits on cortisone injections however expert medical consensus suggests there should be a 3-month gap between the administration of cortisone. Typically, if you do require more than 2 cortisone injections then you may be advised to consider other treatment options.
  • It is important to understand that cortisone is an excellent way to reduce pain quickly to engage in a rehabilitation programme, which will provide the long-term solution to most problems.
  • Hyaluronic acid does not have any side effects and therefore can be administered on multiple occasions provided it is effective. 

Will the injection hurt?

  • Minor discomfort is common however most patients report the injection was far less painful than they thought. There may be the need to use ultrasound to guide injections, where deemed appropriate. 
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Are there any complications?

  • Short term: A small number of people will experience a temporary increase in their pain as the cortisone is working. This is nothing to be concerned about and will pass after 24-48 hours.
  • Long Term: Too many cortisone injections can cause tendon damage or worsening osteoarthritis. If you are concerned about this then your practitioner will be happy to discuss your specific case with you.
  • Many patients are concerned that steroid injections will make them gain weight. This is extremely unlikely after a corticosteroid injection as the doses are very small in comparison to oral steroids.
  • Hyaluronic acid carries very few side effects.  Pain is perhaps the only side effect because of soreness after having the injection.  
  • The rate and risk of infection is very very low.

 

What can I expect from the Injection?

The cortisone can be given with a local anaesthetic so you will usually experience a mild numbness and pain relief for a few hours. When the local anaesthetic wears off many people experience a dull ache or throbbing sensation. A small percentage of people will get a temporary increase in their pain; know as a ‘steroid flare’. This is nothing to be concerned about and painkillers such as paracetamol can be used to help calm symptoms, this will settle quickly.

Hyaluronic acid can also be given with a local anesthetic and again can cause some flair up once the pain killer wears off.  This is because we often feel better and tend to do a little more before we are ready. 

  • It is often best to consider driving arrangements after an injection as the local anaesthetic can cause some localised numbness, therefore driving may be best avoided.
  • If you are having a joint injected then it is advised to avoid strenuous activity for at least 2 days. If an inflamed tendon is to be injected then 10-14 days of relative rest from sport activities is recommended.
  • Cortisone will actively work to reduce your inflammation for 21 days. This means that the benefits of cortisone are seen within 3 weeks. The vast majority of people will start to feel benefits within 7 days after the injection. 

 

Please call or email the clinic to speak to Adrian about Injection therapy and whether this is the right thing for you.