Our new injection service is run by Joanna Gardiner, a chartered physiotherapist who qualified in 1986 and has a great deal of experience in the diagnosis and treatment of Orthopaedic and Musculo-skeletal problems.
She works primarily in the NHS as an Extended Scope Practitioner in the Outpatient Orthopaedic department where she diagnoses orthopaedic and Musculo-skeletal problems. She then either lists directly for surgery, administers a steroid injection or refers on to Physiotherapy, Orthotics or Podiatry etc.
She runs a separate injection clinic, where GP’s and other Allied Health Professionals have diagnosed the problem and then referred onto her for specific injections.
She is a supplementary practitioner in the NHS upgrading to independent prescribing later in 2017, so at the moment for private clients she would write to your GP requesting the correct prescription for your condition, which you would then collect and then bring the drugs to your appointment.
Please consider the information below prior to referring to the injection clinic
|Hypersensitivity to drugs||No treatment can use steroid alone if allergic to LA|
|Previous history of anaphylaxis||No treatment
|Recent fracture site||No treatment|
|Infection – local/joint/systemic||Needs to wait until infection has been cleared and anti-biotic course has been completed
|Adjacent osteomyelitis||No treatment|
|Recent trauma to the affected area||Fracture should be eliminated|
|Haemarthrosis||Fracture should be eliminated|
|Concurrent oral steroids||Greater risk of infection|
|Immunosuppressed/recent history of malignancy||Greater risk of infection|
|Anti-coagulant therapy/bleeding||Low dose Asprin is OK. Warfrin patients need INR checking. Greater risk of bleeding therefore firm compression for 10 mins|
|Poorly controlled diabetes||Diabetes needs to be stable. Greater risk of sepsis in diabetics and blood sugars may rise for a few days post in injection|
|Children||Consider alternative treatment for those under the age of 18|
|Pregnancy||Not appropriate in the first trimester|
|Breast feeding||Risk of excretion into milk therefore discuss with patient|
|Psychogenic/anxious patient||Injection may make pain appear worse|
|Spinal/intrathecal injection||Refer back to GP|
|Prosthetic join||Not appropriate|
|Large tendinopathies, e.g tendo-achilles, infrapatellar tendon||Need imaging first|
Injections covered are
Shoulder Joint OA or Capsulitis (frozen shoulder)
Specific rotator cuff strains
Acromio-clavicular, elbow joints
Tennis and Golfer’s elbow
Wrist, thumb and finger joints
Hamstring tendon insertion
Bursitis (trochanteric, olecranon, gluteal, infra-patella, pes anseurine, achilles
Great toe joint (Hallux valgus and rigidus
If you are a current patient with us the charge is £80
If you are not a current patient the charge would be £100, this would include a telephone consultation, with Jo, before and after the injection.
It may be necessary to bring you into clinic before the injection in order make the correct diagnosis and this would be charged at our usual rates.
Patient injection information
What is a corticosteroid?
A medicine which can relieve swelling, stiffness and pain by reducing inflamation
Is that the same drug that athletes and bodybuilders take?
No. The steroids we inject are completely different and are totally safe.
Why do I need a steroid injection?
Because it will help reduce your pain. You can then start rehabilitation sooner, have fewer treatment sessions and return to normal activities more quickly.
Why don’t I just take anti-inflammatory pills?
You can, but the side effects of these are much more common and can cause stomach upsets and bleeding. These injections bypass the stomach.
Are there times I should not have an injection?
Yes, if you:
Have any infection on your skin or anywhere else in your body
Are allergic to local anaesthetic or steroid
Are due to have surgery at the area soon
Are under eighteen
Do not want the injection
What are the possible side effects?
These are very rare and your physiotherapist will discuss them with you:
Flushing of the face after a few hours
Small area of fat loss or a change in colour of the skin around the site
Slight vaginal bleeding
Diabetic patients may notice a temporary increase in insulin levels
Injection: if the area becomes hot, swollen and painful for more than 24 hours you should contact your physiotherapist or doctor immediately.
You will be asked to wait for 30 minutes after the injection to ensure there is no allergic reaction to the drug
How is the injection done?
The skin is cleaned with antiseptic. A needle is gently put into the affected part and the solution is injected through the needle. Shortly after, you will be examined again.
Is the injection painful?
Not particularly, as your physiotherapist has had intensive training in the technique. Sometimes it can be sore for a few hours, but you will be told what to do about this.
How fast does the injection work?
If the local anaesthetic is also used, the pain should be less within a few minutes, though it may return after an hour, just as when you visit the dentist. Usually one injection is sufficient, but if the pain is severe or has been there for a long time, you may need more.
How long does the effect last?
This varies from person to person and the condition being treated, but the steroid usually continues working for three to six weeks
How many injections can I have?
This depends on the part of the body involved and will be decided by your therapist and yourself. Usually one injection is sufficient, but if the pain is severe or has been there for a long time, you may need more.
What should I do after the injection?
If the problem is due to overuse, you will probably be told to rest the area for about a week; if it is a joint pain, you may start early gentle movement.