Complete Physio Clinic

Injection Therapy and Diagnostic Ultrasound

Diagnostic Ultrasound

Chris Myers and Dave Baker are clinical directors at Complete Physio and are highly specialised physiotherapists who have trained in the use of dynamic ultrasound to diagnose muscle, tendon, ligament and joint problems. Diagnostic ultrasound technology has improved significantly over the past 15 years and is an effective imaging modality in sports medicine. These technological advances mean that ultrasound is now considered to be superior to MRI scans for visualising and diagnosing certain tendon, ligament and muscle complaints. These include Achilles and patella tendon pain, tennis elbow and rotator cuff complaints of the shoulder. Accurate diagnosis is key to implementing the most effective treatment regime for your recovery and to monitor your progress so you get back to fitness and out of pain as quick as possible.

If you would like further information please email chris@complete-physio.co.uk or call 02074823875 or direct 07970628643

Steriod Injection Therapy

Injection therapy can form an extremely effective treatment either as part of a physiotherapy programme for conditions such as frozen shoulder or joint arthritis. Also it can be used as a stand alone treatment for conditions such as trigger finger or De Quervains Tenosynovitis (wrist tendon pain).

Steriod injections provide an effective anti-inflammatory and pain relieving treatment directly to the joint or soft tissues causing pain. All our injections are performed by highly trained clinical specialist physiotherapists using ultrasound guidance to ensure precision with diagnosis and accuracy of treatment. Normally, only one injection is required to gain sufficient pain relief and restore normal range of movement.

If you would like to discuss treatment further please email dave@complete-physio.co.uk or call 02074823875 or direct 07932528520.

Hyaluronic Acid Injections

Hyaluronic acid injections are normally used for the treatment of osteoarthritis by reducing pain and improving the function of our joints. Research shows reduction in cartilage erosion and periarticular fibrosis and improvement normal movement patterns e.g. walking / running gait. They are licensed for use in any joint in the body (except the spine). They are particularly favoured by patients who are active as they work to nourish and lubricate joints mimicking the bodies natural synovial fluid which generally become depleted and less viscous with age. A course normally gives relief for 9-12 months. Ostenil (hyaluronic acid) is widely used in Sports Medicine, and is used by most UK premiership Football clubs, Rugby clubs, Cricket clubs, and the British Olympic Association.

They can be used on regular basis if required as they have no known side effects and they are not known to be detrimental the the bodies tissues in any way. Hyalonronic acid is classed as a 'medical device' rather than a drug such is its level of safety. For optimal affect, chronically swollen joints can be injected first with steroid to reduce inflammation and then injected with hyaluronic acid around 4 weeks later reducing the need for repeated steroid injections. Our clinical specialist therapists have worked with hyaluronic acid injections for many years and are thus able to give expert advice as to they usefulness for any particular patient presentation. All hyaluronic acid injections are delivered with image guidance to maximise their effectiveness. To discuss further please contact Dave Baker (dave@complete-physio.co.uk) or Chris Myers (chris@complete-physio.co.uk) direct or call 0207 482 3875 and ask for them to call you back.

More information on hyluronic acid injections can be found here:
http://www.isakos.com/innovations/bobic2.aspx
http://www.shoulderdoc.co.uk/article.asp?article=83§ion=56
http://www.vivomed.co.uk/pdf/opcd.pdf

Here is a list of common complaints that can be effectively treated with injection therapy.

• Shoulder
• Impingement / bursitis – pain on flexion and abduction
• Adhesive Capsulitis / frozen shoulder
• Acromioclavicular joint sprain
• Elbow
• Tennis elbow (lateral epicondylitis pain)
• Golfer's elbow (medial epicondylitis)
• Hand and Wrist
• Osteoarthritis of the joints of the hand
• Trigger finger
• Carpal Tunnel Syndrome
• De Quervain's Tenosynovitis
• Hip
• Trochanteric bursitis - lateral hip pain
• Knee
• Osteoarthritis knee joint
• Ankle and Foot
• Ankle and subtalar joints
• 1st MTPJ of big toe (big toe joint)
• Plantar faciitis

PATIENT INFORMATION

Q: What is a corticosteroid?
A: A medicine which can relieve swelling, stiffness and pain by reducing inflammation.

Q: Is this the same drug that athletes and bodybuilders take?
A: No. The steroids we inject are completely different and are for medical use only.

Q: Why do I need a steroid injection?
A: Because it will help reduce your pain. You can then start rehabilitation sooner, have fewer treatment sessions and return to normal activities more quickly.

Q: Why don’t I just take anti-inflammatory pills?
A: You can, but the side effects of these are much more common and can cause stomach upsets and bleeding. These injections bypass the stomach.

Q: Are there any times I should not have an injection?
A: Yes, if you:

• Have any infection on your skin or anywhere else in your body
• Are allergic to local anaesthetic or steroid
• Feel unwell
• Are due to have surgery at the area soon
• Are pregnant
• Are under 18
• Do not want the injection

Q: What are the possible side-effects?
A: These are very rare and your physiotherapist will discuss them with you:

• Flushing of the face for a few hours
• Small area of fat loss or a change in colour of the skin around the injection site
• Slight vaginal bleeding
• Diabetic patients may notice a temporary increase in blood sugar levels
• If you are taking blood thinning drugs there may be some temporary bruising
• Infection: 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

Q: How is the injection done?
A: 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.

Q: Is the injection painful?
A: 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.

Q: How fast does the injection work?
A: If local anaesthetic is also used the pain should be less within a few minutes, though it may return after about an hour, just as when you visit the dentist. The steroid usually starts to work within 24-48 hours but may take longer.

Q: How long does the effect last?
A: This varies from person to person and the condition being treated, but the steroid usually continues working for 3 to 6 weeks.

Q: How many injections can I have?
A: 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.

Q: What should I do after the injection?
A: If the problem was caused by 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.

Q: When will I have to be seen again?
A: Usually your therapist will want to see you again about a week or ten days after the injection. You will then be given appropriate physiotherapy treatment and probably some exercises for you to do at home. You will also usually be reviewed a month after the injection to monitor the long term effect of the treatment.