The Joint Injection Clinic
What conditions do we treat?
- Frozen shoulder – Hydrodilatation
- Sub-acromial pain syndrome (“impingement”)
- Acromio-clavicular joint (ACJ) arthritis/inflammation
- Shoulder arthritis
- Knee arthritis/inflammation
- Baker’s cyst
- High Volume Injection (HVI) – Patellar tendinopathy
- Fat pad impingement
- High Volume Injection (HVI) –
- Ankle arthritis/impingement
- Plantar fasciitis (caution with steroid use)
- Morton’s neuroma/intermetatarsal bursitis
- Midfoot/Forefoot arthritis
- Hip arthritis/inflammation
- Trochanteric bursitis (Greater Trochanteric Pain Syndrome)
- High hamstring tendinopathy
- De Quervain’s Tenosynovitis (thumb-sided wrist pain)
- ECU Tenosynovitis (little finger sided tendon pain)
- Small joint arthritis – 1st CMC joint (base of the thumb)
- Trigger finger / Carpal tunnel syndrome
- Wrist ganglion
- Distal Radio-Ulnar Joint (DRUJ)
- Tennis elbow (caution with steroid use)
- Golfer’s elbow (caution with steroid use)
- Elbow nerve entrapment – “cubital tunnel syndrome” & radial nerve hypersensitivity conditions
- Triceps & Biceps tendinopath
Click the images to learn more
PRP is a novel technique that utilises a patient’s own blood. A small sample of blood is taken from an arm vein and centrifuged to separate the platelet-rich layer from the red blood cell layer. The platelet-rich part, containing concentrated growth factors is then injected, under ultrasound-guidance to the specific anatomical site. There is mounting evidence to support the use of PRP injection for mild-moderate knee arthritis.
Platelet-rich Plasma (PRP)
Steroid injections are used to reduce inflammation and the pain associated with it. They have widespread use in the treatment of osteoarthritis but have limitations and recent evidence has resulted in clinicians using steroids more cautiously for certain conditions, i.e. tennis elbow/plantar fasciitis. Steroid injections can be helpful as a temporising measure to reduce pain in order to facilitate rehabilitation but can also effectively treat certain issues such as frozen shoulder (Adhesive capsulitis) and wrist tendon sheath inflammation (De Quervain’s Tenosynovitis).
Prolotherapy involves the use of concentrated glucose, usually diluted with local anaesthetic, which acts as an irritant solution. This solution creates a local inflammatory response and can be used to treat ligament laxity and can help to stabilise joints. It can also be used to treat conditions such as ‘tennis elbow’.
High Volume Injection (HVI)
A High Volume Injection can be used to treat tendinitis/tendinopathy of the large lower limb tendons (Patellar and Achilles). The procedure involves infiltration of fluid into the interface between the tendon (Achilles or Patellar tendon) and the adjacent fat pad. This is thought to disrupt the ingrowth of blood vessels/nerves seen in tendinopathy and therefore have an effect on pain and local sensitivity.
High Volume Injection (HVI)
Hyaluronic Acid (Viscosupplement)
Hyaluronic acid (HA) is a substance similar to synovial fluid, which occurs naturally in joints and acts to lubricate and protect against shock and stress. HA is commonly used for conditions such as knee and hip arthritis, in order to reduce pain, improve function and facilitate rehabilitation.
Hyaluronic Acid (Viscosupplement)
Hydrodilatation refers to a procedure where a relatively large volume of fluid is injected into a joint, as a way of mechanically stretching the tissue to improve the range of movement. This procedure is used almost exclusively for the marked restriction seen with frozen shoulder (adhesive capsulitis) and can be an effective way of allowing the patient to regain range of movement while also significantly reducing pain.
Dr James Thing
Dr James Thing (MBBS; BSc; MRCGP; FFSEM) is a UK-trained Sport and Exercise Medicine Consultant specialising in musculoskeletal ultrasound and ultrasound-guided injections. He has over ten years of experience in this field. He has worked as a consultant in the NHS and teaches internationally renowned ultrasound-guided injection courses.
He is the British Athletics Event Lead Doctor, coordinating trackside care for Diamond League and Anniversary Games Athletics Grand Prix and is a pitchside doctor for Harlequins Rugby in the English Premiership.
Dr Naeem Ahmed
Dr Naeem Ahmed (BEM FRCR FRCP) graduated from Guy’s, King’s and St Thomas’ Hospital with the St Thomas’ Hospital Cup (George Leach Trophy) graduation prize. He completed academic foundation training at King’s College Hospital before completing radiology training at St George’s Hospital, Royal Marsden Hospital, Great Ormond Street Hospital, and Royal Brompton Hospital before completing a subspecialty musculoskeletal imaging Fellowship at Chelsea and Westminster NHS Foundation Trust where he was appointed Consultant Radiologist. Naeem has completed international clinical visitations at Massachusetts General Hospital (US), University Hospital Zurich and FIFA Medical Centre of Excellence Aspetar.
He has over 50 publications and presentations, a postgraduate qualification in medical education, and won the British Medical Association Young Authors Award in 2017. He was awarded Medallist of the Order of the British Empire for services to volunteering and healthcare in the Queen’s Birthday Honours in 2019.
|Steroid Injection – Single site||£415|
|Steroid Injection – Two site||£515|
|Hydrodilatation/High Volume Injection – Single site (W9050)||£520|
Hydrodilatation/HVI – Two site
Platelet Rich Plasma Injection – Single site (W9046)
Platelet Rich Plasma Injection – Two site
Hyaluronic Acid /Viscosupplement Injection – Single site (W9032)
Hyaluronic Acid /Viscosupplement Injection – Two site (W9032
Frequently Asked Questions
The injection appointments take 30 minutes. This allows time for registration, discussion with your consultant about the injection, completion of a consent form and then the procedure itself. The procedure normally takes less than five minutes. Afterwards, you will be given post-injection advice.
A referral is required for all injections and procedures. The referral must be made by a medical doctor i.e. General Practitioner, orthopaedic surgeon or specialist musculoskeletal physiotherapist/osteopath and should be received by the clinic prior to the appointment.
The main complication to look out for after an injection is an infection. If the injection site becomes red, hot, tender or swollen or if you develop a fever then you should contact the clinic or seek medical advice immediately, i.e. GP, walk-in-centre, Accident & Emergency. This issue would normally be managed with antibiotics as required.
After an injection, it is not uncommon to develop a painful flare in your symptoms. This may start after the local anaesthetic has worn off and may last 24-48 hours. If this is the case then you can use simple painkillers such as paracetamol and ibuprofen (as long as they are well tolerated), as well as applying ice (wrapped in a paper towel) to the area for 10 minutes every hour as required.
Insulin-Dependent Diabetes Mellitus (IDDM):
A steroid injection can temporarily increase blood sugar levels by making insulin less effective. If you have IDDM then it is advisable to cautiously monitor blood sugar levels for 5-7 days after the injection. This may mean testing two or three times a day to ensure that the levels are not increasing. If blood sugar levels become high then medical advice should be sought from the person who normally manages your diabetes (usually your GP).
The main risks associated with a musculoskeletal injection include: local infection (1 in 10,000 risk). This means that for every 10,000 injections performed one would expect to see 1 infection.
If you have any concerns following the injection then please contact our friendly admin team who will help with any queries.
If you have concerns about a possible infection and are unable to reach the admin team (out of hours) then please contact the NHS emergency helpline on 112 or seek further medical advice via a Walk-In-Centre or Accident and Emergency.