Image guided therapeutic injections

Image guided therapeutic intra-articular joint injections are anaesthetic and steroid based injections (corticosteroid injections) used to relieve severe joint pain and jointinflammation. The injections may be given with the aid of image guidance in the formor x-ray or ultrasound.

Arthritis is a chronic musculoskeletal disorder, which may be either degenerative or inflammatory in nature and is characterised by involvement of all joint structures including the synovial membrane, cartilage and bone. Knees, hips, feet and small hand joints are the common areas affected by arthritis where joints are unable to repair themselves. However, it can affect most joints and cause severe pain and inflammation resulting in reduced mobilityand quality of life.

Treatment:

Intra-articular corticosteroid injections are used when other forms of treatment such as physiotherapy, painkillers or lifestyle changes that have not worked well.

Corticosteroid injections

The corticosteroid injection includes an anaesthetic to provide quick pain relief and the steroid ‘cortisone’ provides longer inflammatory relief to ease pain and swelling.

Hyaluronan injections

Hyaluronan injection are lubricating injections to replace the natural hyaluronic acid in thejoint fluid.

Image Guided Injections

Ultrasound image guidance may be used to help the clinician to place the needle in the correct position for the injection to be given.

Palpated injections

Instead of using image guidance, the trained clinician feels the joint to identify the correct position for the injection to be given.

Risks:

include post-injection pain, crystals forming in the joint fluid (crystal synovitis), bleeding in the joint (haemarthrosis), severe infection of the joint (joint sepsis), cells of the tissue dying (necrosis), worsening of the smooth white tissue that covers the ends of bones (atrophy) and fluid retention. Hypertension or diabetes may worsen by the injection.

Advice and guidance:

Treatment policy for patients covered by NHS Birmingham and Solihull CCG

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