Shoulder or elbow pain can be debilitating. We use these joints for everything from brushing our teeth to reaching to take something down off the supermarket shelves, so it can be hard to rest the affected area and pain can make everyday activities like these a challenge.
Thames Shoulder and Elbow offers a range of injections which – alongside physiotherapy – can provide effective relief from symptoms in many different shoulder and elbow conditions. It is always important to get a proper diagnosis as, while conservative treatment can be helpful in many cases, for some more serious problems early surgical intervention is important. Where they are a suitable treatment, injections provide a quick, easy and less invasive approach than surgery with faster recovery times and lower risks.
Here are some of the common injections you may be offered for shoulder and elbow pain.
(1) Steroid injections
An injection of steroids into the joint or muscle can provide effective relief from pain for several months. Steroids (also known as cortisone) are a very powerful anti-inflammatory. They are used to treat a range of shoulder conditions including: acromioclavicular arthritis, glenohumeral arthritis, rotator cuff tears, rotator cuff tendinopathy (tendinitis) and adhesive capsulitis (frozen shoulder).
Steroid injections are also used to treat elbow joint arthritis. The benefit of this type of injection is it is a safe and proven treatment for specific causes of shoulder and elbow pain. It is quick to administer and you can go home immediately afterwards. The treatment can be repeated once the benefits start to wear off. Potential side-effects include slight whitening or thinning of the skin at the injection site. For around 10% of people there can be a brief worsening of symptoms afterwards (referred to as a ‘flare’ reaction). People with diabetes may experience a slight increase in blood sugar levels.
(2) Dry needling
In the past, steroid injections were used to treat tendinopathy, which is the most common cause of elbow pain. Both tennis elbow and golfer’s elbow are forms of tendinopathy. However, more recently this treatment has been replaced by dry needling as it was found that injecting steroids close to these tendons could be detrimental to the tendons in the long-term. By contrast, dry needling works by stimulating blood flow in to the area to aid the body’s own natural healing processes.
An ultrasound machine is used to guide the needle into the correct part of the tendon to ensure accuracy. The benefit of dry needling is it encourages the healthy tendon and bone to heal the damaged area. Consequently, it can reduce the need for surgery in manysome cases. It is not the same as acupuncture or blind muscle dry needling, which are technique with very limited research evidence for their use.
Straight after dry needling it is possible to inject a biological substance around the tendon in an attempt to further produce accelerated healing (called ‘wet needling’). Such substances include platelet-rich plasma (PRP) or stem cells. Unfortunately the results of these treatments have been largely disappointing to date, and not proven to be any better than dry needling, but it is an ever expanding area of research for the future.
(3) Shoulder Hydrolidation
Shoulder hydrodilation (also known as hydrodistension or hydrodilatation) is an injection treatment specifically developed for the treatment of frozen shoulder, also known as adhesive capsulitis. This is when the lining of the shoulder joint, known as the capsule, has become very inflamed, thickened and contracted, severely limiting motion in the shoulder.
A hydrodilation injection is performed under ultrasound or x-ray machine guidance to ensure accuracy. A needle is introduced into the shoulder joint under local anaesthetic. A combination of steroid and at least 20 millilitres of isotonic salt water (saline) is injected until either the capsule bursts and no more salt water can fit in. It is not a painful procedure because of the local anaesthetic and has a success rate of up to 90% when performed for the correct diagnosis. Physiotherapy is started immediately after the injection and in most patients the pain goes away within days and the movement is profoundly improved by 6 weeks.
If you are experiencing shoulder or elbow pain and would like to discuss your treatment options, including injections or surgery, contact us for more information.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
