If you are experiencing pain, stiffness or loss of movement in your shoulder or elbow joint, there is a high chance that conservative, non-surgical treatment, such as an injection combined with physiotherapy, can resolve your symptoms. This will depend, of course, on your diagnosis and how it occurred. Some conditions are best treated surgically early on.
A mixture of steroid (cortisone) and local anaesthetic is recommended for most injections. If the area being injected is not deep then the injection can be given in the clinic. However, many areas of the arm are hard to access accurately and the needle needs to be guided in by an ultrasound specialist.
They are normally given into a joint (intra-articular injection) or muscle (intramuscular injection). It can take a few days for the injection to take effect and the benefits normally last for a few months. Steroid injections often contain local anaesthetic which provide immediate pain relief that lasts a few hours. They are administered in the outpatient clinic and you will be able to go home immediately afterwards.
Steroid injections have been used for many years and are very safe. In the majority of cases they are curative, but sometimes it takes up to two weeks for them to start working. If the effects of the steroid wear off after a period of time then it can be repeated, at the very least it has provided valuable confirmation for your doctor that the area injected corresponds with the correct diagnosis.
The possible side effects of steroid injections are few and far between, but include slight whitening or thinning of the skin at the injection site, a short period of worsening of symptoms in 10% of patients (flare reaction), and a slight increase in blood sugar levels for people with diabetes.
Conditions for which a steroid injection may be suitable include:
- Rotator cuff tendinopathy
- Acromioclavicular arthritis
- Glenohumeral (main shoulder joint) arthritis – if steroid does provide the desired results another type of injection called hyaluronate is often successful
- Rotator cuff tears – if you wish to avoid or are unable to have surgery
- Adhesive capsulitis (frozen shoulder) – if your shoulder has already become very stiff then the steroid injection is combined with a hydrodilation procedure. This is where the tight, scarred lining of the joint is expanded with saline under local anaesthetic
Steroid injections are very useful for the treatment of elbow joint arthritis. However, the most common cause of elbow pain is tendinopathy (formerly tendinitis), of which tennis elbow and golfer’s elbow are the two most common types. In the past, steroid injections were used to treat these conditions commonly. We now know that the injection of steroid very close to tendons, although providing good short-term relief, is bad for the long-term health of the tendon.
Nowadays, injection treatments for tendinopathy concentrate on stimulating your body’s own natural healing processes. The best example of this is a procedure called dry-needling. The small ‘microtears’ in the tendon are identified using an ultrasound machine so that a needle can be guided into the area, under local anaesthetic, to stimulate a healing response from the neighbouring bone and healthy tendon. This procedure has really helped reduce the number of patients needing to undergo surgery.
A purified version of your own blood, known as PRP, can be injected along with the dry-needling procedure. Unfortunately, this has not been conclusively proven to add any benefit over the dry-needling alone, but is an area of intense ongoing research.
Whatever your diagnosis we will always have a detailed discussion with you about the pros and cons of each treatment option available. You will be given time and space to think through each option carefully.
If there is a clear benefit to non-operative treatment or you wish to exhaust all conservative options before committing to surgery then we will arrange an injection for you. Rotator cuff injections can be performed in the consultation room. For other types of injection, we have rapid access to some of the best radiologists in the UK who will perform your ultrasound guided injection as soon as possible, so that you can start getting your arm and your life back on track.