Steroid & PRP Injections
Steroid injections into the shoulder can be used as the first treatment for many different types of shoulder problem. This is sometimes referred to as a cortisone injection. Coupled with physiotherapy, this is a very powerful way of rapidly taking away the pain from your shoulder. Sometimes, the injection can work within minutes, leaving you pain-free before you even leave clinic!
Although the effect of the injections can wear off over time, they often provide a pain-free window to give you a good chance to make progress with physiotherapy. By the time the injection has worn off, you should be feeling the benefits of your exercise programme.
Before agreeing to an injection, it is important that you are aware of the risks, as well as the benefits of the injection. The main benefit, of course, is to relieve shoulder pain. Although they are rare, here are the risks:
- Allergic reaction: This is very rare, but can be life-threatening.
- Infection: This is rare, but can result in severe pain 1-2 weeks after the injection and may require surgery to wash out the injection.
- Change in the colour or texture of your skin where it is injected. This is very uncommon and more pronounced in people with darker skin colours.
- Steroid 'flare': This can result in a temporary worsening of pain from 1-3 days after the injection.
How much does a shoulder injection cost?
My. Davies offers injections for between £50 and £150, depending on the type of injection and whether it is a guided injection using ultrasound. The hospital typically charges an additional £150 for drugs, equipment and staff.
What can an injection be used to treat?
Injections can be put into different areas of the shoulder or elbow, depending on the source of your pain. They provide effective pain relief for subacromial impingement, rotator cuff tears and frozen shoulder. They are used occasionally for tennis elbow too. They are also very effective for inflamed joints, for example in people who suffer from rheumatoid arthritis. More specialised injections can be used to treat inflammation around the biceps tendon (biceps tendonitis) and a build-up of calcium (calcific tendonitis).
What is in the injection?
Mr. Davies uses a mixture of local anaesthetics and steroids. The local anaesthetic starts to work within minutes and can last for several hours. The steroids kick in over the next few days.
How is the injection performed?
Most injections can be performed in the outpatient clinic. You will be asked to remove your top and sit comfortably on the edge of a bed. The skin is cleaned with an antiseptic wipe to minimise the risk of infection. A needle is gently introduced either from the side or the back of your shoulder or elbow and the steroids injected in. The whole process takes around 60 seconds. You are asked to rest for a few minutes while the injection takes effect.
Some more specialised injections are performed by X-ray specialists (radiologists). These are done using an ultrasound scanner or X-rays to make sure that the injection is put into the correct spot. These injections include:
- Hydrodilatation for frozen shoulder
- Some AC joint injections
- Biceps sheath injections for biceps tendonitis
- Barbotage for calcific tendonitis
- Suprascapular nerve blocks
Recovery
What should I do after an injection?
It is important to rest your arm a little bit for a few days after an injection. Avoid heavy-lifting or repetitive use overhead. WIth the short-term relief of the local anaesthetic that is mixed with the injection, it is tempting to get back to normal activities. However it is important that you don't overdo it early on or you will pay the price a few days later. Be guided by your physiotherapist to give the injection the best chance of success.
How long will the injection work for?
The local anaesthetic usually starts working after 5-10 minutes and can last for around 4-6 hours. The pain often gets a little worse after that for a day or two until the steroids start working. Coupled with physiotherapy, it is expected that the pain relief will be permanent. However, if physiotherapy is not successful, people get an average of 3-4 months of relief after an injection. Of course, this is very variable, with some people only getting a few days' relief and others 6 months or even permanent relief.