Ultrasound-guided joint injections are undertaken at out Aberdeen clinic by our highly experienced sonographer. In order to book in for an injection, you will need a referral. This may be obtained from one of our in-house GPs or your own GP, specialist or allied medical professional such as a physiotherapist.
Cortisone is used to treat a range of inflammatory conditions and can be injected into joints, bursae, and tendon sheaths. Among other things, you may need an injection for bursitis, tenosynovitis, arthritis or gout. Common areas to inject are:
- Shoulder bursa or joint
- Hip bursa or joint
- Ankle joint and tendon sheaths
- Wrist tendon sheaths or ganglion
- Knee joint
- Intermetatarsal bursa
- Morton’s neuroma
Please call our friendly staff if you have any queries or would like to make an appointment.
Below is a list of frequently asked questions with all you need to know about these procedures.
Ultrasound Guided Injections FAQ
Cortisone is a powerful anti-inflammatory medication. It is a catabolic steroid so this procedure is also known as a 'steroid injection', or 'corticosteroid injection'. Delivering this anti-inflammatory medication via ultrasound-guided injection ensures a high dose of the drug gets directly to the area in which it is needed.
Cortisone is used in a variety of areas in the body to reduce inflammation and pain. It can be injected into joints, bursae and tendon sheaths. Common areas for injections include the shoulder joint and the subdeltoid bursa of the shoulder, the greater trochanteric bursa of the hip, the knee joint, and tendon sheaths around the wrist and ankle.
Cortisone can take a few days to start to have an effect and will continue working to decrease inflammation for 10-14 days.
Pain relief from a cortisone injection is temporary and varies greatly from person to person. Some people get excellent relief from one injection while others feel there was no benefit. The efficacy of the injection depends on the presenting problem, the severity of symptoms, the accuracy of the injection, and the individual's response to cortisone. In general, a successful injection will suppress local inflammation for between 6 weeks to 6 months.
Common areas in which to receive a cortisone injection include:
- The shoulder joint, the shoulder bursa and the acromioclavicular joint
- The hip joint and the hip bursa
- The knee and ankle joints
- Joints of the wrist, hands, fingers, feet and toes (including ganglions, Morton’s Neuromas and intermetatarsal bursitis)
- Tendon sheaths of the wrists and ankles for tenosynovitis
Cortisone can weaken tendons and is particularly dangerous when being injected around weight bearing tendons as it can cause them to rupture. Therefore, it is not used in the Achilles or Patellar tendons. However, there may be other treatment options for these areas that involve an ultrasound-guided procedure so if these areas concern you, please get in touch.
Three more areas where the use of cortisone is controversial are around the common extensor and common flexor tendon origins of the elbow and the plantar fascia. If these areas concern you, injection options will be assessed on a case-by-case basis in discussion with you and your referring practitioner.
It is possible to have more than one injection if your referring practitioner feels it is an appropriate course of action. Oftentimes, people get some relief from one injection but need a second to really get on top of their symptoms. If this is the case, it could be performed 6 weeks after the first injection. Some people require repeat injections over the course of the year for chronic conditions while for others, if no relief has been experienced after two injections, it is usually not appropriate to continue injecting. In these cases, further imaging and clinical tests may be required to investigate your problem.
Most people can have steroid injections but you will need a referral from your doctor or allied health professional in order to book in at ROC Private Clinic. You can see our GPs here if you wish. Please call
to discuss this with our friendly reception staff.
Situations that may
exclude you from receiving a cortisone injection include:
If any of these apply to you, please call us to discuss your particular situation. We will do our best to guide you and tell you your treatment options.
- Previous allergic reaction to steroid
- Current infection anywhere in your body
- Being pregnant, breastfeeding or trying to get pregnant
- Uncontrolled diabetes or hypertension (high blood pressure)
- Taking strong anticoagulants (blood thinning medication)
- Immunocompromised people
- Have recently or are about to have any vaccinations
- Previous steroid injection less than 6 weeks ago
- Already had 3 steroid injections into the same area within the last 12 months
Yes, as with any medical procedure, there are risks with a cortisone injection. Whilst very rare, it is important to be aware of them when making your decision to opt in for an injection. The risks include:
- Introducing an infection into the body – you may notice the area injected get red, hot, swollen and painful. If this occurs, contact the clinic or see your doctor.
- Tendon rupture. Cortisone can weaken tendons and potentially cause an already degenerating or partially torn tendon to rupture completely. It is for this reason cortisone injections are contraindicated in some parts of the body – primarily the Achilles and patellar tendons but also the common extensor and flexor tendon origins of the elbow.
- Fat atrophy (a loss of fat) at the site of injection which may cause a dimple.
- Hypopigmentation (paler skin) around the site of injection.
- Risk of bruising if taking anticoagulants (blood thinners). This can be discussed with us before your appointments.
The incidence of complication after a steroid injection is extremely low with an estimated risk of less than 1%.
There are potential side effects after a cortisone injection. You won’t necessarily get any of these but they include:
- Warm flushing of the face for a few hours
- Elevated blood sugar for a few days – important to be aware of this if you have diabetes
- Elevated blood pressure for a few days – important to be aware of this if you have hypertension
- You may have some pain or a small bruise at the site of injection
Most people can but if you have a foot or ankle injection, we advise you bring a driver with you to take you home. For people getting injections into other areas (not the foot or ankle), if you were able to drive to your injection appointment, you should be able to drive afterwards. However, you will need to wait at our clinic for 20 minutes after the injection before driving to ensure you don't have any adverse reaction to the medication.
Cortisone takes a few days to start working so you may not feel better straight away. In order to give the medication the best chance of working for you, it’s a good idea to rest the area that was injected for at least 3 days. This does not mean you can’t use it, but aim to minimise unnecessary strain such as repetitive movements, heaving lifting, excessive walking or anything known to aggravate the area. Be particularly careful in the first few hours as the local anaesthetic will make the area feel numb and you may be excited to move a lot while pain free. This will may cause more post-injection pain once the anaesthetic has worn off.
There is no need to completely stop using the limb or area that was injected. You do not need to wear a sling or stop walking altogether. Just take it easy.
Cortisone injections at ROC Private Clinic are performed under ultrasound guidance. This means the sonographer can see the area that needs injecting and be certain the needle is entering the correct space.
You will need to expose the area that needs injecting so may be given a gown to wear. You will be lying on the ultrasound bed or sitting on a chair. The sonographer will clean the skin in the area of interest with antiseptic and whilst using sterile equipment, she will inject local anaesthetic and cortisone at the same time.
This is a difficult question to answer. Some areas are more painful than others to get injected. Please don't listen to your friend's friend who has a story about someone's injection and how terrible it was. The needle used for a cortisone injection is very thin and in the hands of someone who can see what they're doing under ultrasound guidance, you're less likely to have a painful experience. Big spaces like the bursa in the shoulder are generally not too painful while small, tight joints near the collar bone or between the toes can be painful.
Cortisone is not a magic bullet, it will not instantly cure your problem. The aim of cortisone is to settle down your body's inflammatory response thereby decreasing your pain. This should allow you to move more freely, improve your sleep and the general comfort in the affected area. However, if the underlying cause of the condition is not addressed, it is not uncommon for the pain and inflammation to return. It is for this reason, we recommend you seek the advice of an appropriate practitioner that will help you identify and deal with the root cause of the problem. This may require the help of a physiotherapist, podiatrist or sports physician, for example. A cortisone injection may help you experience enough pain relief and return of function for you to perform rehabilitation exercises as prescribed by your practitioner.
In order to achieve long-term relief you may need to stretch and strengthen the affected area, lose weight, change your footwear, or make changes to your lifestyle to limit the potential of the problem recurring.
The main reason that you may not be experiencing much relief after multiple attempts with cortisone is that you have a chronic issue that warrants multiple injections and your condition is degrading. Your joint, ligament or tendon is generally wearing out due to age, disease/ disorder, or repetitive strain. Seeing a relevant allied medical health professional such as a physiotherapist, podiatrist or dietician will help slow down this degradation. Strengthening the affected area, losing weight, or using physical aids may be required so finding a local practitioner who can guide you will be a great help.
Traditionally, cortisone injections have been performed 'blind' which means doctors have been looking at and feeling anatomical landmarks on people's bodies to guide their injections. Once the needle is in the body, they can't see it but are guided by feeling the body and their knowledge of anatomy. This method is still practiced today and in the hands of a skilled physician can be very beneficial.
However, with the advances made in ultrasound imaging over the last few decades, doctors and allied medical professionals have been able to visualise the area to be injected as well as the needle by using ultrasound. Studies have shown this method to be a more accurate and efficacious for patients.