A steroid injection into a joint works for weeks rather than months. It beats a placebo at 1 to 6 weeks and there is no evidence of an effect left at 6 months, so it buys time for the treatment that lasts. Placed under ultrasound, with the scan and the review in one visit, £750.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
A joint injection puts a corticosteroid, usually mixed with a local anaesthetic, into or around a joint to settle inflammation. It treats pain and it repairs nothing, and the effect has a measured shelf life. Pooled across 27 randomised trials in knee osteoarthritis there was benefit at 1 to 6 weeks and no evidence of any effect remaining at 6 months.Cochrane Database of Systematic Reviews Jüni, 2015
The useful question is therefore not whether it works. It is what you intend to do with the weeks it gives you. Used to open a window for a loading programme it earns its place. Used alone and repeated whenever the pain comes back, it becomes the treatment rather than the tool, and the harm sits in that second version.NICE NG226, 2022
The structures injected in clinic are the shoulder and the space above the rotator cuff, the knee, the small joints of the hand and wrist, the elbow, and the carpal tunnel where a nerve is compressed rather than a joint inflamed. Which of them is producing the pain is settled by examination and scan, not by the needle.British Journal of Sports Medicine Aly, 2015
The evidence differs sharply between them. In frozen shoulder, corticosteroid into the joint was statistically and clinically better than the other treatments in the short term for both pain and function, and better still with a home exercise programme alongside it.JAMA Network Open Challoumas, 2020
In carpal tunnel syndrome a local corticosteroid injection relieves symptoms up to one month after it is given, and a second injection adds no further improvement. That last finding is the reason a second injection is discussed rather than simply booked.Cochrane Database of Systematic Reviews Marshall, 2007
Send us what you are seeing and we will tell you what it is likely to be.
The appointment is an examination and a scan before it is a procedure. Where the pain sits through the range of movement, what is tender under a thumb, what the joint does under load, then diagnostic ultrasound in the same room to look at the tendon, the bursa and whether there is fluid.British Journal of Sports Medicine Aly, 2015
The guidance is not decoration. In the meta analysis of shoulder girdle injections, a needle placed under ultrasound reached its target more often than a needle aimed by landmark, and gave better results for the space above the rotator cuff and for the biceps tendon sheath. A drug in the wrong tissue plane never had a chance.British Journal of Sports Medicine Aly, 2015
Some assessments end without a needle. The answer is sometimes that the pain is coming from elsewhere, or that a loading programme deserves 12 weeks before anything is injected into anything.NICE NG226, 2022
Loading and supervised exercise, which comes first
A review of 54 trials in knee osteoarthritis found supervised land based exercise reduced pain and improved function, with benefit still present months after the sessions stopped. No injection lasts that long, and the programme is the thing an injection exists to make possible.Cochrane Database of Systematic Reviews Fransen, 2015
Pain relief and load management
Topical anti inflammatories for a knee, oral ones at the smallest dose that works for the shortest time. Unglamorous, cheap, and effective often enough that they are tried before anybody reaches for a needle.NICE NG226, 2022
The same injection placed by landmark
Identical drug, no scan, lower fee. It reaches the intended tissue less often, and a corticosteroid delivered into the wrong plane is a fee spent on something that could not have worked.British Journal of Sports Medicine Aly, 2015
Platelet rich plasma
A different product from this one and frequently confused with it. It is prepared from your own blood and given as a course, used in mild to moderate knee osteoarthritis and in tendon problems, and the evidence behind it is thinner than the evidence behind exercise.NICE NG226, 2022
A surgical opinion
For a locked knee, for a full thickness tear in an active person, and for a joint where a proper programme and a well placed injection have both had their time. We arrange the appointment and the letter comes back to us.General Medical Council GMC guidance, 2020
An ultrasound guided injection here
The assessment, the diagnostic scan, the injection watched onto the structure and a review at 2 weeks, in one visit at £750. The same pathway elsewhere is commonly three or four appointments with a fee attached to each of them.British Journal of Sports Medicine Aly, 2015
The local anaesthetic wears off within hours, so the first day tells you where the needle went rather than whether the drug will help. The result is judged at 2 weeks. In the pooled trials 36 people in every 100 responded against 26 given a placebo, and the quality of that evidence was graded low.Cochrane Database of Systematic Reviews Jüni, 2015
Here is the result that governs how often we will do this. In a 2 year randomised trial, 140 people had either a steroid or saline injected into the knee every 3 months. The steroid group lost more cartilage thickness, 0.21mm against 0.10mm, and their pain at 3 months was no better than the saline group.JAMA McAlindon, 2017
The same shape appears in tendon problems. Across the randomised trials a corticosteroid injection was clearly better in the short term while other treatments did better in the intermediate and long term, and at the elbow it was helpful early and harmful later on.The Lancet Coombes, 2010
So injections are counted and spaced rather than repeated on request. Thinning of the skin and loss of pigment where the needle went are documented adverse effects of injecting around a joint, and they are part of why the count matters more than the technique.BMC Musculoskeletal Disorders Brinks, 2011
Score the pain before you come and again at 2 weeks, out of 10, on the same activity both times. Stairs, or reaching a high shelf, or gripping a kettle. One number on one day is noise. The same activity scored twice is the only honest way to know whether an injection did anything, and it costs nothing.Cochrane Database of Systematic Reviews Jüni, 2015
Ask any provider offering you one these 4 questions. Is it placed under ultrasound. How many have I had in this joint already. What is the plan for the weeks it buys. And what happens if it does not work. Anyone who cannot answer the third is selling the injection rather than the treatment.NICE NG226, 2022
Begin the loading programme before the injection rather than after it. The exercise evidence takes months to pay out and the injection buys weeks, so the order that works is the programme running already with the injection dropped into it at the point where pain is blocking progress.Cochrane Database of Systematic Reviews Fransen, 2015
Do not buy a third injection into the same joint inside a year. The 2 year trial that injected every 3 months found more cartilage loss and no pain advantage over saline, and in carpal tunnel a second injection added nothing to the first. That is the evidence to hold when a fourth is being asked for.JAMA McAlindon, 2017
Do not buy an injection before you have done the loading. Saying so costs us a £750 booking and it is still the right order, because the drug is worth most when there is a programme underneath it to protect.Cochrane Database of Systematic Reviews Fransen, 2015
Do not buy an MRI to decide whether to have an injection. The decision is made on the examination and the ultrasound in the room. A scan is worth paying for where a surgical decision depends on what it shows, and not before that.Royal College of Radiologists iRefer 8th edition, 2017
Do not buy a platelet course believing it is this. They are two products with two bodies of evidence, and any clinic or page that describes a platelet course as an ultrasound guided injection is running them together. Ask which one you are being sold and at which price.NICE NG226, 2022
Step 1
Movement, tenderness and load, then diagnostic ultrasound in the same appointment to look at the tendon, the bursa and whether there is fluid sitting in the joint.
Step 2
The needle is watched onto the structure rather than aimed at it. Where the scan says a needle is the wrong answer you leave with the assessment and a plan instead of a procedure.
Step 3
The same pain score on the same activity, and a decision about the programme that has to carry the result once the drug has worn off.
Ask before you book if you are not sure this is the right appointment.
£750 here, which covers the assessment, the diagnostic ultrasound, the injection placed under the scan and a review at 2 weeks. Elsewhere the consultation, the scan and the procedure are commonly three separate appointments with a fee on each.
Weeks rather than months. Pooled across 27 randomised trials in knee osteoarthritis there was benefit at 1 to 6 weeks and no evidence of any effect remaining at 6 months. That is the window it buys, and what you do inside the window decides whether the pain stays away afterwards.
Fewer than most people expect. In a 2 year trial, injecting a knee every 3 months produced more cartilage thinning than saline, 0.21mm against 0.10mm, and no better pain at 3 months. In carpal tunnel a second injection added nothing to the first. They are counted, spaced and stopped.
Yes, to placement and to results. A meta analysis of shoulder girdle injections found guided needles reached their target more often than landmark ones, and gave better outcomes for the space above the rotator cuff and for the biceps tendon sheath. A drug in the wrong tissue plane never had a chance to work.
A sharp scratch, then pressure. The local anaesthetic mixed with the steroid usually quietens the joint within minutes and then wears off within hours, which is why the first day is not the test. Some people have an ache for a day or two before the steroid itself has any effect.
They are two different products. This is a corticosteroid placed under ultrasound in a single visit at £750. Platelet rich plasma is prepared from your own blood and given as a course, used in mild to moderate osteoarthritis and tendon problems, and the evidence behind it is thinner than the evidence behind exercise.
No. It settles inflammation and pain for a period of weeks and repairs nothing. A review of 54 trials found supervised exercise reduced pain and improved function with benefit lasting months after the sessions ended, and the injection is what makes that programme possible when pain is blocking it.
Yes. Thinning of the skin and loss of pigment where the needle went are documented after injections around a joint, infection is rare and serious, and repeated injections into one knee over 2 years took more cartilage than saline did. The number of injections matters more than the technique used.
It still tells you something. Either the pain is not coming from the structure that was injected, or it is not the kind of pain a steroid settles. The review at 2 weeks exists for that, and the next step is usually the scan reread, a different structure treated, or a surgical opinion we arrange.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
BMC Musculoskeletal Disorders
Adverse effects of extra articular corticosteroid injections, a systematic reviewBrinks, 2011
British Journal of Sports Medicine
Cochrane Database of Systematic Reviews
Local corticosteroid injection for carpal tunnel syndromeMarshall, 2007
Cochrane Database of Systematic Reviews
Intra articular corticosteroid for knee osteoarthritisJüni, 2015
Cochrane Database of Systematic Reviews
Exercise for osteoarthritis of the kneeFransen, 2015
General Medical Council
Decision making and consentGMC guidance, 2020
JAMA
JAMA Network Open
Comparison of treatments for frozen shoulder, a systematic review and meta analysisChalloumas, 2020
NICE
Osteoarthritis in over 16s, diagnosis and managementNG226, 2022
Royal College of Radiologists
iRefer, making the best use of clinical radiologyiRefer 8th edition, 2017
The Lancet
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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