Please note a referral letter is required before an appointment can be confirmed.
About our service
We offer a number of types of injections to patients who have been referred by their GP or consultant. Each injection is tailored to your specific requirements.
- Intra-articular (joint) injection
- Ultrasound guided injection
- Caudal epidural injections
- CT guided facet joint/nerve root injection
Below you will find information on what you need to do before getting your injection and what to expect afterwards. Each injection follows a slightly different process. Please read 'the procedure' information for your specific injection type.
Before the procedure
- Every patient has individual needs and will receive a tailored injection. You will be given a detailed explanation of what to expect and asked to sign a consent form only after it is agreed that you understand and are happy to proceed with the procedure.
- When you make your appointment, please advise us of any medications you may be taking prior to your injection, such as blood-thinning agents e.g. Warfarin etc. We will let you know if you need to stop taking any medication for a brief period ahead of your injection. It is also important to let your doctor know if you’re diabetic or have chronic kidney disease prior to your procedure.
- Please bring your insurance details with you, along with any relevant scans you may have.
- Wear comfortable clothing. You may be asked to remove items of clothing and jewellery and put on a hospital gown, depending on where you need the injection, therefore we would ask you to leave all valuables at home.
- Let us know if you have any allergies, if you may be pregnant or breastfeeding.
- You may eat as normal, however, please do not eat a heavy meal before the procedure.
Following the procedure
- You may feel some discomfort or pain for up to 48 hours post-injection. During this time you can take any painkiller or anti-inflammatory medication according to your doctor’s instructions. It can take three to four weeks before you notice full relief from the injection.
- Please arrange for someone to drive you home. The local anaesthetic may leave a residual numbness and you should not drive for the rest of the day.
- Your referring GP or consultant can advise you on the level of activity you can undertake post-injection.
- As with any interventional procedure there are possible risks, side effects and complications. Some patients experience worsening of the pain temporarily and may feel some tingling, clumsiness or even weakness to the affected limb but this weakness should subside in a couple of hours and is due to the local anaesthetic. Serious side effects are rare and will be discussed with your radiologist/doctor prior to the procedure.
- Complications include haematoma at the site of injection, worsening of symptoms, bleeding, sleep disturbance, flushing, transient increase in blood sugars in patients with diabetes and infection.
- Signs of infection include sweating, shakes and fever with possible redness and heat at the injection site and worsening of symptoms. Infection is rare but can be serious. If you develop symptoms that concern you or experience severe pain following an injection, please contact us.
If you have a painful or swollen joint, a steroid medication may be injected into the joint, sometimes along with a local anaesthetic.
- The radiologist will use an X-Ray to find the area to be injected, and may mark the skin with a small pen. They may also inject a local anaesthetic under your skin to minimize the pain of the injection.
- Sometimes a small amount of contrast (x-ray dye) is injected into the joint to confirm the correct position of the needle. A steroid medication and a long acting local anaesthetic will follow.
The ultrasound examinations are to visualise tendons, tendon sheaths or any other non-bony orthopaedic problems as this anatomy does not show up on traditional X-ray. It is a completely safe and painless way to visualise soft tissues in the body.
You may have been referred by your consultant for an ultrasound guided injection due to pain or inflammation of a particular area. Ultrasound is used in this case because it is the most accurate means of injecting a medication to the exact area of concern. It is used to confirm a diagnosis and at the same time pinpoint the area of interest for the injection.
- The ultrasound will be carried out by a radiologist. He or she will put a thin layer of clear gel on your skin over the area to be scanned and slide a small handheld probe (like a large pen) over this area; this will transmit a picture onto a screen beside the bed. This is not painful, but it may be necessary to press a little harder at times to get a clearer picture.
- A local anaesthetic may be injected under the skin to minimize the pain of the injection. A steroid medication, which is related to cortisone, and a long acting local anaesthetic will follow.
Caudal epidural Injections are used to relieve symptoms of lower back, buttock, and/or leg pain as a result of injury, nerve inflammation or nerve compression due to a bulging disc using steroid and/or anaesthetic agents. The site of injection is at the bottom of the spine (the tail bone) into the epidural space.
The epidural space is located around the outer covering of the spinal cord and the nerve roots which exit the spine. The local anaesthetic acts on the nerves and may temporarily block their function and cause short term relief from pain. The steroid decreases inflammation and improves the chances of long term relief from the injection.
- The radiologist will use an x-ray to find the area of interest to be injected. A local anaesthetic will be injected under the skin between the upper buttocks to minimize the pain of the injection. A small amount of contrast (x-ray dye) will be injected into the epidural space to confirm the correct position of the needle.
- A high-volume injection of steroid medication, which is related to cortisone, and a long-acting local anaesthetic will follow. There is also some normal saline (sodium chloride) in the mixture. This high volume is used to bathe the lower lumbar and sacral nerves with the medication. It is injected in small amounts at a time and the Radiologist will give small breaks in between, depending on how you are tolerating the injection.
- You may feel a small amount of pressure going down the legs or in the lower back. This should subside when the radiologist stops injecting the steroid medication.
A spinal injection is an injection of local anaesthetic and steroid (anti-inflammatory medication) into or around a part of your spine (neck, back or lower back) in order to relieve pain/symptoms you may be experiencing. The injection will either be into the facet joints which are located in the spine at each vertebral level, or around the nerve roots of the spine. Nerve roots exit the spine from the spinal cord and are also found at each vertebral level.
Computed tomography (CT) is used to guide the injection into the symptomatic site i.e. the facet joint or nerve root, depending on your symptoms. The steroid injected reduces inflammation at the site and thus reduces pain and the associated symptoms in the medium to long term. Some patients experience worsening of the pain temporarily and may feel some tingling, clumsiness or even weakness to the affected limb but this weakness should subside in a couple hours.
- You will be positioned on the CT table and asked to lie as still as possible for until the end of the procedure. Depending on the site for injection, you will be asked to either lie on your side or face down.
- An initial scan will be taken to identify and mark the area to be injected. The skin will be cleaned with antiseptic fluid and a local anaesthetic will be injected under the skin.
- The radiologist will use the CT scanner to produce images to guide a very fine needle close to the nerve. Several scans will be taken to confirm the position of the needle tip as it is advanced. When the needle is in the exact location, an injection of local anaesthetic and steroid will be injected.
- You may experience some discomfort and/or pressure to your limbs but this should dissipate quickly. The procedure usually takes 20-30 minutes but this can vary.