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Ultrasound Guided Joint Injections

We are excited to offer ultrasound guided joint injections in-house. This service is normally only offered in specialist hospitals with very long waiting times - but Willesden Green Surgery is now able to provide this service within days with our new GE Logiq E ultrasound machine.
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What are Ultrasound Guided Joint Injections?

Ultrasound imaging uses sound waves to produce pictures of muscles, tendons, ligaments and joints. These pictures help us to diagnose things like sprains, tendonitis, nerve injuries, inflamation and tears within the soft tissues.

 

An ultrasound guided injection allows the doctor to form a diagnosis based on the imaging and inject medication directly and accurately into the affected area, under image guidance. 

 

Most commonly we inject a local anaesthetic plus an anti-inflammatory corticosteroid. Corticosteroid injections are used to treat conditions such as arthritis, bursitis, tendonitis or tendinosis, ligament injuries, nerve entrapment or soft tissue injuries. Your doctor will advise you if an injection is appropriate for your condition. 

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What are the benefits of Ultrasound Guided Joint Injections?

Ultrasound guided injections are safe and simple. They effectively reduce pain and inflammation to your affected area, in a minimally invasive way. Most people notice an improvement in their symptoms within 1-2 weeks. The benefit can last for months or may be permanent.

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Who will be carrying out the procedures?
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Dr Muhammad Najim carries out the procedures in the practice, performing hundreds of ultrasound guided injections every year. Dr Muhammad Najim is a GP with a special interest in musculoskeletal medicine, and is specially trained in musculoskeletal ultrasound and injections. 

He works at University College London Hospital (UCLH) in the complex musculoskeletal clinic were he provides ultrasound guided injections.

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Post Procedure Physiotherapy

A vast majority of the injections provide rapid, pain relief for our patients. This pain relief can last months to years and it can cure the condition. The evidence shows that the benefits of joint injections are most effective when combined with a consistent physiotherapy programme. Joint injections provide a window of opportunity whereby you are pain free and able to engage with physiotherapy to correct any underlying imbalances that may have caused the initial problem.  

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To maximise the benefits of an injection it is essential that a physiotherapy program start within 1-2 weeks after an injection. 

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After your injection the doctor will therefore email you a physiotherapy programme with videos tailored specifically for you. We also have an in-house Senior Physiotherapist, that you can see for a one-off physio programme. For regular physiotherapy sessions we advise that you self refer to the Brent MSK Physio service here. 

Cost


Free!

 

Whilst this isn't normally a free NHS GP service, we are delighted to provide this service for free in an NHS GP setting.

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Risks of the Procedure

Corticosteroid injections are safe and serious side effects are very rare.

 

However, with any procedure there are can be some risk, most notably:

  • Steroid flare-up (increase in pain for a day or two)

    • This is one of the more common side effects. This is a transient increase in pain that will only last a day or two. This can affect up to 20% of patients. This is a normal reaction and nothing to be worried about.

  • Joint infection

    • This is extremely rare and affects less than 1 in 10,000 joint injections. Please contact us, if you notice that the area is hot or swollen or you develop a fever in the days after the injection. 

  • You will be informed of any other risks specific to your condition prior to the injection

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Frequently Asked Questions

​I'm not a Willesden Green Surgery patient, can I have an ultrasound guided joint injection?

Unfortunately not, this service is currently only for NHS patients registered with Willesden Green Surgery.

I've heard of ultrasound guided hyalauronic acid, ostenil, PRP, dry needling, myofascial and prolotherapy injections?

There is limited evidence proving the efficacy of hyalauronic acid, ostenil, PRP and prolotherapy injections. We therefore primarily only inject local anaesthetic and corticosteroids as these are proven to work. However, if you are keen on receiving one of these alternative injections then simply discuss this with Dr Muhammad Najim and they can be considered under special circumstances.

Do you do nerve block injections?

Yes

Do you do ultrasound guided spinal injections for back pain secondary to slipped discs or spinal arthritis?

Ultrasound guided spinal injections are the only injections currently not offered at the practice. Spinal injections under ultrasound guidance are only offered in very few tertiary hospitals in the UK.

What exactly is the substance being injected?

The local anaesthetic will be either lidocaine or bupivacaine. The antinflammatory corticosteroid will be either kenalog (triamcinolone), depo-medrone (methylprednisolone acetate) or betamethasone. The choice of medication will depend on the condition and type of injection.

What do I need to do to prepare?

The area being examined will need to be visible so wearing shorts for lower limb examinations, or a vest top for shoulder or arm exams will be helpful. No other preparation is required.  

What will happen during the procedure?

Your affected joint may be briefly examined before an ultrasound will be used to confirm the diagnosis. The procedure will explained including any risks, and you will be able to ask any questions before consenting to the procedure.  Your skin around where we will inject will be cleaned with antiseptic solution. The doctor will then inject the medication under ultrasound guidance. A small plaster will be placed over the injection site, this can be removed after a few hours. The whole procedure usually takes between 15-20 minutes.

Will the injection hurt?
The injections last for seconds. There can be discomfort but most injections are not painful. 

How will I feel after the injection?

You may have some numbness after the injection that may last for a few hours due to the local anaesthetic. You should not have any pain for the first few hours. However, when the local anaesthetic wears off, your pain may return. Sometimes this initial pain can be a little worse than before the injection. This generally settles within 48 hours, you can take regular analgesics such as Paracetamol and Ibuprofen if required. Most people notice an improvement in their symptoms within a week or two. The benefit can last for months or may be permanent. You will be able to do normal light activity immediately following the injection, however we advise against any strenuous activity for the first 48 hours following the injection. It is important that you start your physiotherapy programme 5-7 days after the injection, when your pain is improved. Pain should guide your level of activity and exercise.

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