JOINT INJECTIONS
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CORTICOSTEROID INJECTIONS
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What is Corticosteroid?
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The main purpose of the steroid injection is to decrease pain and increase movement and use of the affected area. Steroid injections are usually well tolerated and much less likely than steroid tablets to cause serious side-effects.
Steroid injections can give relief within hours and can then be effective for 3-6 months or even longer. A local anaesthetic may be combined with the steroid in the injection to reduce any discomfort of the injection. If the injected joint or soft tissue is painful after the injection, then simple painkillers like paracetamol will help.
What can steroids be used for?
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Osteoarthritis; knee, shoulder, ankle, elbow, wrist, thumb and fingers, toes, foot
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Soft tissue issues; tennis elbow, rotator cuff problems, plantar fasciitis
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Bursitis
Why use a steroid?
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Steroids can be used when there is a barrier to doing what is required in order to get over a condition, for example, you are trying to increase the movement and strength of a joint and there is too much inflammation to allow you to carry out exercises. Patients are often unable to perform any rehabilitation or exercise for their condition due to the pain in this situation. A steroid injection can reduce the inflammation to allow you to progress with pain free mobility and exercise to get over the episode of inflammation.
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OSTENIL®
What is OSTENIL® (sodium hyaluronate)?
Sodium hyaluronate (also known as hyaluronic acid or hyaluronan) is a natural substance which is present in the body wherever moisture is stored or lubrication between layers of tissue is required to eliminate friction.
Examples are the vitreous body of the eye itself, the tear film, the joint cartilage, the synovial fluid in the joints, all the mucous membranes of the body, but also the basic substance of the skin which consists of up to 55% sodium hyaluronate.
Sodium hyaluronate takes on a variety of functions:
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Storage: it absorbs and stores moisture in enormous quantities
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Lubrication
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Transport medium for nutrients
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Filter for inflammatory molecules.
Sodium hyaluronate is an essential component of the synovial fluid. It enables the fluid to act as a lubricant, a shock absorber and a filter controlling the movement of cells and large molecules within the joint.
How does OSTENIL® work?
OSTENIL® is a solution containing sodium hyaluronate. It is injected into the space in the joint that contains synovial fluid and works by restoring the normal balance between the breakdown and production of sodium hyaluronate. This procedure is known as 'viscosupplementation', and the effect of OSTENIL® means that it can decrease pain and stiffness and improve the other symptoms of osteoarthritis.
The sodium hyaluronate in all versions of OSTENIL® injections is very pure and is manufactured using a process called fermentation. It contains no animal proteins, which means that it is very unlikely to cause an allergic reaction. OSTENIL® has been given to thousands of patients and has not been found to cause any serious side effects. The exact make-up of the sodium hyaluronate in OSTENIL® has been carefully chosen so that it is as effective as possible in treating osteoarthritis.
Effects of OSTENIL®
1. An injection of sodium hyaluronate increases the viscosity of the synovial fluid, restoring its lubricating, shock-absorbing, and filtering properties
2. In addition, it re-establishes the protective coating of hyaluronan over the inner surface of the joint and increases the scavenging of free radicals
3. As a result of these changes, sodium hyaluronate reduces inflammation of the synovial membrane
The direct effects of OSTENIL®, while resulting in immediate lubrication, and an additional shock absorbing effect, cannot account for its long-term benefits, as it is cleared from the joint within a few days. Instead, research shows that the OSTENIL® over time restores the ability of the joint to produce its own hyaluronan/synovial fluid, and thus returns it to a state of homeostasis (i.e. stable condition) that persists for several months.
Evidence also exists suggesting that exogenous hyaluronan may slow the destruction of cartilage.
What to expect with the treatment
You will probably not notice any benefits immediately after the first injection, but you should gradually start to feel less pain and stiffness over the next few weeks. The improvement in your symptoms is likely to persist for several months, depending on the progression of the degenerative change in the joint being treated.
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When the effects of your OSTENIL® injections begin to wear off, you can safely choose to have another injection if your clinician agrees it is appropriate. Thereafter, you can continue with OSTENIL® therapy whenever necessary with no risks or deterioration to the joint.
Are there any side effects?
As with any joint injection, there is a very small risk of infection. However, stringent aseptic no-touch techniques are used, and this is exceptionally rare. Unlike steroids, you are not limited to a maximum number of injections per year.
As a rule:
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Mild-moderate osteoarthritic - benefit 6-12 months
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Moderate to severe - benefit 4-6 months
It is best to use this treatment to prevent/slow down the osteoarthritis rather than wait for the severe stage. This is due to the research that shows using the OSTENIL® in this earlier situation can over time restore the joints’ ability to produce it’s own synovial fluid. Whilst we cannot reduce the wear and tear from the osteoarthritis, it is possible to maintain the symptoms with this treatment.
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OSTENIL® IN COMBINATION WITH CORTICOSTEROID
When a joint is particularly painful as well as stiff, we can combine a steroid with OSTENIL®. Corticosteroids, when used too frequently over time, can damage joints and cartilage. However, when combined with OSTENIL® for the initial treatment, they can reduce the cycle of inflammation and allow for further management with OSTENIL® only. Osteoarthritis often responds to physiotherapy in the form of exercise and rehabilitation. Often the pain is a barrier to this approach due to the level of inflammation. In this instance, again, a corticosteroid can reduce this inflammatory cycle to allow you to overcome any physical difficulties with activity.
Where can OSTENIL® be used?
Any osteoarthritic joint can benefit from this treatment. The most commonly treated areas are:
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Knee
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Ankle
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Shoulder
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Elbow
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Wrist
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Thumb and hand
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Foot and toes
Note: We are unable to inject any part of the spine.
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18+ only
Duration: Approx. 30 minutes to 1 hour
Cost: Corticosteroid £95 | OSTENIL® £180 | OSTENIL® with Corticosteroid £200
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