Ultrasound Guided Steroid injections

Joint & Soft tissue: Aspirations Information

What is a Joint or Soft tissue aspiration?

Joint aspiration is performed by using a thin needle to take some of the fluid out of the joint. This procedure, also known as arthrocentesis, is one of the most common procedures used for muscle and bone problems. It is mostly done at the knee or shoulder but a soft tissue haematoma may also indicate an aspiration.

When will a joint or soft tissue aspiration necessary?

If a joint is swollen, a sample of joint fluid (synovial fluid) can help to find the cause of swelling. A sample of the fluid may be tested to find out whether, for instance, it contains bacteria  or abnormally high levels of white blood cells.

In some cases, the excess fluid (effusion) causes pressure and pain. By removing some of the fluid during the aspiration will help to reduce pain and promote healing.

How is an aspiration performed?

Aspiration may also be used as a treatment, to reduce the pressure on the joint or soft tissue. The clinician uses the syringe to remove the excess fluid. If needed, medication can be injected into the joint during joint aspiration.

Special preparation is usually not needed. The surrounding skin is carefully disinfected beforehand to keep germs from entering the joint. The clinician wears sterile disposable gloves during the procedure to avoid any infection. Sterilized disposable cannulas and syringes are unpacked right before use.

The clinician can use diagnostic ultrasound to locate the position where the aspiration is required. Diagnostic ultrasound is sometimes used to monitor the entire procedure. A local anaesthetic may be used, if required.

A pressure bandage is often applied after the procedure. The joint itself usually needs to be kept still – how long will depend on the cause of the swelling and whether medication was injected during the aspiration.

Is it painful? 

Joint aspiration typically feels a bit like having blood drawn.

What happens after the procedure and what should I look out for?

Afterwards it is important to watch carefully for signs of inflammation. If the joint or puncture site are red, swollen or start feeling very warm, you should inform your clinician immediately. Other warning signs include fever and worsening pain.

What are the risks involved?

There may be bleeding in the joint or soft tissue, afterwards. Inflammation at the needle insertion site is possible. If medication is injected as well, it may cause a feeling of pressure or a short burning sensation. The medication might have side effects such as allergic reactions too. Anti-inflammatory drugs can lead to facial redness, increased blood pressure, a racing heartbeat and flushing.

The greatest risk is that of an infection caused by germs that have managed to get in. This risk varies depending on what is done during the aspiration and which joint is involved. Diabetes or a weakened immune system increase the risk of infection.

Where can I find out more before considering the procedure?

Please contact us: suegnet@meyerphysio.com

Patient information: Hyaluronic acid injections

Patient information: Hyaluronic acid injections for knee OA:

Hyaluronic acid injections, also known as viscos-supplementation, is a pain-relieving treatment
option for mild to moderate knee osteoarthritis (OA).

What is Hyaluronic Acid? 
Hyaluronic acid is a naturally occurring substance found in the synovial fluid of joints. Injections
of hyaluronic acid are used to supplement the depleted natural levels in the knee joint affected
by osteoarthritis.

Why inject Hyaluronic Acid?
The goal of hyaluronic acid injections is to provide lubrication and cushioning to the knee joint,
reducing pain, improving joint function, and potentially delaying the need for more invasive
treatments like surgery.

How is it done?
The injections are typically administered by a healthcare professional, such as a Physiotherapist
in an outpatient setting. The procedure involves injecting the hyaluronic acid directly into the
knee joint using a fine needle. We use a ultrasound guided injection technique, which is more accurate and less painful.

Treatment course:
The number of injections and the frequency of treatment can vary depending on the specific
product used and the severity of the knee OA. Typically, a course of treatment may consists of
one or a series of injections given over a few weeks or months, depending on the type
of hyaluronic acid.. We mainly use Durolane (Bioventus), which is a single long-acting injection for up to 26 weeks.

Effectiveness:
The effectiveness of hyaluronic acid injections can vary among individuals. While some patients
experience significant pain relief and improved joint function, others may not experience the
same level of benefit. It’s important to have realistic expectations and discuss potential
outcomes with your healthcare provider.

Side effects:
Common side effects may include temporary pain or swelling at the injection site. In rare cases,
infection or allergic reactions may occur. It’s essential to discuss any allergies or medical
conditions with your healthcare provider before undergoing the procedure.

Post-treatment care:
Following the injections, it’s generally recommended to avoid strenuous activities involving the
knee joint for a 24-48 hours. Your healthcare provider will provide specific post-treatment
instructions.

Opening Times :

Face to Face Consultations : Monday to Friday 8.30 am – 6.30 pm.

Virtual Consultations: Monday to Friday 8.00 am – 9.00 pm.

Emergency appointment : Please contact us.

Covid Precautions:

Public Health England guidance is upheld for patients and staff safety.

To book an appointment for Physiotherapy or Diagnostic Ultrasound please contact us.

Articles

Equipment and Consumable Products used in Rehabilitation

As part of ongoing rehabilitation or exercise treatment you may want to purchase equipment or consumable products recommended by your physiotherapist. We provide the below links to help you choose the right items. You do not have to use the specific items or brands suggested, but these items have been recommended by us, and used successfully by our patients, in the past.

Hot & Cold Treatments

Microwaveable Wheat Pack – Long

For hot or cold usage. Ideal for neck and shoulder pain.

Microwaveable Wheat Pack – Large

For hot or cold usage. Ideal for lower back pain.

Reusable Hot & Cold Gel Packs

3 per pack

Ice-it-Away Ice Massage Ball

Refillable ice massage ball & bag

Refillable Ice bag with Velcro attachment strap
Disposable Instant cold packs
Game-Ready Rental link

http://gameready.co.uk/Rental.html

Electronic Equipment

TENS Machine
TENS Pads
Pulse Oximeter
Electronic Forehead Thermometer
Blood pressure meter

Tape Wraps and Bandages

Coban wrap 7.5cm width

Coban wrap 5cm width

Coban Wrap 2.5cm

Mueller Under-wrap

Leukotape P Combi Pack

Sports Tape (K-tape)

Pre-tape Skin Adhesive Spray – Mueller

Orthotics, Braces and Supports

Canterbury Base Layers and Compression wear

Men : https://www.canterbury.com/baselayer-compression-c8

Women : https://www.canterbury.com/baselayer-compression-c110

Junior : https://www.canterbury.com/baselayer-compression-c35

A60 Aircast – Black

A60 Aircast – White

Soft Ankle support – Black

Vasyli Orthotics

Blue – Full Length

Blue – 3/4 Length

Heel pads (pair)

Knee braces

Ankle supports and Ankle boot

Crutches

Paediatric crutches

Exercise Equipment

Theraband

Balance or wobble board

Bosu

Stationary bikes

Slant board

Weights

Ankle weights

Swiss balls

Pulleys

A Cross-Sectional Study Comparing Overhead Activities of Senior Tennis Players With and Without Shoulder Pain

Suegnet Meyer, MSc BPHYST MCSP  

MSc Sports Physiotherapy Dissertation

University of Bath, 2018

Abstract

Study Design

Cross-sectional design

Background

Repetitive overhead activity during tennis is a causative factor of shoulder pain. Age and playing years will influence shoulder movement and possibly result in shoulder injuries for throwers and hitting athletes. Literature assessing the shoulder movements of senior overhead athletes with shoulder pain exist, but correlation with serve kinematics is lacking.

Tennis player with motion sensors attached
Tennis player with motion sensors attached
Objectives

This study compares the effect of shoulder overhead activities on senior tennis player – with and without shoulder pain. The differences between movement patterns by means of inertial measurement and shoulder clinical assessments were assessed and correlated with the effect of age and playing history.

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Case Study: Diagnostic Ultrasound of Achilles Tendinopathy – how does Diagnostic Ultrasound fit into physiotherapy practice?

Author: Suegnet Meyer, MSc, BPHYST, PGCert MSK US (cand).

© 2020 Suegnet Meyer. All rights reserved.

Slide 1: Non-insertional or Mid-portion Achilles tendinopathy: Does Diagnostic Ultrasound fit into Physiotherapy Practise?

This presentation was constructed as part of completing a postgraduate qualification in Musculoskeletal Sonography at Brunel University, 2020. This case has been anonymised and patient consent obtained.

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Functional Movement Screening – Is it a valid injury predictor in Sport?

By Suegnet Meyer

Functional movement screening (FMS) is a tool that consist of 7 tests. It is widely used by trainers, coaches and therapists to predict if an athlete is at risk of injury. Many have raised their scepticism regarding the true value of using these tests as injury predictor.

In a recent systematic review (Moran et al., 2017), documented that FMS composite scores prediction and injuries that occurred, did not correlate. ‘Moderate’ evidence exist  ‘against’ using FMS in football injury prediction. Limited and conflicting evidence exists in basketball, running, police and firefighters. Various cases were assessed and ‘strong’ evidence was found that a high FMS composite scores, predicting a high injury risk, only resulted in a small amount of injuries sustained in military personnel. Although FMS has good to excellent inter- and intra-reliability, it is advised not to base injury prediction on FMS, as it is inaccurate.

Reference:

Moran, R., Schneiders, R.W., Mason, J., Sullivan, S.J., (2017). Do Functional Movement Screen (FMS) composite scores predict subsequent injury? A systematic review with meta-analysis. British Journal of Sports Medicine. DOI:10.1136/bjsports-2016-096938

Prevention and Management of Tennis Elbow

What is Tennis Elbow?

Tennis elbow (lateral epicondylitis) is pain that presents on the outside of the elbow.
It usually occurs when the forearm muscles that control the wrist are repeatedly stressed. This causes micro-tearing and degeneration of the common extensor muscle origin at the elbow. Tennis elbow does not only affect tennis players, but can affect anybody who does repetitive movements, such as gripping, lifting kettles or wringing of washing. Of course, as the name suggests, it often affects tennis players, especially on their backhand stroke. Continue reading