ST LUKE’S SURGICAL SERVICES 

Cortisone injections do provide pain relief in many conditions. It is never a cure but allays pain & suffering, and helps you to function, while nature cures the condition or it comes back to a status quo as before

Joint Arthritis. Osteoarthritis or wear and tear arthritis is an ageing condition of the joint—steroid injection cannot improve it. However the arthritis can occasionally flare up causing severe pain, immobility, with or without fluid accumulating in the joint. In such flare ups, Cortisone injections can calm the pain and inflammation and provide dramatic relief.

At St Luke’s surgery we inject all joints including hip, knee, ankle shoulder elbow etc.

Hip Bursa injection . When the bursa on the side of the hip is inflamed, it can cause severe pain going down from the hip to the side of he thigh and limits mobility and even sleep. Cortisone injection can give dramatic relief of pain if injected correctly.

Frozen Shoulder. This is a curios condition where the shoulder becomes very painful and movements become limited , sometimes becoming very stiff and affects sleep at night. There is no reliable treatment for this condition, it tends to run its course whatever fancy treatment is offered by various ’experts’.  The good news is that it is self limiting and ultimately gets better at the end of a painful, frustrating saga lasting anything from 6 to 24 months. Cortisone injection if done into the right place can ease the pain for a while and help with mobilisation/physiotherapy. Physiotherapy and mobilisation is the cornerstone of treatment and needs to be done religiously every single day to speed up the recovery.

Tennis and Golfers Elbow.  Again these are little understood conditions where the forearm muscle attachment to the outside or inside of the elbow becomes painful. The ideal treatment is working these muscles in spite of the pain with a pair of dumbbells, rolling a rolling-pin with a weight suspended by a string etc. If the pain is so severe as to affect your occupation, shopping,  caring for a baby etc, steroid injection can help allay the pain. However steroid delays healing of the tendon attachment and may weaken it. While one off injection will not have any significant long term bad effect, repeated injections are harmful.

Shoulder Pain  Most shoulder pain is due to inflammation of the tendon or bursa in the shoulder and gets better with physiotherapy. Steroid injection is helpful to reduce pain and aid with mobilisation only and should be used judiciously. It is not good to inject  cortisone in young shoulders as it can weaken the tendon and even lead to complete rupture. If there is a partial rupture and the pain is due to the body’s attempt at healing, the best treatment is to allow the tear to heal or surgically repair it in young people. Older people over the age of 72 with arthritis  will get short term benefits with cortisone injection and is not harmful if repeated at reasonable intervals 

Wrist Arthritis. Wrist joint is a complicated joint and arthritis develops in old age, in people who have worked hard with their hands all life, and after wrist fractures. Carefully assessing which part of the joint is inflamed and injecting correctly into that space is very helpful.

Thumb Joint Arthritis  The joint at the base of the thumb often becomes arthritic and painful. A thumb splint cheaply available on the internet can help reduce the inflammation. Cortisone injection is very helpful when you cannot hold your pint  or  hold your grandchild, knit,  do the hobbies or indeed affects your occupation.

Dequervain’s Tendon sheath inflammation.  The is an inflammation of the tendon sheath on the wrist at the thumb side . Very tender at the site and when using the thumb. It used to be very common when women had to wring the clothes before hanging it out to dry. The advent of washing machines have largely reduced its occurrence now. Again thumb splints are very helpful in reducing pain, but cumbersome for many jobs. Cortisone injection done by  expert hands  produces dramatic improvement . If these fail we do an operation to cure it.

Carpal Tunnel Injection: Mild to moderate carpal tunnel syndrome with pins and needles in the hand, waking up with pins and needles in the hand, burning pain in the hand, etc. will get good relief with cortisone injection. 

Trigger Finger injection: Trigger finger and trigger thumb are caused by the tendon being trapped in the palm causing pain first and then troublesome triggering. Cortisone injection will cure approximately half the people and the other half will need operation.

Hand and finger arthritis The small joints of the hand and fingers can become very painful . When any joint in the hand is painful the whole function of the hand is difficult. Cortisone injection  can quickly make pain and movement better. This is a very skilled injection and need   an expert to do this. 

Hip Arthritis. Cortisone injection can ease the pain in the elderly and in whom operation is not feasible. The joint is deep and needs a skilful injection to put the cortisone into the joint. There is a  small danger that cortisone can lead to loss of blood supply of the ball and cause it to flatten at the top. Then it will need Total hip replacement.

Knee Arthritis This is the most common injection and most doctors can do it.

Ankle Arthritis; The ankle becomes arthritic especially in those who had an injury or fracture of the ankle before. Cortisone can ease the pain and stiffness for a  good while. 

Heel Pain  Heel pain or Plantar fasciitis happens in people who stand for a long time in their work. It is self limiting and goes away after many months. However injection can be god sent in those who cannot walk to the toilet, let alone for work.

Foot and Toe Arthritis Any of the joint in the foot or toes can become painful . Most commonly it happens in the big toe and the base of the second toe. When it is very painful injection can make a dramatic difference. Again these are small joints and needs very skilful injection to get the cortisone into the correct  joint . 

Cocygodynia Some people develop pain at the lower end of their spine. Although the reasons are not very clear, doughnut pillow to sit on can help. Cortisone injection can give some welcome relief for a good while.

Sciatica and Epidural Injection. When a displaced disc in the spine presses on the nerve root, the chemicals in the disc causes an inflammation of the nerve root and quite  horrendous pain going down the leg into the foot. When no oral medication stops the pain, a caudal Epidural injection can reduce the inflammation and relieve pain. The disc, in the long term,  shrinks and moves away from the nerve root to provide  the natural cure 

Bursitis Bursae are present in the shoulder, elbow, hip knee etc. They can get  inflamed in conditions like gout rheumatoid arthritis etc. and often for unknown reason. They can be very painful and red, often looks like an  infection and gets prescribed antibiotics.  Steroid injection can calm down this inflammation and pain very dramatically.

Rheumatoid Arthritis. Rheumatoid Arthritis can flare up occasionally with pain and warmth in multiple joints in spite of being on treatment and symptoms largely controlled. One shot of Cortisone injection can calm it down and prevent long term damage to the joints.

Gout Flare up. Acute gout is usually treated with anti-inflammatory tablets. However intra articular cortisone injection in accessible large joint  gives quick relief of symptoms . It can also be used when gout flare up is in multiple joints, or where patient cannot have anti-inflammatory medication due to acidity or kidney problems.

Hay Fever Injections Hay fever in the  large majority are well controlled by over the counter pills and nose sprays. Your doctor can prescribe stronger nose sprays. There is a small group of people who really suffer with uncontrolled eye streaming, nose block and even asthma due to hay fever in whom all sort of pills and nose sprays are useless. Here one shot of cortisone injection a season  can be a ‘lifesaver’ for such people.