Musculoskeletal Ultrasound Guided Injection

Introduction

Your Consultant, Physiotherapist or GP has advised you have an Musculoskeletal Ultrasound Guided Injection scan to help find the cause of your symptoms.

This leaflet is designed to give you some information to help you prepare for your scan and to give you some idea of what to expect when you attend.

Your appointment letter will tell you where to go for your scan.

What is an ultrasound scan?

An ultrasound scan is an examination, using sound waves to take pictures of the inside of your body.

Is an ultrasound safe?

Ultrasound is safe and no radiation (X-ray) is used.¹

What preparation will I need?

Usually no preparation is needed. Printed instructions will be given to you with your appointment information if any preparation is required.

What happens if I take anticoagulants?

If you take anticoagulants (medicine to thin your blood), then please phone the Ultrasound Department and let us know what type of medication you are using.

Can I have this treatment if I am diabetic?

Yes, but please see the section below, which explains the details of possible side effects.

What is a steroid/ local anaesthetic injection?

Before your Ultrasound Guided Injection, you will be given a steroid or a local anaesthetic. Steroids work by reducing any swelling. The local anaesthetic helps to relieve any discomfort immediately after your injection, but it will start to wear off after a few hours.

You must phone (see contact details section) and let the ultrasound department know if:

• You have been in contact with someone who has chickenpox/shingles and you have not previously had the illness

• You have severe depression or bipolar disorder

• You have glaucoma

• You think you may be or are trying to become pregnant

• You are breast-feeding.

What if I cannot attend my appointment?

If your appointment time is not convenient, it is essential you contact the Ultrasound Department immediately, so that a more appropriate time can be arranged.

This will allow us to give valuable scanning time to someone else. Your ultrasound-guided injection may not take place at your nearest hospital, depending on where these ultrasound lists are performed.

Who will carry out the test?

The test will be carried out by a Radiologist (Doctor) or by a specialist Sonographer (person who specialises in ultrasound). Occasionally, a person who is training to do this type of injection will carry out the procedure.

If a trainee is carrying out your procedure, they will be closely supervised by an experienced member of the Ultrasound Department. However, you have the right to say you would prefer not to have a trainee carrying out your test.

What does the procedure involve?

When you arrive, you may be asked to undress and to put on a hospital gown. When you are in the examination room, you will lie on a couch or sit on a chair next to the ultrasound machine.

The person performing the procedure will place a small amount of clear gel onto your skin and gently run a small probe, like a microphone, over your skin surface.

You may be asked to change your position slightly and hold your breath from time to time.

The scan will let the team identify the exact area where an injection is needed.

If an injection is needed, this is when you will be given the steroid or local anaesthetic.

You will be asked to sign a consent form after the procedure has been explained to you. The team will discuss significant and frequently occurring side effects and complications. They will also answer any question about the injection at the time.

If you have any concerns before the test, please contact the doctor or physiotherapist who you saw in clinic who will be able to discuss the injection further with you. At any stage, you have the option of not having the treatment.

The pictures produced on the TV screen will be recorded and kept along with your other X-ray films.

How long will it take?

This test will usually take between 5 to 30 minutes.

How long will it take to work?

This can vary, but most people start to feel an improvement straight away. Sometimes, in the first 24 hours after the injection, you may feel your pain gets worse, but it should start to improve over the next 2 to 3 days.

Are there any risks or possible complications?

No side effects are known from Diagnostic Ultrasound. The team will explain any potential side effects due to the injection, however the common side effects are:

• Anaphylatic shock or allergic reaction – This is a rare, wide spread reaction and generally happens in the first 30 minutes after the injection.

• Infection – Infection could be passed into your joint during the injection. The risk of infection is very rare but can happen.

You are at an increased risk if you have diabetes or rheumatoid arthritis. Steps are taken to prevent infection at the time of injection. The injection site is cleaned thoroughly and a sterile syringe and needle are used.

Your injection site will be covered with a dressing, which should be left in place for 24 hours. If the joint becomes very painful and hot, please contact your GP immediately, taking this leaflet with you.

• Short-term increase in pain – This effect is short lived and can be relieved with an ice pack or with simple painkillers.

• Possible raised blood sugar in diabetic patients – Diabetics should monitor their blood sugar after the injection, adjustment of diet or medication may be necessary for a few days.

• Facial or body flushing – this may happen for a short time only and will usually settle without any need for treatment.

• Thinning or loss of colour to the skin – This is very rare but may happen if the steroid leaks into the skin around your injection site or you have a number of these injections.

• Soft tissue or tendon rupture – This is a rare complication but can occur. This is usually only a concern if you are taking blood thinners. Seek medical advice immediately is this happens.

• Bleeding – Localised soft tissue or joint bleeding and bruising can occur although only a very small needle is used. This is usually only a concern if you are taking blood thinners. Seek medical advice immediately is this happens.

Will the injection be painful?

You may have some discomfort during the injection. The local anaesthetic mixed with the steroid helps ease the pain for up to 4 hours. However, you may wish to take some painkillers later (always follow the instructions provided in the leaflet supplied with your tablets).

Can I drive home?

We advise that you DO NOT drive home immediately after an injection. You should arrange alternative transport. It is advised that you do not drive for 24 hours after your injection.

When will I be told the results?

A report will be sent to the Consultant, GP or Physiotherapist who asked for it to be done within two weeks of your examination.

Contact numbers

If you have any questions or concerns, please use the contact numbers below:

University Hospital of North Tees:

X-ray Department

Telephone: 01642 383193

Opening hours: 9:00am to 5:00pm (Monday to Friday)

University Hospital of Hartlepool:

X-ray Department

Telephone: 01429 522938

Opening hours: 9:00am to 5:00pm (Monday to Friday)

Further information is available from:

NHS Choices

Telephone: 111 (when it is less urgent than 999).

Calls to this number are free from landlines and mobile phones or via the website.

References

1. Ter Harr, G (2012) The safe Use of Ultrasound in Medical Diagnosis, 3rd Edition. BIR The British Institute of Radiology, pages 46-104.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]