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Joint Injections

Joint and soft tissue injections can be really helpful in controlling and managing swelling and pain affecting a joint or soft tissue (bursa, nerve, tendon, ligament).
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Joint & Soft Tissue Injections

Joint and soft tissue injections can be really helpful in controlling and managing swelling and pain affecting a joint or soft tissue (bursa, nerve, tendon, ligament). These can be used in conjunction with rehabilitation and other treatments to help with movement, pain and restore the ability to exercise. Pain and swelling often limit the progression of rehabilitation and an injection of steroid (cortisone) combined with a local anaesthetic can remove that barrier and allow you to move pain free. This provides a helping hand in progressing with exercise.

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Steroid Injection
Steroid injections
Steroid (Cortisone) is a powerful anti-inflammatory and stops the transport of fluid across the membrane by vasoconstriction (closure) of the small and local blood vessels. In the case of joint inflammation and synovitis, it will stop the process of inflammation allowing the body to remove any excess fluid and calm the area, reducing pain and enabling movement. This is helpful in osteoarthritic joints or in bursas and around tendons. The pain causes abnormal movement patterns placing more aggravation on the tissue or it causes painful compression of the tendon causing pain whenever you load. A joint injection will restore movement and enable the correct pattern of movement, such as walking without a limp. Reducing pain will allow the muscles to recover and the tissues to regain their load tolerance, reducing the likelihood of a recurrence of pain.
Where can i have an injection?
Injections can be used in number of conditions listed, but not limited to, below:
  • Knee Osteoarthritis
  • Hip OA
  • Shoulder pain: Impingement, rotator cuff pain
  • Frozen Shoulder
  • Thumb arthritis
  • Tennis and Golfers elbow
  • Carpal Tunnel syndrome
  • Some tendinopathies
  • ITB Syndrome
  • Hand and finger arthritis
  • Bursitis
  • Trigger finger / Trigger thumb
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When joints and tendons become degenerative, their concentration of hyaluronic molecules reduces. Hyaluronic molecules provide our joints and tendons with tolerance to compression and load. Without hyaluron, we are vulnerable to injury, pain and further tissue damage. Hyaluronic acid injections work by increasing the concentration and molecular weight of hyaluron within the joint or around the tendon. This helps to reduce inflammation, increase viscosity, enhance gliding and decrease pain. Hyaluronic acid may be of consideration as an alternative to steroid or can be used in combination with steroid. If you have had a steroid injection and either had limited or no benefit, then a hyaluronic acid injection is the next treatment.
The major benefit of Hyaluronic acid injections is that they can help reduce joint inflammation by lowering the levels of harmful inflammatory substances and enzymes that break down cartilage tissue. These treatments may also stimulate the joint’s own cells to produce more natural lubricating compounds, potentially helping to restore and maintain healthy cartilage structure
We use a range of industry-leading hyaluronic injections: Sinovial, Sinogel, Durolane, Ostenil, Cignal and Monovisc. We do find that Sinovial and Sinogel are the most fast acting injection and we will offer this as our first line and novel injection. However, if you have had a different injection with good outcomes then we tend to advise to stick with the same injection and we will make this available to you, as you are highly likely to benefit again.

The regions to be injected:

  • Knee Osteoarthritis
  • Hip OA
  • Shoulder pain: Impingement, rotator cuff pain
  • Shoulder OA
  • Thumb arthritis
  • Tennis and Golfers elbow
  • Patella tendonitis
  • ITB Syndrome
  • Trigger finger / Trigger thumb
  • Ankle arthritis
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Treatment Benefits

Hyaluronic acid (HA) injections are supported by clinical evidence for reducing pain and improving joint function in osteoarthritis. HA works by restoring the natural lubrication and shock-absorbing properties of synovial fluid, particularly in larger joints like the knee and hip. This can lead to improved mobility and quality of life, with many patients experiencing meaningful symptom relief for at least six months.

Recent research continues to support its effectiveness. A 2023 study of 166 patients receiving a single high-concentration HA injection reported that the majority achieved at least a 50% improvement in pain, stiffness, and function—including walking ability—lasting up to six months.

Who Benefits Most

Hyaluronic acid injections are most effective for individuals with mild to moderate osteoarthritis, particularly those who have not gained sufficient relief from first-line treatments such as pain medication, physiotherapy, or activity modification. It is commonly used for knee osteoarthritis in patients who continue to experience symptoms despite conservative care.

Treatment Timeline and Duration
Relief is not always immediate. Patients typically notice improvements within 4 to 6 weeks after injection. Benefits commonly last around 6 months, though some patients may experience relief for up to 12 months. Injections can be safely repeated if symptoms return.
Safety Profile

Hyaluronic acid injections are well tolerated, with a strong safety profile demonstrated in clinical studies. Side effects are usually mild and temporary, most commonly including localised pain, swelling, or stiffness at the injection site. These effects typically resolve on their own, and systemic reactions are rare.

Mechanism of Action

Arthrosamid® is a 2.5% polyacrylamide hydrogel injection that works by integrating into and thickening the synovial membrane, forming a biological scaffold. Arthrosamid® is an injectable implant and is administered with a single dose of antibiotics. The pain from Osteoarthritis and continual swelling is a result of synovial inflammation. This injection seeks to prevent the inflammation from happening. Less swelling, improved movement and less pain will lead to an improved functioning.

Clinical Effectiveness

Patients often experience pain reduction within 4 weeks, with improved mobility. Clinical studies report success rates above 80%, with significant improvements in pain and function.

Long-Term Benefits
A single 6 ml injection provides durable results. Studies show sustained, clinically significant improvements (WOMAC and PGA scores) at 2 years, with pain relief lasting 3–5 years. Anecdotal reports suggest some patients continue to benefit for up to 5–8 years.
Procedure

A simple, one-step outpatient injection performed under local anaesthetic. No surgery is required, and it is designed as a one-time treatment. Each syringe is 1ml and there are 6 individual syringes.

Safety Profile

Arthrosamid® is well tolerated. Side effects are usually mild and short-lived, including temporary swelling, redness, or discomfort at the injection site. Infection risk is below 1%.

Clinical Evidence

Backed by over 20 years of research, with data from 463 patients showing statistically significant improvements at 52 weeks and beyond.

Who Is It For?

Best suited for patients with moderate knee osteoarthritis, though those with more advanced disease may still benefit. It is ideal for individuals seeking a non-surgical alternative when other treatments have failed.

Comparison to Other Treatments

Unlike hyaluronic acid injections, which typically require repeat treatments every 6–12 months, Arthrosamid® is non-biodegradable and can provide long-lasting relief from a single injection.

Cost Consideration

While more expensive upfront, Arthrosamid® may be cost-effective over time due to its long duration of action and reduced need for repeat treatments.

Risks

Joint injections carry a very low infection risk (<1%). Rare allergic reactions to local anaesthetic can occur. Patients are fully assessed beforehand and may receive antibiotics prior to treatment.

Booking

Patients can book an assessment online or contact the clinic directly. All patients require evaluation before treatment to ensure safety and suitability.

If you have a Frozen shoulder then a procedure called hydrodilatation can be highly effective in enabling movement.
Frozen shoulder has three phases. Freezing, characterised by a sudden onset of pain and limited movement. Here, we would generally inject with steroid as it is an inflammatory phase. The next phase is Frozen, where the joint is very stiff and difficult to move. Here, the joint has shrunk and become stiff. In order to regain movement a method used is hydrodilatation where by a large volume injection of saline, together with steroid, is placed into the capsule under ultrasound guidance with the additional fluid working to stretch the joint capsule and restore movement. This is highly effective and quickly advances the condition to its 3rd phase – ‘thawing’ – where pain is reduced and movement slowly returns. In this phase manual therapy and exercise are highly effective in rehabilitating the shoulder back to normal.

This injection is for those patients who have mild to moderate osteoarthritis, who want to continue leading an active life and who may not be having the longevity of hyaluronic acid alone. Sinogel is a long acting injection providing additional stability and durability when injected into the knee.

What is Sinogel?

Sinogel contains sodium hyaluronate and sodium chondroitin in a hybrid cooperative complex. It’s a proven treatment for osteoarthritis and similar degenerative conditions of large joints such as the hips. This combination represents an innovative approach that goes beyond traditional single-component hyaluronic acid injections.

What can I expect

We usually find that the knee responds after 7 days and then a further 6 weeks to find maximum benefits.

Aftercare

Unlike other hyaluronic acids, this unique injection can give rise to some stiffness for up to 72 hours. This reaction is thought to be prompted by the presence of sodium chondratin as the joint begins its regenerative process. We recommend a period of rest during this time.

How Sinogel Works
The treatment addresses the root cause of osteoarthritis pain at the joint level. In osteoarthritis, the synovial fluid which cushions the bones where they meet at joints tends to be lost or becomes too thin, which leads to pain and stiffness.
Hyaluronic acid is similar to a substance that occurs naturally in the joints. It works by acting like a lubricant and shock absorber in the joints and helps the joints to work properly. The addition of sodium chondroitin in Sinogel’s formulation may provide additional benefits for cartilage health and joint function.
Treatment Benefits
The effectiveness of Sinogel and similar hyaluronic acid treatments has been documented in clinical studies. Various scientific studies found it significantly reduces pain, restores mobility and quality of life for at least six months after the injection. This injection restores shock absorption in large joints (knee and hips joints), providing pain relief and improved joint mobility for people with osteoarthritis.
Recent research on hyaluronic acid treatments shows promising results. A 2023 study found that a majority of 166 patients who received one injection of a highly concentrated form of HA showed at least a 50% improvement in pain, stiffness and mobility, including walking, that lasted six months.
Who Benefits Most
They are generally most effective for patients with mild to moderate arthritis who have not found relief from medications, activity modification, or physical therapy. Hyaluronic acid injection is used to treat knee pain caused by osteoarthritis (OA) in patients who have already been treated with pain relievers (e.g., acetaminophen) and other treatments that did not work well.
Treatment Timeline and Duration
The effects don’t appear immediately. Benefits typically appear 4 to 6 weeks after treatment and can last up to 6 months; injections can be repeated if pain returns. Some patients may experience longer-lasting effects, with effects generally lasting 6 to 12 months.
Safety Profile
Sinogel has demonstrated good tolerability in clinical studies. It has a very good tolerability profile, with only mild, transient, and easily managed, local injection-site reactions and absence of systemic reactions. The most common side effect is mild pain and swelling at the injection site that goes away on its own.
The type of injection will be determined after your assessment. As independent clinicians we must assess your condition fully to ensure we provide you with the most effective treatment for your condition and the most evidence based. We will be able to help you with this decision at your assessment. If you have a mildly degenerative condition then we might suggest hyaluronic acid as this provides good pain relief and keeps the joint healthier for longer. Steroid is a great anti-inflammatory and works fast. However, repeated use is not healthy for the joint and we recommend no more than 3 injections per year with at least 3 months between injections. If you have a painful impingement or rotator cuff pain syndrome then we would suggest steroid as this is often a single injection and followed by expert rehabilitation, the pain does not come back. Injections can be administered on the day of your assessment, or you can book directly for an injection if your diagnosis is known. We will always perform a scan prior to the injection to confirm the diagnosis.
Injections are combined with a local anaesthetic and this helps to reduce any pain associated with the injection. Local anaesthetic can last for a an hour or two depending on where it is placed. The steroid can remain in reducing quantaties for many weeks. These injections can be curative, though for longer term and more chronic problems they can last for 2-8 weeks. Rehabilitation and continued treatment is best practice to ensure you achieve lasting results.