Operation
Injection of Joint or Other Area.
Procedure
An injection procedure is one that is carried out with a special needle and an x-ray machine is used to guide the needle into the correct area. The substance for injection is made up of local anaesthetic which blocks any pain, and a medication such as a steroid or hyaluronic acid (such as OSTENIL) that reduces inflammation.
You will be seen by the surgeon the day before or the day of the operation. If you have any questions, now might be a good time to ask them. The surgeon may also take this opportunity to draw an arrow (mark) on you – to make sure the correct joint is operated upon.
An anaesthetic will be administered in the theatre. This may be a general anaesthetic (where you will be asleep), sedation (where you are given medication to make you drowsy or a local block (e.g. Where you are awake but the area to be operated on is completely numbed). You must discuss this with the anaesthetist.
Your skin will be cleaned with antiseptic liquid and covered with clean towels (surgical drapes). You will be placed in such a way as to allow the surgeon a good view of the area.
The surgeon will take an x-ray and guide the needle into the area. Important structures will be avoided. Sometimes a dye that can be seen on the x-ray is injected and a picture is taken.
Then the surgeon will complete the operation by injecting the local anaesthetic and other medication such as steroids or hyaluronic acid.
ADDITIONAL PROCEDURES It may be necessary to do additional procedures which may include:
- release tightness or perform a division of a tendon or other structure with the tip of the needle that is used for the injection. (Percutaneous tenotomy).
- Manipulation of the area to ensure that the medication reaches all areas or to free a joint.
When you wake up, you may feel sore or feel nothing at all for a while. The numbness may be due to a special injection some anaesthetists use. There may be a thick bandage around the injected area.
You may be able to go home the same day as the operation, but you should discuss this with your surgeon.
The physiotherapists may show you some exercises to perform. It is important to follow these.
You will be informed of any follow-up appointments to see the surgeon again.
You should start to notice the vast majority of recovery within 6- 8 weeks.
Approximate Operating Time
10 Minutes
Alternatives
Simple painkillers may help you control the pain.
Your surgeon may recommend surgery. The type should be discussed prior to this injection. These can be successful at reducing the pain when injections, manipulation and tenotomies have not fully resolved the pain.
Risks-Common
PAIN: Usually disappears and then returns as the local anaesthetic wears off. Sometimes the pain becomes much worse for a few days. It usually takes up to 4 days for this pain to subside. It is important to discuss this with the staff and ask for painkillers if needed. Even after the operation, you may still have pain.
Risks- Less Common
SWELLING: Occurs when a tenotomy is performed.
Risks-Rare
NERVE DAMAGE: Within the area around the injection are a number of important nerves. These may be damaged by the injection or the instruments. Most effects are temporary. Nerve damage may result in muscle weakness or numbness further down from the site of injection. As there is local anaesthesia injected the effects of the injection can mimic nerve damage, however, this usually recovers within 12 to 48 hours leaving no permanent effect.
TENDON DAMAGE: The tendons around the joint may also be damaged during the operation or sometimes the tendons may become atrophic (thinned0 as a result of the steroid itself. This is rare.
BLEEDING: There will inevitably be some bleeding. But is usually small in this operation.
SCAR: The operation will leave one or two pinhole scars. You should discuss the position of these with your surgeon. The wounds can sometimes not heal well. This may lead to thickened scars or further surgery.
FAT ATROPHY (thinning): This can occur with the steroid injection which may cause a dimple or hollow in the skin.
INFECTION: This is may present as redness, discharge or temperature around the injection site. A course of antibiotics may be necessary or very rarely an operation to wash out the area.
FRACTURE: This can occur during the manipulation of an area. This is rare and every effort is taken to reduce this risk.