Joint & soft tissue injections.

About these injections

Joint and soft tissue injections use a small dose of corticosteroid (a powerful anti-inflammatory medication) often combined with a local numbing agent, injected directly into the painful joint or soft tissue. The goal is to reduce inflammation, ease pain, and improve function — usually alongside other treatments like physiotherapy or activity modification.

These are NOT cosmetic injections, joint replacements, or cures for underlying degenerative disease. They’re a tool to break the cycle of pain and inflammation, giving you a window of better function to engage with rehabilitation.

Common conditions treated

Shoulder

• Subacromial bursitis / impingement
• Rotator cuff tendinopathy
• Frozen shoulder (adhesive capsulitis)
• Acromioclavicular joint (AC joint) arthritis

Elbow

• Tennis elbow (lateral epicondylitis) — evidence is mixed; we discuss honestly
• Golfer’s elbow (medial epicondylitis)

Wrist and hand

• De Quervain’s tenosynovitis (thumb tendon)
• Carpal tunnel syndrome
• Trigger finger
• Thumb basal joint arthritis

Knee

• Osteoarthritis (mild to moderate)
• Pes anserine bursitis
• Some types of patellofemoral pain

Hip and pelvis

• Greater trochanteric bursitis (lateral hip pain)

Foot and ankle

• Plantar fasciitis (selectively, with careful technique due to fat pad atrophy risk)
• Morton’s neuroma
• Ankle joint and tendon conditions

Spine

Most spinal injections (epidural, facet joint) require imaging guidance and are typically done by pain specialists rather than in a GP setting. We refer for these.

What they do (and don’t)

Honesty matters here. Injections work well for some things and poorly for others.

What they do well

• Reduce inflammation
• Provide pain relief lasting weeks to months
• Improve function enough for productive physiotherapy
• Confirm a clinical diagnosis (if pain settles, the source is confirmed)
• Avoid or delay more invasive treatments in many patients
• Settle acute flares of chronic conditions

What they don’t do

• Reverse arthritis or repair structural damage
• Permanently cure tendinopathy — loading is the cure for tendons
• Substitute for rehabilitation
• Always work for everyone — about 30% of patients don’t get meaningful relief
• Work indefinitely — effects fade over time, particularly in degenerative conditions

Assessment

Proper injection requires proper diagnosis. We don’t just inject because someone has pain. Assessment includes:

1. History — onset, pattern, aggravating and easing factors, previous treatments, what you’d like to achieve.
2. Examination — specific clinical tests for the joint or tendon in question, looking for signs that match (and signs that don’t match) the suspected diagnosis.
3. Imaging where indicated — ultrasound or MRI helps confirm the diagnosis for some conditions and may also guide the injection itself.
4. Trial of conservative measures first where appropriate — sometimes physiotherapy, activity modification, or simple analgesia is the right first step.
5. Informed consent — the benefits, risks, and realistic expectations are discussed.

How the procedure works

The general process for an in-clinic injection:

1. Position — you’re positioned to give clean access to the target area (lying down, sitting, etc.)
2. Mark the spot — we identify the injection site by anatomical landmarks (and sometimes ultrasound).
3. Skin preparation — alcohol or antiseptic.
4. Injection — a small needle delivers the mixture of corticosteroid and local numbing agent. Most patients feel a brief sharp scratch, then pressure as the medication goes in.
5. Removal of needle and small dressing.

The whole procedure usually takes 5–10 minutes once you’re positioned. Total appointment time including assessment is typically 30 minutes for a single area, longer for multiple.

Ultrasound guidance

Some injections benefit from ultrasound guidance for accuracy — particularly deeper structures, small joints, or where the anatomy is unclear. We discuss whether this is needed and arrange accordingly. Image-guided injections may be done with our ultrasound colleagues or referred for accordingly.

After the injection

Most patients walk out and return to normal activity quickly. General after-care:

• The first 24–48 hours — the local numbing agent provides several hours of relief; this may then wear off and there can be a temporary increase in pain (“steroid flare”) before the corticosteroid effect begins
• Activity — rest the joint for 24–48 hours; avoid heavy use or impact
• Resume normal activity after 48 hours unless we advise differently
• Effect — typically begins within 3–7 days, with full effect by 2 weeks
• Side effects to watch for — significant pain increase, redness, warmth, swelling, fever (suggesting infection); contact us
• Skin colour or fat pad changes at the injection site — uncommon but possible, usually temporary
• Follow-up — we typically review at 4–6 weeks to assess response and plan next steps

How often, how many

General principles for joint injections for pain and inflammation:

• For most conditions, repeat injections to the same joint should be separated by at least 3 months
• Most clinicians limit joint injections for pain and inflammation to 3–4 per year for any single joint
• Persistent need for frequent injections suggests the condition isn’t being adequately addressed by other means — physiotherapy, surgery, or different diagnosis
• For some tendons (Achilles, patellar), corticosteroid is generally avoided or used very cautiously because of rupture risk

Alternatives

Injection isn’t the only option. Depending on the condition, alternatives include:

• Physiotherapy — often first-line, particularly for tendinopathy and most musculoskeletal pain
• Activity modification and analgesia — reasonable first step for many
• Hyaluronic acid injections — for some types of knee osteoarthritis
• PRP (platelet-rich plasma) — evidence is mixed but growing in some conditions
• Surgery — for some conditions, particularly carpal tunnel, trigger finger, severe arthritis
• Splinting or bracing
• Weight management — significantly affects knee and hip joints

We’ll discuss alternatives honestly — sometimes the right step is NOT an injection.

When to see us

Consider booking if:

• You have musculoskeletal pain that hasn’t settled with simple measures
• You’re on a long NHS waiting list and want assessment now
• You have a specific condition (trigger finger, tennis elbow, frozen shoulder, knee OA) and are considering injection
• You’ve had previous injections and want to discuss timing of the next
• You want a second opinion on whether injection is appropriate
• You have unclear musculoskeletal symptoms that need diagnosis

Frequently asked questions

Will it hurt?

Less than people expect. A brief sharp sting as the needle goes through skin, then pressure as the medication goes in. Most patients tolerate it well.

How fast does it work?

Local anaesthetic component works immediately but lasts hours. The corticosteroid effect begins in 3–7 days and reaches maximum at about 2 weeks.

How much does it cost?

Current prices are on our Fees page. Costs vary by joint and whether ultrasound guidance is used.

Will my insurance cover this?

Most UK PMI policies cover joint injections for recognised musculoskeletal conditions. We provide procedure codes. Verify with your insurer.

Will I need multiple injections?

Depends on the condition. Some respond to a single injection. Some need a series. Some don’t respond at all, and we change tack.

Are there side effects?

Most side effects are mild and short-lived — temporary pain increase (steroid flare), transient flushing, sleep disturbance, mild blood glucose rise in diabetics. Serious side effects (infection, tendon rupture, significant skin changes) are uncommon with good technique.

Can I drive home?

Usually yes — depends on which joint is injected. Knee or shoulder injections rarely affect driving. We’ll advise individually.

What if I have diabetes?

Tell us at booking. Corticosteroids can transiently raise blood glucose; we may monitor more closely or limit dose. Most diabetics can still have injections safely.

Can it make things worse?

Occasionally. Steroid flare (temporary pain increase) is the most common. Rarely, repeated injections to certain tendons cause weakening. We’re cautious about this.

What about Achilles tendon injections?

We generally don’t inject directly into the Achilles or patellar tendon because of rupture risk. There are safer alternative treatments for these conditions.