Read on: danhwilliams.com

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I had a steroid injection once. And it was…

MIRACULOUS!

18 years ago. Training for a triathlon.
At the peak of my training. And..

Ankle tendon pain stopped me in my tracks.

I could hardly walk. Let alone run.

Where I work, I’m lucky to be surrounded by colleagues at the top of their game. One of our foot and ankle team took a look and injected the tendons on the outside of my ankle.

And that night... I was in AGONY.

‘Ah! This has NOT worked.’

I called my colleague all sorts of names (to myself, of course).
Then I woke up the next morning…

COMPLETELY PAIN FREE.

Wow! Could not believe it…

Pain = switched off.
Colleague = zero to hero.

I got back to ankle strengthening. Quickly scaled back to running.
And swam, biked and ran to a pretty good time.

Steroid injections-  at the right time, in the right place- can work really well. So...


Why I am now doing fewer and fewer injections?

Well, as ever the answer lies in the evidence. Let’s walk through joint injections…

Hip injections are in-and-out day cases. Done in the operating theatre.
Knee injections are sometimes theatre day cases, sometimes clinic cases.

Portable x-ray imaging guides a long needle into the hip joint under local anaesthetic.

Patients are awake. The joint is filled local anaesthetic + (usually) steroid. That numbs the hip (or knee) for about 4 hours. It takes away any pain coming from the hip joint.

It’s a good test of where the pain is coming from.

NO PAIN in those first 4 hours = all your pain is coming from your hip joint.
NO CHANGE in pain = your pain is from elsewhere. Not your hip joint.

The local wears off. And pain is worse on the night of the injection.
Patients don’t like me. They swear my name (to themselves).
A hip, full of fluid, is more painful.

Steroid in a joint takes longer to kick in than in, say, around an ankle tendon.
Pain settles over 7 to 10 days.

Inflammation is dampened. And that relief can last a few weeks to a few months.
Less pain. A window in time to start moving more. To strengthen muscles.

It’s difficult to start moving more when a joint is screaming at you. Even though joints hurt less when we DO move more.


And when it wears off?

The temptation is to have another injection. However...

Injection 1 => generally works well.
Injection 2 => less well, and…
Injection 3 => a waste of time.

Repeated hip or knee injection might make both of us- surgeon and patient- feel like we were doing something.

But it’s NOT the best approach, even in the medium term.

A few weeks of pain relief is not a good return on investment.
And there's some recent evidence shows that joint injection can accelerate joint arthritis.

Oh!

AND joint injection too close in time, before hip replacement, increases the risk of a deep infection. A small increase, but a BIG disaster...