What will happen during my ultrasound appointment?

Allow 10-15 min before your appointment time.

There is no preparation required for the scan.

You may be asked to change into a gown.

The procedure takes 15-20 min and will be performed by a specialist musculoskeletal radiology consultant.

You will be in a sitting position when the radiologist will scan the shoulder in various positions after applying water based gel. If you prefer this procedure could be done in reclined position. Please ask.

Following the scan the radiologist will discuss results with you.

When steroid injection is planned he will do the injection while watching the needle continuously to guide it into the desired location.

After the injection you may wish to help yourself with a drink in the waiting room and make sure that you are comfortable before you set off.

What Clothing should I wear?

No specific clothing is required.

It will help if you can wear clothing that will allow you to easily expose the shoulder in question.

You will be asked to strip to the waist and to change into a gown if required. Bras can be left on but with the strap on the affected side down. During the ultrasound scan you will be covered except the shoulder in question.

My shoulder is very painful. Does it need moving during the scan?

Your radiologist will briefly examine the range in which your shoulder can move.

The high frequency ultrasound is a dynamic examination and therefore some easy positions are required to examine different tendons and structures. Usually the entire scanning can be done in natural position and ‘hand on the back pocket’ position.

If certain movements are painful the radiologist will modify the test to tailor fit your requirements and maximise assessment.

How is the injection performed?

I have had injection before. Is this different?

Will the injection be done from front, back or side?

Is the injection painful? Is it done with anaesthetic?

This is a very precise injection and is achieved first time every time.

The needle is constantly watched till the appropriate location. The injection is seen going into the desired structure. It is for this reason that the injection can be done from any direction (front, back or side) to get into the correct location.

Accurate injection is thus achieved with relative ease and no needle manipulations are required ‘to find the spot’, making the injection as painless as possible. The injected preparation contains anaesthetic (Lidocain or Marcain) which reduces any sore feeling afterwards.

The whole injection procedure itself takes only a few seconds and if you prefer you could watch it on the monitor as it is done.

Depending on the problem the injection is done in the bursa, shoulder joint, AC joint (acromioclavicular joint) or in combination.

The injection site will be covered with a small dressing which can come off in the next 24 hrs.

After the injection should I rest the shoulder to stop it going elsewhere?

Are there any specific precautions afterwards?

No. There are no specific restrictions or rest recommendations. Once the injection is made into the correct structure the shoulder movements do not change its effects.

Shoulder movements, exercises and physiotherapy can be resumed as tolerated.

Will the injection work straight away?

No. The steroid can take up to 10 days before it works well. Usually it starts working in 5 days or so. The anaesthetic used during the injection will last for the first few hours.

What are the side effects?

The steroid injection is a very safe drug with approval for use in bursa and joint.

It can be used safely with other conditions with no significant drug interactions.

The injection is precisely injected and works on the injected area only. It has no general effects and does not put you at risk of putting on weight.

Even if you are on oral steroids, there is no need to change your dose.

However, if you are a diabetic and take insulin, it may affect your blood sugar levels initially for a few weeks

Side effects are very rare and include

• Skin thinning, dimpling and change in skin colour at the site of injection.

• Flushing and redness of the face and upper chest for a few days. It is more of a nuisance rather than a reaction and usually settles down over a few days.

• The area of injection may look or feel bruised for a few days.

• Infection is a very unusual complication which can occur from any kind of injection. If the injection area become red, hot and swollen and you feel unwell you should seek immediate medical help.

• Serious or breathing related side effects are not expected with this injection and if such symptoms are encountered, you should seek immediate medical help via a GP or emergency department.

What is a pain diary?

It may be helpful to maintain some sort of record which you could take to your GP or surgeon during follow up. We recommend maintaining a record at least once a week for first 6weeks or so. Numerical pain score from 1-10 scale is better e.g. shoulder pain of 8 before injection and 5 one week after, etc.

It is also useful to record improvements in shoulder movements in various directions (front and side elevations and out and in rotations) but this can be a bit more tricky and you may wish not to. Elevations can be recorded roughly in degrees of angle e.g. front and sideways 90 degrees means at the shoulder level. Rotations can be recorded when elbow bent by the side of body in degrees e.g inwards 20 deg and outward 30 deg. Rotations can also be recorded as above the head and behind the back to a e.g. backward rotation to hip or to midback.

We could give you a simplified pain diary when you attend- please ask.

Can I drive afterwards?

Most people are able to drive after an injection, however if the shoulder joint is quite painful and stiff before the injection, it might be best to plan public transport or arrange someone to drive you home.

Will I get the results?

Following the scan the report is printed on the same day and is posted to your referring GP or Surgeon. A copy of this report could be sent to you on request.