ABOUT HAND AND WRIST PAIN TREATMENT
The base of the thumb joint is called the ‘Carpo-meta-carpal (CMC) joint’. This joint is prone to wear and tear, also known as ‘Osteoarthritis’.
The symptoms associated with this is a gradual worsening of the
- decreased strength
- loss of joint function
In moderate to severe cases of arthritis, a lump around the joint location can be seen. This is due to the enlarged or bony overgrowth due to bony repair.
Middle of the thumb joint called MCP (Metacarpophalangeal) joint, MCP joint is also prone to develop arthritis, but less common compared to the base of the thumb.
If you are experiencing painful joints, muscles, tendons or ligaments please get in touch for a diagnostic scan and or treatment
Who is prone to develop?
Occupations involving the repetitive use of the thumb joint, such as builders, butchers, carpenters, chefs, drummers, computers and keyboard users, engineers, housekeepers, plumbers, and painters. Other locations of hand /wrist prone to Arthritis:
- Radiocarpal joints
- Distal radio-ulnar joint
- Scapholunate joint
- Meta Carpo-phalangeal (MCP) joints.
- Interphalangeal joint (PIP/DIP)
- Scapho-trapezio-trapezoid joint (STT joint)
- De Quervain's Tenosynovitis
- Trigger finger /thumb
- Carpal Tunnel (Median nerve) syndrome
- Ganglion cyst aspirations and infiltrations
De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is an inflammation of the tendon sheath around the tendons (Abductor pollicis longus, Extensor pollicis brevis) that supply to the thumb.
• You may notice swelling /lump in between the base of the thumb and wrist.
• Very painful to move the thumb. Ex: Pinching, grasping, lifting, wringing.
• Make a fist by placing the thumb inside the palm and bend the wrist towards your little finger – if it causes pain, this can be due to De Quervain’s tenosynovitis.
- Any repetitive activities, such as sports, hobbies, typing, carpentry, painting, decorating can lead to this condition.
- This condition is commonly seen after pregnancy.
- In some cases cause is unknown.
If your symptoms do not improve with pain, rest, physiotherapy, medication you will benefit from an Ultrasound diagnostic scan to confirm the diagnosis and guided steroid injection to reduce the inflammation.
Surgery may be needed if you are not responded to the steroid injections.
Trigger finger /thumb
This is an inflammatory condition, which affects the tendon that catches or locks when tried to bend or straighten the affected finger or thumb. Tendon catching is due to the swollen nodular part of the tendon that cannot move freely throughout the tendon sheath.
- The sudden or gradual development of snapping tendon.
- You may feel a lump at the base of the finger – due to nodular thickening the tendon.
- Snapping/catching is more common in the mornings.
- Rheumatoid arthritis
- Occupation involving repetitive usage of hands/wrists.
Ultrasound sound can diagnose the trigger finger and helps to guide the needle to accurately infiltrate Corticosteroid injection to the problematic area. Prior to this rest, ice and physiotherapy are suggested.
Carpal Tunnel (Median nerve) syndrome
In this case, the median nerve is entrapped in the wrist at the carpal tunnel level.
- Loss / weak grip strength.
- .sually worse at night and in the morning.
- Tingling/pins and needles in the thumb, ring and middle finger.
- Reduced sensation/ numbness along the thumb side of the wrist
- Wrist tendons tenosynovitis
- Mass/cyst in the carpal tunnel
- Wrist injury
- Family history
Steroid injections can reduce the inflammation around the nerve and bringing the symptoms. Sometimes you may need another injection in a few months’ time. Surgery is needed if steroid injection fails to control the symptoms.
Ultrasound-guided injection ensures the steroid injection is carried out around the nerve, without actually damaging the nerve itself.
Ganglion cyst aspirations and infiltrations
A ganglion cyst is a thick fluid-filled sac, usually appears in the middle of the back of the wrist or front of the wrist on the thumb side.
- Not harmful, but It can be painful at times.
- It looks and feels like a smooth lump under the skin.
A ganglion cyst sometimes resolves on its own, other times, it requires aspiration of cystic fluid. Diagnostic ultrasound ensures the diagnosis of cyst and accurately aspirate the fluid/gel.
FREQUENTLY ASKED QUESTIONS ABOUT ULTRASOUND GUIDED INJECTIONS
How long does an ultrasound guided injection take?
This will vary dependant on the area and other factors, but an assessment, scan & ultrasound-guided injection will generally take around 60 minutes. Ultrasound guided injection alone is done in a few seconds. Injection alone is carried out in few seconds.
Are ultrasound guided injections painful?
Discomfort from the needle insertion can be minimised by using the local anaesthesia using a very fine small needle. Ram is an experienced and carried out more than 30,000 Ultrasound guided injections sofar. He routinely treats complex patients and patients with needle phobia, through the technique he developed through his experience.
What is an ultrasound guided cortisone / Steroid / Corticosteroid injection?
Cortisone injection is also known as Corticosteroid injection or steroid injection. This is a strong anti-inflammatory medication is used for many of the inflammatory and arthritis conditions to control pain, swelling, stiffness and improve function. Corticosteroid injections are NOT the same used by body builders use. Corticosteroid injections do not cause weight gain. To find out more please visit our ultrasound-guided steroid injections page from the 'Types of Guided injection' menu on the top.
Always, consider having the Steroid injections under ultrasound guidance for accuracy.
What is an ultrasound guided hyaluronic acid (HA) injection?
HA injection is also known as Gel injection or Lubricant injection. This viscosupplementation injection is a natural component of synovial fluid. This tends to increase joint fluid viscosity and restores the joint lubrication. Hence, acts as a shock absorber to control the joint /tendon symptoms. Limits the further damage to the joint and delays or avoids the need for the surgery. Aslo, helps to enjoy your daily activities or your preferred hobbies. To find out more please visit our GUIDED ULTRASOUND HYALURONIC ACID INJECTIONS page from the 'Types of Guided injection' menu on the top.
These injections are very popular, especially for knee joint pain. Any number of injections can be taken in a given period, due to minimal or no side effects from these injections. Usually a course of 3 Injections are preferred, though some may do well just with an injection per year 9 we have patients managing just with 1/year.
What is an ultrasound guided PRP injection?
Platelet Rich Plasma (PRP) injections are rich in growth factors ( helps in repairing the cell and its growth) and prepared from the patient's own blood. Separated growth factors from the patients blood is injected back into the affected area of the same patient. Due to PRP's ability to heal and even regenerate injured or aging tendons, ligaments and joints, providing some patients with an alternative to surgery. PRP therapy may reduce the required healing time for the injuries ( especially for sports injuries and early Arthritis ); otherwise athletes/ sports professionals may require longer periods of rest from their sports related activities. To read more please visit our Ultrasound Guided PRP page.
Always, consider having the PRP injections under ultrasound guidance for accuracy.
can i drive after an injection
You will not be able to drive immediately after the procedure. Bring someone with you Or use other form of transport to return home. This is mainly due to your driving licence policy, rather injection efficacy. Majority of the motor insurance policies will not allow you to drive for 3-5 hours after the injection with Local Anesthesia.
What should i expect after an injection?
After the injection you may feel pain free for couple of hours due to Local anaesthesia. However, pain returns after 2 hours, you may even feel more painful for couple of days due to bruising pain. Usually, you should starts feeling better from third day onwards. Pain relief from the steroid injection may take 1 to 2 weeks.
How to manage bruising pain?
Discomfort from the needle insertion can be minimised by using an ice pack ( wrapped in a towel, to minimise the risk of frostbite from a direct skin contact) to the area of treatment. 3-4 times a day and 10-15 minutes at each time
Will i always feel 100% pain free?
We can accurately inject the treatment area. However, pain relief depends on several factors, such as severity of the problem, body response to the steroid injection, rest period following an injection, rehabilitation and exposing to the risk factors.
how many injections can i receive?
corticosteroid Injections: 3 or 4 per treatment area / year.
Hyaluronic Acid : no limit as long as you are benefiting.
Platelet Rich Plasma (PRP) a course of 3, you can repeat as you like.
What conditions can be treated?
Arthritis, Tendinopathies, Ligament, Muscle and Nerve related problems. We also offer trigger point injections for persistent pain ( usually a course of 2-5 are effective).
How long the injection effect lasts?
It is hard to determine without an assessment. It may be possible to estimate after assessing the patient. Usually, lasts up to 3 months. There are many patients who benefited for more than a year to 2 years.
"I came to see Ram at his clinic regarding an ongoing issue with a tennis ball elbow injury. After carrying out an ultra scan he was able to carry out steroid injection. Very thorough and professional in explaining the root cause of the problem. Was able to give me an injection straight away and provide me with strict guidelines to follow after treatment. First class service and would highly recommend to anyone that requires pain management control."
Tennis Elbow Injury - Robbie Mehan
"Ram came to my home to deliver the treatment which was much appreciated. He was able to see me straight away, no waiting. We were able to look closely at the joint on ultrasound before he injected (hip) and see how it was looking. The injection was relatively pain-free (sharp scratch as it is done under local anaesthetic) and over fairly quickly. I have had an improvement in my mobility in the joint although I am still awaiting the full effect. I hope it will help me until the NHS are able to operate. Ram was very kind, very courteous and has kept in touch to check on my progress. Having sought other quotes for the same procedure he was very reasonable also. I would recommend him to anyone who has had this type of injection recommended to them by their Doctor. Thank you, Ram, it was much appreciated.."
Hip Pain Treatment - Alison Augustus
"Excellent treatment for trochanteric bursa.
Ram explained the procedure for the steroid injection given. He answered all of my mother's questions and provided her with the documentation for aftercare.
The procedure itself was painless and performed to her complete satisfaction. I would have no hesitation in recommending Joint Care Clinics"
Trochanteric Bursa - Lisa Mackie
"Our experience with Ram has been very positive and we would happily recommend his services to anyone. Ram is a very polite and friendly professional who took the time to explain his work before undertaking a guided steroid injection into my Mother’s knee joint. After experiencing months of pain in her knee, Mum had a GP administered steroid injection but derived no benefit. After Ram’s guided steroid injection Mum reports no pain whatsoever and it has improved her mobility considerably. Thanks, Ram"
Knee pain treatment - Julie Melck
"Great Service & highly recommend Joint Care Clinics:
My Mother-In-law has chronic knee & ankle pain. She was on painkillers every day, the pills caused a lot of heartburn & didn't help much with the pain. Ramakrishna Rachaputi suggested & explained in detail about the possible treatments. My Mother-In-law received an ultrasound-guided Injection on her knee & ankle. After that, she started feeling a lot better and no need to take pain killers every day.
All thanks to Joint Care Clinics"
Knee and ankle pain treatment - Vara Prasad Manda
"Having been in severe pain for several months in desperation I rang the Joint Care Clinic. Rami visited me at home the next day and was very thorough with his assessment. I had a ultrasound-guided injection into my hip. 10 days on and the pain has almost gone. I would recommend Rami
to anyone suffering pain in their joints."
Hip pain treatment - michael john cambridge
"Great service. I am a L4 sports massage therapist and corrective exercise specialist - and I am thoroughly impressed with the competency and knowledge of Rama. I would recommend his great service to anyone who suffer from musculoskeletal problems."
James Tang Fitness
"I recently had an Ostenil plus injection from Ram. He was very knowledgeable and put my mind at ease about the injection. He explained the procedure really well. He used an ultrasound to find the area that needed the injection. I would highly recommend him and I will definitely have another ostenil injection. I had an Injection one year earlier and it has really helped and would have no hesitation in having another one."
"Rami, was very clear in describing the procedure of what might or not occur during and afterwards. Rami also helped to make the appointment very relaxed. I personally had a very good experience and wouldn't hesitate to return"
"After experiencing bad arthritic knee pain I made an appointment with Ram for PRP injections, he was amazing, he explained everything clearly to me and reassured me as I am needle phobic, I would not hesitate to recommend this gentleman to anyone. Fantastic man ."
Knee pain treatment - JAN HATT
"I was suffering significant hip pain and the NHS muscular-skeletal unit were unable to diagnose the problem even though I had multiple scans including MRI. They were, therefore, unable to provide any treatment other than physiotherapy which didn't really help. At the first appointment with Ram, he was able via an ultrasound scan to diagnose Bursitis and give me a steroid injection. After a week or two, the pain was just about gone and my quality of life was significantly improved. I would highly recommend Ram."
hIP pain treatment - Jim McAlpine
"I have suffered problems with my left knee for several years now and have seen my local GP, Physio. , etc. and had various x-rays and treatment plans prescribed. Sadly, none of these have really helped and my knee has become progressively worse. Rami was excellent - taking a full background history to the problem followed by an exhaustive Ultrasound examination; fascinating to see ‘inside’ your knee in real-time! It is early days yet (just over one week) but , already I can start to feel an easing of the pain and a gradual ‘freeing-up’ of the joint. Overall I am very happy with the service and look forward to continuing improvement…"
"Exceptional Service & highly recommend Joint Care Clinics:
My mum has chronic knee & ankle pain. She was on painkillers everyday, the pills caused a lot of heartburn & didn't help much with the pain. Ramakrishna Rachaputi suggested & explained in detail about the possible treatments. My mum received an ultrasound guided Injection on her knee & ankle. After that she started feeling a lot better and no need to take pain killers everyday. She did enjoy her holiday in UK.
All thanks to Joint Care Clinics"
We cover a wide area throughout Warwickshire and surrounds, either by home visit or clinics in the following areas: Rugby, Coventry, Warwick, Solihull, Aylesbury, Milton Keynes, Leamington Spa, Stratford, Kenilworth, Whitnash, Atherstone, Bedworth, Leicester and Nuneaton. We also have clinics throughout the West Midlands including Birmingham and Solihull. We also have a clinic in Newcastle covering the North East.
If you do not see your area listed please still get in touch as we may be able to refer you to another practitioner in your area.