There are other injectables such as hyaluronic acid derivatives, which is normally found in the synovial fluid of the joints and is supposed to help with lubrication, in conditions such as osteoarthritis. It is now also being used for soft tissue injections for tendon related symptoms. These are more expensive but efficacy is similar to steroid.
Conservative management with NSAIDS and physiotherapy are other means of controlling symptoms. Surgery is another alternative to injections.
Types of procedures
There are a number of other procedures that can be performed under image guidances.
Barbottage- guided dry needling of calcific deposits in shoulders and elsewhere
Dry needling- making a number of passes through an area of tendon abnormality, where there is vascularity under ultrasound guidance. The aim is to produce bruising and scarring, that helps with symptom remission.
Autologous blood injection- taking blood from arm and injected into tendon abnormality. The aim is to instigate healing and scarring by platelets, a blood content and other factors found in blood.
Hydrodilation-this is used in frozen shoulder. Under fluoroscopy or ultrasound guidance, a large volume of local anaesthetic mixed with steroid is used to distend the shoulder joint. This alleviates frozen shoulder symptoms and is preferred to surgical manipulation. Prof Khan is currently co-applicant in national research in this procedure (2019-).
High volume injection- this is used in Achilles tendon symptoms. High volume of local anaesthetic is injected around the Achilles tendon, in order to improve symptoms.