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À propos de nous Tendon Fenestration (Dry Needling) ​Includes: ​ Thorough clinical assessment Diagnostic ultrasound Ultrasound guided tendon fenestration Written report Care plan & exercise prescription if indicated What is Tendon Fenestration ? Also called Percutaneous Tenotomy, fenestration is performed on chronic tendon disorders (tendinopathies) which have not improved after at least 6 months of conservative management. During the procedure, we perform several small incisions with a small needle in the affected tendon under local anaesthesia and ultrasound guidance. These incisions can stimulate blood flow to the area and promote the body's natural healing response. The process also triggers an inflammatory reaction, which helps in the repair of the tendon. This is followed by an intensive rehabilitation period. ​ Do I need Tendon Fenestration ? We typically recommend this treatment for non improving tennis or golfer's elbow as an alternative to surgical management . Recent research also suggest that it could help for lateral hip pain in case of gluteal tendon disorders . If you are unsure that it is the right treatment for you , please reach out and book a free virtual consultation . ​ How is Tendon Fenestration performed ? In tendon dry needling, thin small needles similar to the ones used for injections, are inserted repetitively into the tendon after numbing the area with local anaesthetics. The exact mechanisms through which tenotomy works are not fully understood, but it is thought to involve several factors. The insertion of needles may stimulate the release of certain chemicals in the body that help reduce pain. Additionally, the needles may create small disruptions in the muscle tissue, promoting a local healing response. ​ ​ Our South London Clinic We also provide home visits 2 min from Brixton Underground Station 8 min from Pimlico via Victoria Line 15 min from Oxford Circus 27 min from King's Cross St Pancras ​ South London Clinic Details Book an Appointment Booking an appointment is easy. Simply choose an available slot for a free phone consultation and we'll do the rest. ​ There are no long wait times and we offer same day appointment. Book Appointment Now

À propos de nous Ultrasound guided Shoulder Hydrodistension Includes: ​ Thorough clinical assessment Diagnostic ultrasound Ultrasound guided hydrodistension Written report Care plan & exercise prescription if indicated What is a shoulder hydrodistension? ​ Hydrodistension, also called hydrodilatation, is a technique is used to treat capsulitis (frozen shoulder) when other treatments have failed. Frozen shoulder is characterized by pain and stiffness in the shoulder joint resulting in severe limited mobility. After numbing the shoulder with an anaesthetic agent, sterile saline is injected to attempt to stretch the joint and help to recover some mobility. Here's an overview of the expected benefits: ​ Mechanical Stretching: The injected fluid creates pressure within the joint, mechanically stretching the capsule. This stretching aims to break up adhesions that may have formed within the joint capsule, contributing to the restricted range of motion in frozen shoulder. Increased Joint Space: Hydrodistension temporarily increases the joint space within the shoulder. This temporary expansion can help improve shoulder mobility and reduce the sensation of tightness associated with frozen shoulder. Facilitating physiotherapy: Shoulder hydrodistension is often used in conjunction with exercises. The increased joint space created by the procedure can make it easier for individuals to engage in physiotherapy, which plays a crucial role in restoring normal shoulder function. Pain Relief: The mechanical stretching of the joint capsule, the associated disruption of adhesions and injection of corticosteroid also contribute to pain relief for individuals with frozen shoulder. ​ Recent medical research suggests that hydrodistension helps more in the short term mobility in comparison to steroid injection alone. However it is not clear if it helps in the long term. We typically recommend this procedure if more conservative management has failed and prior to consider surgical management. ​ How an hydrodistension is performed? ​ Here's an overview of how shoulder hydrodistension is typically performed: ​ An ultrasound scan is first performed to exclude other pathologies and confirm where the injection will be performed. We first inject local anaesthetics around and inside the shoulder joint in order to minimize pain during the procedure. Sterile fluid (often a saline solution) is injected slowly into the joint capsule to attempt to stretch the joint capsule. A corticosteroid injection is then performed at the end of the procedure. ​ How much do an Hydrodistension for frozen shoulder cost? Our hydrodistension procedures start at just £300 including initial telephone consultation, diagnostic ultrasound, ultrasound-guided intervention, written report with care plan and exercise prescription if appropriate. See our fees Is an hydrodistension painful? ​ Most of our patient report no or very limited pain during our procedures. However, like any medical procedure it can cause varying levels of discomfort. The sensation during the injection may range from mild pressure to more noticeable pain, depending on factors like the injection site or individual pain tolerance. ​​ What if I am scared of needles? That is absolutely fine, we are used to dealing with needle apprehension and phobia. Patient anxiety and fear of needles can contribute to the perception of discomfort. Discussing concer ns with the healthcare provider and employing relaxation techniques can help manage anxiety. While some individuals experience minimal pain, others may feel more discomfort. It's essential to communicate openly with your clinician about pain levels to ensure a comfortable and effective experience. Let us know about any needle phobia or intervention related anxiety as our care can be adapted. ​ Our South London Clinic We also provide home visits 2 min from Brixton Underground Station 8 min from Pimlico via Victoria Line 15 min from Oxford Circus 27 min from King's Cross St Pancras ​ South London Clinic Details Book an Appointment Booking an appointment is easy. Simply choose an available slot for a free phone consultation and we'll do the rest. ​ There are no long wait times and we offer same day appointment. Book Appointment Now

À propos de nous Consultation & Diagnostic Ultrasound Ultrasound Guided Cortisone Injection Hyaluronic Acid (Gel) Injection Ultrasound guided Barbotage US guided Tendon Fenestration (Dry Needling) Ultrasound guided Shoulder Hydrodistension Our South London Clinic We also provide home visits 2 min from Brixton Underground Station 8 min from Pimlico via Victoria Line 15 min from Oxford Circus 27 min from King's Cross St Pancras ​ South London Clinic Details Book an Appointment Booking an appointment is easy. Simply choose an available slot for a free phone consultation and we'll do the rest. ​ There are no long wait times and we offer same day appointment. Book Appointment Now

À propos de nous Hyaluronic Acid Injection ​Includes: ​ Thorough clinical assessment Diagnostic ultrasound Ultrasound guided injection Written report Care plan & exercise prescription if indicated What is a Hyaluronic Acid Injection ? ​ Hyaluronic acid (HA) is a naturally occurring substance found in the human body and other animals and is present in various tissues and fluids, with high concentrations found in connective tissues, skin, eyes, and synovial fluid within joints. In joints and tendons, HA ensures normal, painless movement due to its lubricating and shock­ absorbing properties. It is also responsible for the nutrition of the cartilage. It's important to note that the production of hyaluronic acid in the body can decrease with age, and this reduction is associated with changes in joint health and skin aging. As a result, hyaluronic acid-based treatments are sometimes used to supplement the body's natural levels. ​ Hyaluronic acid injections have been proven safe and effective for chronic moderate osteoarthritis and tendon disorders . We typically recommend these injections for knees and hip osteoarthritis or patellar, Achilles and posterior tibial tendinopathy . We use Ostenil Plus and Ostenil Tendon. ​ How do Hyaluronic acid injections work ? Hyaluronic acid, also called viscosupplementation, is injected as a gel. Mechanism of action and effects on joints and tendons is multiple but here are some general considerations: ​ Joint Lubrication : Hyaluronic acid is a natural component of synovial fluid, which lubricates joints. In individuals with osteoarthritis or certain joint conditions, the concentration and quality of hyaluronic aci d in the synovial fluid may be reduced. HA injections supplement the natural hyaluronic aci d in the joint, improving lubrication and potentially reducing friction and pain during joint movement. Anti-Inflammatory Properties : Hyaluronic acid has anti-inflammatory properties. By reducing inflammation within the joint, it may help alleviate pain and improve function. This can be particularly beneficial in conditions like osteoarthritis, where inflammation contributes to joint discomfort. Stimulation of Tissue Healing : Some research suggests that hyaluronic acid injections may have a positive effect on the tissues within and around the joint. This includes potential benefits for cartilage and other joint structures, promoting tissue healing and regeneration. Tendon Health : While hyaluronic acid injections are primarily targeted at the joint space, there is medical research suggesting that they may have positive effects on the surrounding tissues, including tendons by promoting tendon gliding, reducing adhesion as well as improving tendon architectural organisation. ​ How often do I need to have hyaluronic acid injections? ​ The frequency of hyaluronic acid injections depends on various factors, including the specific medical condition being treated, individual response to the injections, and individual features. Typically, we perform a single injection per joint and two injection with one week in between for tendons. Prior to repeat an injection, we will consider the severity and chronicity of the condition, the location of the injection, and any potential side effects associated with repeated use. There is no risk of becoming addict to hyaluronic acid if you have repeated procedures. Hyaluronic acid injections can also be c ombined with co rticosteroid injections in some occasions. How much do Hyaluronic Acid injections cost? Our HA injections start at just £300 including initial telephone consultation, diagnostic ultrasound, ultrasound-guided injection, written report with care plan and exercise prescription if appropriate. See our fees ​ What are the contraindications and risks associated to HA injections? ​ Hyaluronic acid injections are extremely safe and very rarely cause side effects. However, like with any medical intervention, there are risks of allergic reactions, infection, bruising, feeling of heat, redness, joint swelling, tachycardia, hypertension, hypotension, shortness of breath, nausea, itchiness or temporary incre ased pain after the procedure. H yaluronic acid preparations used in our clinic have been obtained by biofermentation and contain no animal protein but Ostenil Tendon contains mannitol which helps to stabilise the hyaluronic acid. If you have known allergy to Ostenil components it's an absolute contraindication. Other contraindications includes patients under 18, pregnant and breastfeeding women. We also do not inject hyaluronic acid on patients with rheumatoid arthritis or ankylosing spondylitis due to the absence of clinical studies. For more information, the manufacturer leaflets are available here for Ostenil Tendons and here for Ostenil Plus. ​ Is the injection painful? Most of our patient report no or very limited pain during our procedures. However, like any injection, administration of hyaluronic acid can cause varying levels of discomfort . The sensation during the inj ection may range from mild pressure to more noticeable pain, depending on factors like the injection site or individual pain tolerance. Whenever possible, we also use local anaesthetic to minimize pain. ​ What if I am scared of needles? ​ That is absolutely fine, we are used to dealing with needle apprehension and phobia. Patient anxiety and fear of needles can contribute to the perception of discomfort. Discussing concerns with the healthcare provider and employing relaxation techniques can help manage anxiety. While some individuals experience minimal pain, others may feel more discomfort. It's essential to communicate openly with your clinician about pain levels to ensure a comfortable and effective experience. Let us know about any needle phobia or intervention related anxiety as our care ca n be adapted. Book an Appointment Booking an appointment is easy. Simply choose an available slot for a free phone consultation and we'll do the rest. ​ There are no long wait times and we offer same day appointment. Book Appointment Now Our South London Clinic We also provide home visits 2 min from Brixton Underground Station 8 min from Pimlico via Victoria Line 15 min from Oxford Circus 27 min from King's Cross St Pancras ​ South London Clinic Details

À propos de nous Cortisone Injections ​Includes: ​ Thorough clinical assessment Diagnostic ultrasound Ultrasound guided injection Written report Care plan & exercise prescription if indicated What is a Cortisone Injection? ​ ​​ Although “cortisone" is often used as a general term, it refers to a class of hormones called corticosteroids which are natural anti-inflammatory substances produced by the body. We do not actually inject cortisone as per say as it is short acting and less potent, but we use medications of the same family such as Triamcinolone Acetonide, Methylprednisolone or Dexamethasone which last longer and are more effective to manage inflammation, decrease pain, swelling and stiffness. We usually combine these injections with local anaesthetic drugs such as lidocaine , to reduce the discomfort of the injection and limit pain afterward. These are very safe and effective treatment which can be used for a high range of conditions. Are corticosteroid injections painful? ​ Most of our patient report no or very limited pain during our procedures. However, like any injection, administration of corticosteroid can cause varying levels of discomfort. The sensation during the injection may range from mild pressure to more noticeable pain, depending on factors like the injection site or individual pain tolerance. Some areas like the sole of the feet or the palm of hands may be more uncomfortable. Whenever possible, we also use local anaesthetic to minimize pain. ​ What if I am scared of needles ? That is absolutely fine, we are used to dealing with needle apprehension and phobia. Patient anxiety and fear of needles can contribute to the perception of discomfort. Discussing concerns with the healthcare provider and employing relaxation techniques can help manage anxiety. While some individuals experience minimal pain, others may feel more discomfort. It's essential to communicate openly with your clinician about pain levels to ensure a comfortable and effective experience. Let us know about any needle phobia or intervention related anxiety as our care can be adapted. ​ How often do I need to have cortisone injections done ? The frequency of corticosteroid injections depends on various factors, including the specific medical condition being treated, individual response to the injections, and individual features. Prior to repeat an injection, we will consider the severity and chronicity of the condition, the location of the injection, and any potential side effects associated with repeated use. There is no risk of becoming addict to corticosteroids if you have repeated procedures. ​ ​ How much do cortisone injections cost? Our cortisone injections start at just £240 including initial telephone consultation, diagnostic ultrasound, ultrasound-guided injection, written report with care plan and exercise prescription if appropriate. See our fees ​What are the risks associated with cortisone injections ? Fortunately, serious side effects to corticosteroid injections are rare but like any drug or medical intervention there are risks such as anaphylaxis (life-threatening allergic reaction, which is extremely rare in response to injected steroid or local anaesthetics), infection (1 out of 50 000 patients), but more likely to occur if you suffer from diabetes, rheumatoid arthritis, Chronic Kidney Disease, HIV or if you take intra venous drugs. If the injected area becomes extremely painful, hot, red, swollen or that you develop fever or feel unwell after the injection it might indicate the presence of an infection. You should immediately attend an urgent care centre or your local A&E department. ​ Less serious reaction can occur such as a temporary increased pain (20% of the cases), cosmetic changes to the skin including depigmentation or localized fat atrophy around the injection site, bruising around the injection site (more likely, if you are on blood thinning medications), tendon rupture, increased cartilage degeneration, numbness or tingling, abnormal vaginal bleeding, temporary facial flushing, mood disturbances or depression (if you or your family have a history of psychosis or bipolar disorders) and of course failure to work. ​ Your clinician is trained to recognise and deal with severe immediate reaction and we are equipped with the appropriate first aid equipment. To minimise risks of side effects we advise rest for 48h (including driving) and you will be asked to wait up to 20 minutes in the waiting area. ​ What are the contraindications to cortisone injections ? ​ Like for any medical intervention, careful consideration of risks and benefits with your healthcare provider is crucial before opting for cortisone injections. Our absolute contraindications to cortisone injections are: ​ 1. Previous allergic reaction to corticosteroids or local anaesthetics (corticosteroids can be injected without local anaesthetic). 2. Ongoing fever, feeling unwell or currently taking antibiotics (you can receive the injection after your course of antibiotics). 4. Recent trauma or fracture. 5. Osteoporosis near the injection site. 6. Injection in an unstable joint (dislocating regularly). 7. Injection into a prosthetic joint (e.g., Total knee replacement). 8. Any surgery planned in the next 6 weeks (including dental) or joint replacement in the next 9 months . 9. If you have received a live vaccine within 2 weeks prior to the injection or due to have it within the 2 weeks following the procedure. Typical live vaccines include Live-attenuated Influenza (LAIV) vaccines (flu), some COVID vaccines, Measles, Mumps & Rubella (MMR), Polio, Smallpox, Chickenpox, Yellow Fever, Japanese encephalitis, Shingles, Rotavirus. 10. You already had 3 injections in the same site on the past 12 months , or last injection was less than 3 months ago for a load bearing joint (knee, hip, ankle...) or 1 month for any other body part. 11. Pregnancy. 12. Under 18. ​ Below is the list of precautions which need further attention prior to receive a corticosteroid injection: ​ 1. If you are currently receiving treatment for cancer, HIV, Hepatitis C or currently take Disease-Modifying Anti-Rheumatic Drug (DMARD), you need approval of your consultant prior to receive a corticosteroid injection. 2. If you have glaucoma , your need approval from your optometrist prior to receive a corticosteroid injection. 3. If you are on anti-coagulants : Warfarin (Coumadin) : INR needs to be within patient’s therapeutic range and not greater than 3 within 48h prior to the procedure. You do not need to stop the warfarin. DOACs (Direct Oral Anticoagulants) such as Apixaban (Eliquis), Rivaroxaban (Xarelto), Edoxaban (Savaysa), Betrixaban (BevyxXa), Dabigatran (Pradaxa) do not need to be stopped. 3. If you are Diabetic and taking insulin, you need to have your HbA1c below 69mmol/mol (8,5%) within three months prior the injection. Corticosteroid injections can lead to transient hyperglycaemia and you will be advised to check your blood glucose level for up to a week after the injection. 4. If you have high blood pressure , you can experience a transient raise in blood pressure and you need to monitor it the 48h following the procedure. Are cortisone injections only treating the symptoms and not the root of the problem? A common belief is that cortisone injections do not address the underlying causes of your pain but are there to only rapidly stop the symptoms. Your pain has a massive impact on your daily life and any relief, even temporary, can help significantly with your sleep, work or family activities, and as a result, improve your general wellbeing and mental health.​ Fortunately, simple pathologies, even when causing severe pain, tend to improve overtime and when the steroid effect start to fade away, your body has healed by itself and the pain won't return. However, steroid injections can also be part of a permanent solution by offering a pain free window that you should use to begin further treatment with a physiotherapist to address other causative factors for your pain. A cortisone injection can also be a permanent solution by stopping chronic inflammation or breaking your cycle of pain. More information can be found on our blog. ​ Can I have a cortisone injection while I am pregnant or breastfeeding? Cortisone injections during breastfeeding is safe. No side effects on breastfed infant has never been reported for any corticosteroids. The amount of drug passing through the breast milk is very small and will no cause any harm to your baby. However, reduced maternal milk production has been reported. More information can be accessed on the Breastfeeding Network or the Drugs & Lactation database (LactMed®). Of course we will always weigh potential benefits against potential risks, considering factors like the specific condition being treated, and the overall health of the mother and baby. As with any treatment, the lowest effective dose for the shortest duration is preferred. ​ Pregnant women are often subject to various musculoskeletal conditions which are commonly well managed with cortisone injections such as Carpal Tunnel Syndrome, De Quervain Tenosynovitis or sacroiliitis. Corticosteroids are known to cross the placenta with systemic administration such as oral or intravascular drugs. However there is little support that it increases any developmental defect on the baby. Despite non-systemic corticosteroids, which means drugs not reaching the entire body circulation such as cortisone injections inside a joint, are not considered absolute contraindication by recent medical research , we do not offer injections during pregnancy. If you are suffering from a MSK condition during your pregnancy, a diagnosis from a medical professional is an essential first step in understanding your problem and understanding what is the right course of treatment for you since effective alternative management can be offered. Book an Appointment Booking an appointment is easy. Simply choose an available slot for a free phone consultation and we'll do the rest. ​ There are no long wait times and we can offer same day appointments. Book Appointment Now Our South London Injection Clinic Our South London Injection Clinic is conveniently situated just a couple of minutes from Brixton underground and on many major bus routes. ​ Our full range of services is available, including South London Cortisone Injections . We also provide cortisone injection home visits in London . ​ For more details including opening hours and directions, follow the link below. South London Injection Clinic

À propos de nous Cortisone injections for De Quervain tenosynovitis at our clinic We are a leading cortisone injection clinic offering steroid injections for pain from De Quervain tenosynovitis. Steroid injections can bring significant relief from your tenosynovitis pain and bring you much-needed respite from your condition. ​ We offer private injections at our South London clinic and also offer home visits in the South London area. A free telephone consultation is available to understand whether injections will be helpful and appropriate in your particular case, and your appointment also includes a diagnostic ultrasound consultation to ensure your injection will be safe and give you maximum benefit. ​ Booking is quick and easy, please see our book appointment page for more details. Types of tenosynovitis that are suitable for cortisone injections Tendonitis is a general term used to describe conditions that affect tendons, the thick, fibrous cords that connect muscles to bones. The term tendinopathy is preferable since tendonitis suggests an underlying inflammation which is not always present and tendinopathy encompasses a range of tendon disorders, including tendonitis and tendinosis. These conditions involve damage, degeneration, or inflammation of the tendons, typically due to overuse, injury, or aging. ​ Tendonitis : Inflammation of a tendon which often occurs as a result of repetitive stress, overuse, or acute injuries. Common symptoms include pain, swelling, and tenderness at the site of the affected tendon. The pain is usually aggravated by movement. Tendinosis : Non-inflammatory condition characterized by degeneration of the tendon tissue. It is often associated with chronic overuse and may result in microscopic tears in the tendon. Tendinosis may present with pain, stiffness, and reduced function. Unlike tendonitis, there is not always inflammation. ​ Calcific tendonitis : condition where calcium deposits form in a tendon, leading to inflammation, pain, and potential restriction of movement in the affected joint. It often occurs in the shoulder. ​ Tendinopathy can affect any tendon in the body, but it commonly occurs in the tendons of the shoulders, elbows, wrists, hips, knees, and ankles. ​ Causes and risk factors usually include repetitive stress or overuse, natural degeneration from age, incorrect or poor technique during physical activities, poor general health and conditioning, smoking or the presence of other condition such as diabetes, thyroid dysfunction or inflammatory diseases like rheumatoid arthritis. ​ In order to ensure injection therapy is the right course of action in your particular case, we offer a free virtual consultation to get a quick picture of your health and the condition you are experiencing, and advise on whether steroid injections are a good course of action for you. At your appointment we will also carry out a full ultrasound-led diagnosis and assessment to ensure you are receiving the most appropriate treatment and best possible care. “Max is a highly trained, responsive, competent, communicative, and caring practitioner and person. He has successfully treated me for the management of knee pain and other arthritic conditions over the last 5-6 years enabling me to live a physically active life. I really cannot recommend Max highly enough.” ​ Helena Davis, 55, Personal Assistant at Royal College of Psychiatrists What our patients say How do cortisone injections help with De Quervain tenosynovitis? Cortisone injections can rapidly reduce pain, bringing much-needed relief and increased mobility. If you have found your work or other daily activities involving pinching, gripping, or anything being hindered by your pain, a steroid injection can allow you the freedom to get back to work and normal life. ​ Pain is not to be underestimated and when it becomes bad it can become debilitating and lead to depression. Pain can also lead to inactivity which can cause further problems such as postural and health issues, leading to even further inactivity, known as the chronic pain cycle . It is crucial to seek help when you are in pain and not simply try to live with it, as when left unchecked pain can cause gradual deterioration of both mental and physical health. ​ The break from pain and other symptoms brought by steroid injections will also allow you to take other actions to proactively combat your problem. In particular, you will be able to follow a physiotherapist-prescribed exercise programme to deal with your condition at the root. It is important you do any exercises your physiotherapist gives you to avoid your problem worsening in the future and potentially leading to more problems further down the line. ​ All our treatments include a written report and guidance on moving forward with treating your problem following your injection, so that you can use the opportunity the injection gives to set yourself on a path to better health. We also include a personalised physiotherapy exercise plan wherever appropriate. ​ For more information about cortisone injections and frequently asked questions, see our cortisone injections page . How much do cortisone injections cost? Our cortisone injections start at just £240 including initial telephone consultation, diagnostic ultrasound, ultrasound-guided injection, written report with care plan and exercise prescription if appropriate. See our fees What tenosynovitis do you typically treat with injections? Whilst there is no definitive list, tendons disorders that we often see as candidates for injection therapy include: ​ De Quervain tenosynovitis Peroneal tendinopathy Long head of biceps tenosynovitis Posterior Tibial Tendon Dysfunction Tennis elbow & golfer's elbow Rotator cuff tendinopathy Gluteal tendinopathy Plantar fasciitis ​ We offer corticosteroid or hyaluronic acid injection depending the type of condition and its location. In all cases, a consultation with a medical professional is crucial in choosing the right course of treatment for your particular case. Are cortisone injections a long-term solution for De Quervain tenosynovitis? A common belief is that cortisone injections do not address the underlying causes of your pain but are only there to rapidly stop the symptoms. First of all, your pain has a massive impact on your daily life and any relief, even temporary, can help significantly with your sleep, work or family activities, and as a result, improve your general wellbeing and mental health. Fortunately, simple pathologies, even when causing severe pain, tend to improve overtime and by the time the steroid has stopped working, there is a good chance that your body has healed by itself and the pain won't return. ​ Secondly, the pain free period allowed by steroid injections is a window that will be used to begin further treatment such as an exercise program that we will prescribe or sessions of physiotherapy to address other causative factors for your problems. ​ In some cases steroid injections can also be a permanent solution by stopping chronic inflammation or breaking your cycle of pain. More information can be found on our blog. At your virtual consultation and first appointment our physiotherapist will carry out diagnostic work to fully understand your problem and explain to you the options available. They will help you to understand how you can use the respite from pain which a corticosteroid injection provides to work directly on your problem and provide you with a personalised exercise plan to avoid reliance on steroids in the future. Your clinician All our injection treatments are carried out by our experienced physiotherapist and injection clinician, Maxence Legout. Max has over 15 years experience and holds a senior position in the NHS, where he carries out over 2000 ultrasound-guided injection & procedures every year. ​ For more information please see our clinician page , or book a free telephone consultation to speak to Max directly. Read More What other treatments are available for De Quervain tenosynovitis? After an acute injury, such as recent repetitive strain or overuse, usually rest, ice, activity modifications and painkilling treatments like over-the-counter medications or gels are often sufficient. Depending on the location, bracing or Supports can provide stability and reduce strain on the affected tendon. Giving the affected tendon some time to recover is often a key component of treatment and fortunately, most tendonitis will resolve naturally overtime. If symptoms do not settle after 6-12 weeks the following treatments can be alternative, complementary or subsequent to cortisone or hyaluronic acid injections . ​​ Physiotherapy and exercises is an important aspect of tendon rehabilitation as it modulates pain, helps strengthen muscles, improve flexibility, and promote healing with an exercise induced response in collagen turnover, blood flow, anti-inflammatory activity. Extracorporeal Shock Wave Therapy (ESWT) uses shock waves to stimulate healing in the affected tendon. Dry Needling or tendon fenestration is a procedure involving the creation of small openings in a tendon to promote healing. Barbotage for calcific tendonitis which involving the injection and aspiration of fluid into and out of a tendon to remove calcifications. Platelet-Rich Plasma (PRP) Therapy involves injecting a concentrated form of the patient's own blood platelets into the tendon to promote healing. There is currently limited evidence to supports its use in regard to costs. Surgery might be necessary for severe cases not responding to conservative management. More information can be found here . ​ The specific treatment approach depends on the type and severity of tendinopathy, and it's crucial for individuals experiencing symptoms to seek professional medical advice for an accurate diagnosis and appropriate management MEDICAL REVIEW - The medical information on this page has been reviewed for accuracy by Maxence Legout, Physiotherapist . Our South London Clinic We also provide home visits 2 min from Brixton Underground Station 8 min from Pimlico via Victoria Line 15 min from Oxford Circus 27 min from King's Cross St Pancras ​ South London Clinic Details Book an Appointment Booking an appointment is easy. Simply choose an available slot for a free phone consultation and we'll do the rest. ​ There are no long wait times and you can normally have your injection treatment within 3-4 days of first making contact. Book Appointment Now

À propos de nous What is bursitis ? ​ Bursitis is the inflammation or irritation of a bursa. A bursa is a small, fluid-filled sac that acts as a cushion and lubricant between bones, tendons, muscles, and other tissues near joints. The purpose of a bursa is to reduce friction and allow smooth gliding between these structures. When a bursa becomes inflamed, it can lead to a condition known as bursitis. The inflammation may be caused by repetitive motion, overuse, direct trauma, or infection. What are common areas where bursitis occurs ? Common areas where bursitis occurs include the shoulder, elbow, hip, knee, and heel. ​ What are the different types of bursitis ? Some specific types of bursitis include: Subacromial bursitis : Inflammation of the bursa in the shoulder, often associated with impingement of the rotator cuff tendons. Olecranon bursitis : Inflammation of the bursa at the tip of the elbow, often caused by repetitive pressure or trauma. Trochanteric bursitis : Inflammation of the bursa on the outside of the hip, typically associated with activities that involve repetitive hip movement. Prepatellar bursitis : Inflammation of the bursa in front of the kneecap, often associated with prolonged kneeling. What are the symptoms of bursitis ? ​ Symptoms of bursitis may include pain, swelling, and tenderness in the affected area. Movement of the joint may exacerbate the pain. ​ ​ W hat is the best treatment for bursitis ? Treatment often involves rest, ice, anti-inflammatory medications, and, in some cases, physical therapy. In instances where the bursitis is caused by an infection, antibiotics may be necessary. What should I do if I think I have bursitis ? ​ If bursitis symptoms persist or worsen, it's important to seek medical attention for a proper diagnosis and appropriate treatment. In some cases, the fluid from an inflamed bursa may need to be aspirated for both diagnostic and therapeutic purposes. ​ No need to wait, book an appointment with us now. We are experts in the field. Book a free consultation Request a call back

À propos de nous What is a Rotator cuff impingement ? Rotator cuff impingement is a condition that involves compression or pinching of the tendons of the rotator cuff muscles as they pass through the subacromial space in the shoulder. The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and facilitating various shoulder movements. ​ Key points about rotator cuff impingement include: Subacromial Space : The subacromial space is the area between the acromion (a bony prominence of the shoulder blade) and the head of the humerus (upper arm bone). The rotator cuff tendons pass through this space. Mechanism : Rotator cuff impingement often occurs when there is reduced space in the subacromial area, causing the tendons to get compressed during certain arm movements. This compression can lead to irritation, inflammation, and, in some cases, damage to the rotator cuff tendons. Causes : Common causes of rotator cuff impingement include repetitive overhead arm movements (common in sports like swimming or tennis), muscle imbalances, bone spurs, and structural variations in the shoulder anatomy. Symptoms : Individuals with rotator cuff impingement may experience pain, especially when lifting the arm, reaching overhead, or during activities that involve arm movements. Weakness and a gradual loss of shoulder range of motion may also occur. Diagnosis : Diagnosis is typically based on a thorough physical examination, medical history, and imaging studies such as X-rays or magnetic resonance imaging (MRI) to visualize the shoulder structures. What are the treatment options for rotator cuff impingement ? Treatments can include: Rest and Activity Modification : Avoiding activities that worsen symptoms and allowing the shoulder to rest. Physical Therapy : Stretching and strengthening exercises to improve shoulder mechanics, posture, and muscle balance. Anti-inflammatory Medications : Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce pain and inflammation. Corticosteroid Injections : Injections of corticosteroids into the subacromial space can provide temporary relief of pain and inflammation. Modification of Activities: Adjusting or modifying activities to reduce stress on the rotator cuff tendons. Surgery : In cases where conservative measures are not effective, or if there is significant tendon damage, surgical intervention may be considered. This can involve removing bone spurs, creating more space in the subacromial area, and repairing or smoothing the damaged tendons. ​ Early intervention can help prevent the progression of the condition and improve long-term outcomes. Contact our clinic for a free initial consultation. Book a free consultation Request a call back

À propos de nous Consultation & Diagnostic Ultrasound Includes a full musculoskeletal assessment, ultrasound scan, written report with care plan & exercise prescription if appropriate What is an Ultrasound examination ? ​ ​ Ultrasound examination , also called ultrasound imaging or ultrasound scan, is a medical diagnostic technique that uses high-frequency sound waves to create real-time images of internal structures in the body. A transducer emits sound waves, and the echoes produced as they bounce off tissues are used to generate detailed images. Ultrasound is widely used to visualize organs, tissues, and blood flow, aiding in the diagnosis and monitoring of various medical conditions. It is commonly employed in obstetrics for monitoring foetal development, as well as in assessing abdominal, pelvic, cardiac, and musculoskeletal structures. The procedure is safe, does not involve ionizing radiation, and is often used for real-time guidance during certain medical interventions such as biopsies or injections. Ultrasound is versatile, portable, and allows for dynamic imaging, making it valuable in diverse medical specialties. ​ Is an ultrasound painful? ​ No, ultrasound examinations are generally not painful but some positions might be temporarily uncomfortable. A gel is applied to the skin to enhance the transmission of sound waves, which are emitted by a transducer. The transducer is moved over the skin to capture images, and the procedure is painless, with most individuals feeling only mild pressure. We encourage you to communicate any concerns with us to ensure a comfortable and informative experience. ​ ​ What kind of ultrasound guided procedures do you offer? We offer different types of ultrasound guided procedures. Please consult the Treatments page. ​ Do you offer Follow-up ultrasound scan check-up? Yes, we do offer Follow-up ultrasound scans for a reduced fee. Please see the Prices page. ​ Our South London Clinic We also provide home visits 2 min from Brixton Underground Station 8 min from Pimlico via Victoria Line 15 min from Oxford Circus 27 min from King's Cross St Pancras ​ South London Clinic Details Book an Appointment Booking an appointment is easy. Simply choose an available slot for a free phone consultation and we'll do the rest. ​ There are no long wait times and we offer same day appointment. Book Appointment Now

À propos de nous Ultrasound guided Barbotage for tendon calcification ​Includes: ​ Thorough clinical assessment Diagnostic ultrasound Ultrasound guided barbotage Written report Care plan & exercise prescription if indicated What is Tendon Barbotage ? We use this procedure to treat resistant calcific tendinopathy, especially on the shoulder's tendons (rotator cuff). Calcific tendinopathy refers to the deposition of calcium. This can lead to pain, inflammation, and reduced joint mobility. The goal of barbotage is to disrupt the calcific deposit, promote the absorption of calcium by the body, and alleviate symptoms such as pain and stiffness. Medical studies suggests up to 70% success rate with this procedure. . ​ How is barbotage performed ? Tendon barbotage generally includes the following steps: Identification of Calcium Deposits using ultrasound to identify the location and extent of calcium deposits within the affected tendon. A thin n eedle is then inserted into the area of the calcium deposit and carefully guided to ensure precision in reaching the targeted site within the tendon. Once the needle is in position, a fluid (usually a saline solution and local anaesthetic) is injected into the tendon. The fluid serves multiple purposes, including numbing the area, breaking up the calcium deposits and creating space within the tendon. After the fluid injection, we use the same needle to aspirate the dislodged calcium deposits and the injected fluid. This process helps remove the debris from the tendon. Following tendon barbotage, patients may be advised to rest and may receive additional treatments, such as physiotherapy or anti-inflammatory medications, to aid in the healing process. How much do barbotage procedures cost? Our barbotage procedure start at just £300 including initial telephone consultation, diagnostic ultrasound, ultrasound-guided procedure, written report with care plan and exercise prescription if appropriate. See our fees Is this procedure painful ? The level of pain experienced during shoulder barbotage can vary from person to person. Some individuals may find the procedure uncomfortable, while others may experience more significant pain. We use local anaesthesia to numb the area before performing the procedure, which can help minimize pain during the actual injection. After the procedure, patients may experience some soreness, but this is typically temporary. ​ Our South London Clinic We also provide home visits 2 min from Brixton Underground Station 8 min from Pimlico via Victoria Line 15 min from Oxford Circus 27 min from King's Cross St Pancras ​ South London Clinic Details Book an Appointment Booking an appointment is easy. Simply choose an available slot for a free phone consultation and we'll do the rest. ​ There are no long wait times and we offer same day appointment. Book Appointment Now

À propos de nous What is a Meniscal tear ? A meniscal tear is a common knee injury that involves damage to one or both of the menisci, which are C-shaped pieces of cartilage located in the knee joint. Each knee has two menisci—one on the inner side (medial meniscus) and one on the outer side (lateral meniscus). The menisci play a crucial role in stabilizing the knee, absorbing shock, and distributing load. Meniscal tears can be post traumatic (after an injury) or degenerative (often age related). Tears can occur in different parts of the meniscus, and the location can influence the type of symptoms experienced. The medial meniscus (inside the knee) tends to be more often injured. ​ How can meniscal tears happen ? Meniscal tears often result from twisting or rotating the knee while bearing weight, particularly during activities that involve pivoting or sudden stops. Athletes, especially those participating in sports that involve cutting or sudden changes in direction, are at an increased risk. Meniscal tears can also develop over time due to degenerative changes, especially in older individuals. What are the symptoms? Common symptoms of a meniscal tear include pain, swelling, stiffness, and difficulty fully extending or bending the knee. Some individuals may also experience a popping or clicking sensation at the time of injury. What is Locking or Catching? In some cases, a torn piece of the meniscus may move into the joint space, causing the knee to lock or catch during movement. ​ What are the different types of meniscal tears ? There are several types of meniscal tears, including: Radial Tear : Extends from the outer edge of the meniscus toward the center. Bucket-Handle Tear : A large tear in the middle of the meniscus that can displace and cause the knee to lock. Flap Tear : A partial-thickness tear where a portion of the meniscus is lifted or flipped. How are meniscal tears diagnosed? Diagnosis of a meniscal tear typically involves a combination of: Physical Examination: A healthcare professional will assess the range of motion, stability, and tenderness of the knee. Imaging Studies: Magnetic resonance imaging (MRI) is often used to visualize the menisci and confirm the presence and extent of a tear. ​ What is the best treatment for meniscal tears ? Treatment options for meniscal tears may include: Rest and Ice: Resting the knee and applying ice can help reduce pain and swelling. Physical Therapy: Rehabilitation exercises to improve strength and flexibility. Anti-Inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce pain and inflammation. Corticosteroid Injections : Injections into the knee joint to alleviate inflammation and pain. Arthroscopic Surgery: In some cases, particularly when conservative measures are not effective, arthroscopic surgery may be considered to trim or repair the torn meniscus. ​ The appropriate treatment depends on factors such as the type and location of the tear, the individual's age, and the overall health of the knee joint. If you suspect you have a meniscal tear or are experiencing knee symptoms, contact us and consult with a professional expert, Maxence Legout , for a proper diagnosis and appropriate management. Book a free consultation Request a call back

À propos de nous What is ulnar nerve entrapment ? Ulnar nerve entrapment, also known as cubital tunnel syndrome, is a condition where the ulnar nerve becomes compressed or irritated as it passes through the cubital tunnel—the bony tunnel on the inner side of the elbow. The ulnar nerve is one of the major nerves in the arm and is responsible for providing sensation to the little finger and part of the ring finger, as well as controlling some small muscles in the hand. ​ What are the causes of ulnar nerve entrapment ? Ulnar nerve entrapment can occur for various reasons, and common causes include: Compression : Prolonged or repeated compression of the ulnar nerve can lead to entrapment. This compression may be due to leaning on the elbow for extended periods, such as during sleep, or consistently keeping the elbow bent. Anatomical factors : Some individuals may have a natural predisposition to ulnar nerve compression due to their anatomy, such as a prominent bony ridge or a shallow cubital tunnel. Repetitive motion : Certain occupations or activities that involve repetitive bending and straightening of the elbow can contribute to ulnar nerve entrapment. ​ What are some symptoms of ulnar entrapment? Symptoms of ulnar nerve entrapment may include: Pain : Pain along the inner side of the elbow. Numbness and tingling : Numbness and tingling in the little finger and part of the ring finger. Weakness : Weakness in the hand, particularly in gripping or pinching activities. Difficulty straightening the fingers : In severe cases, difficulty straightening the fingers may occur. ​ What is the best treatment for ulnar nerve entrapment? Treatment for ulnar nerve entrapment depends on the severity of the condition. Conservative measures may include avoiding activities that exacerbate symptoms, using a brace or splint to keep the elbow straight, and physical therapy. In more severe cases or if conservative measures are ineffective, a healthcare professional may recommend surgical intervention to release the pressure on the ulnar nerve. Early diagnosis and intervention are essential to prevent long-term nerve damage and to improve the likelihood of successful treatment. Individuals experiencing symptoms of ulnar nerve entrapment should seek medical attention for a proper evaluation and appropriate management. ​ Get specialist help and book a free consultation now with Maxence Legout. Book a free consultation Request a call back