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What is a musculoskeletal or bursal injection?

Your doctor or surgeon has referred you for a musculoskeletal (MSK) or bursal injection as they believe that it may provide relief of your bursitis (inflammation of a soft tissue space which allows a sliding movement between bones, muscles, tendons or skin) or tendon inflammation. The injection is often performed for areas such as shoulders or hips, and can be helpful in other areas of the body such as elbows or knees. Steroid medication may decrease inflammation and can assist in relieving pain or swelling and may reduce synovial inflammation. They may not provide long-term pain relief and do not alter the course of underlying joint disease (e.g. osteoarthritis).

Under the guidance of ultrasound, an injection of steroid medication and long-lasting anaesthetic can be accurately directed into the required soft tissue area. The procedure is performed by a specialist doctor called a radiologist. Pain relief achieved can be long lasting or temporary and some people may experience no relief at all.

How long will the procedure take?

The procedure takes approximately 30 minutes but the injection itself takes less than a minute. Please allow time to register at reception and 30 minutes for the procedure. You will be requested to wait up to 30 minutes after the procedure so our staff can be sure that you are ready to be discharged home. In total, you will be in the department for up to 1.5 hours.

Is there any special preparation required?

No special preparation is required; however, you may need someone to drive you home after the procedure. Our staff will advise you if this is required, so that you can make appropriate arrangements.

At the time of your booking please inform the staff before the procedure if you have any allergies, you take blood thinning medication or you are pregnant or breast feeding.

Please list or bring all of your prescribed medications, those medications that you buy over the counter, including herbal remedies and supplements.

What do I need to do on the day of the procedure?

On the day of your appointment, please ensure you bring:

• Your referral form (if you have it)
• All previous relevant scans or x-rays
• Medicare and healthcare cards (e.g. DVA card or concession card)
• List of all medications

What happens during the procedure?

An ultrasound scan will be used to assist the radiologist in identifying the injection site; this may be marked on your skin with a pen. To reduce the risk of infection an antiseptic solution will be used to clean the skin.

You will remain awake during the procedure. To prevent discomfort, the area may be numbed using local anaesthetic which causes a pinprick and stinging sensation that is uncomfortable for a few seconds.

Ultrasound will be used to guide the placement of the fine needle into the region of concern.

Are there any after effects from the treatment?

For a few days following the procedure you may experience some discomfort. This is often relieved with simple pain medication and applying ice to the area.

There is a slight risk that following the injection pain and/or swelling in the area could increase, this is called steroid flare. Steroid flare can develop within a few hours of the injection and last up to three days. The pain and/or swelling will go away on its own. Applying ice to the area frequently will help.

What happens after the procedure?

Our staff will advise you of ways to look after yourself following a MSK or bursal injection. This includes information such as: resting on the day of the procedure, then avoiding strenuous activity for a few days, arranging a follow up appointment with your referring doctor and how to look after the injection site.

What are the benefits?

The injections can assist in relieving pain and may reduce inflammation. The injection may aid in your management by allowing you to undertake appropriate physical therapy.

Overall, bursal injections provide short- to medium-term pain relief (weeks to months), particularly when combined with appropriate rest, medication and physical therapy.

Are there any risks?

In referring you for this injection, your doctor is of the opinion that the benefit of this procedure for you are greater than the risks.

There are some risks and minor complications associated with bursal injections. These include; slight bleeding or bruising at the site, this is more common if you take a blood thinning medication. It is possible that the local anesthetic may not work, which may require a further injection of anesthetic.

Less common risks and complications may include infection or damage to surrounding structures such as tendons. Some people may have an allergy to injected drugs or the procedure may not be possible due to medical and/or technical reasons.

The use of ultrasound to guide the procedure minimises these risks.

Before the injection the radiologist (or delegate), will discuss the procedure with you in detail, including any risks specific to you. You will be provided with the opportunity to ask questions. It may be necessary to do a formal consultation to make sure that the procedure is the most appropriate for you.

When do I get the results?

The radiologist will send a report outlining the procedure to your referring doctor/ surgeon and your regular GP. It is important that you make a follow-up appointment with your referring doctor/surgeon if the injection has not helped to ease your pain.

I still have questions; who can I ask?

Medical information can be complex and you may receive information that you do not fully understand. It is important for you to consider the risks and outcomes of the procedure, as well as your personal needs before making a decision to undergo the procedure.

If you have read this online information and are still unsure if this is the correct procedure for you; before you make a booking, you should discuss your questions or concerns with your referring doctor in the first instance. Your regular GP and/or your family may also be a useful resource. Your referring doctor can answer questions about the risks and benefits of not having the procedure and other alternative options for treatment.

If you have questions before your appointment about what is involved on the day, our staff would be happy to assist. Please contact the imaging centre where you have made your appointment.