General Injection

Pain management injections allow a small dose of medication to be injected into a localized and specific area of concern while keeping potential side effects to a minimum. It can also confirm the origin of your pain – considered a “diagnostic” injection. These procedures can be used to treat joint pain or arthritis, or inflammation of a bursa or around a tendon (tenosynovitis).

• Cortisone is an anti-inflammatory medication that can be injected into joints and soft tissues under X-ray or ultrasound guidance to decrease inflammation and reduce pain. Relief may last 3-6 months and, if successful, repeat injections can be performed up to four times per year.
• Tenotomy/fasciotomy involves needle fenestration of a tendon, fascia, or other tissue, similar to acupuncture, which encourages your body to stimulate healing. A radiologist will use a small needle to gently treat the torn or inflamed area with the help of image-guided technology. This procedure is used to treat chronic tendon inflammation, local tendon tears, ligament tears, or fascia inflammation.
• Hyaluronic acid (HA) is a natural element present in joints. Injection of HA can improve mobility, acting as a natural lubricant and reducing pain. Injections are performed under X-ray guidance to ensure the solution is delivered exactly into the joint. Please note there’s a fee for this service.

We use HA injections to help relieve pain from osteoarthritis or mechanical difficulties in joints. Hips, knees, and ankles are the most commonly treated, and relief can last up to 12 months. We provide all HA products (Durolane, Monovisc, Synvisc, and others) onsite to patients at cost*, including newer generation products containing a combination of HA and steroid (Cingal). A prescription is required. Your doctor may request an initial diagnostic steroid injection before HA injections (except Cingal).

*Medications are provided at cost, but prices vary depending on dosage and manufacturer. Please contact our pain management department for the most current price.

HOW DO I PREPARE FOR MY PROCEDURE?

• You’ll need a prescription and requisition from your practitioner. Many insurance plans cover HA products as “medical devices.” Your booking coordinator will discuss this with you when they call to give you details about your appointment. We provide most products onsite at cost. Otherwise, you will need to bring your medication to your appointment.
• If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin etc.) you may need to have an international normalized ratio (INR) test and stop your medication prior to the procedure. Please inform our booking coordinators of any blood thinners you may be taking, so that they can discuss further instructions with you.
• If you take insulin to manage your diabetes, please let your booking coordinator know. You may have some juice and a small snack after taking your insulin.
• IMPORTANT: Please schedule your injection either two weeks before or one week after any vaccination appointment.
• If you are currently taking antibiotics, you will need to wait two days after your last dose before having your injection.
• Take all prescribed medications as directed.
• In case you have any discomfort, please have someone accompany you on the day of your test. It may be more convenient to have someone else drive you home.
• Please arrive 15 minutes before your appointment to allow enough time to fill out a consent form.
• Bring photo identification and your provincial health card.
• Wear comfortable clothes.
• Please do not bring children who require supervision.

WHAT HAPPENS DURING MY PROCEDURE?

• We may provide you with a comfortable clinic gown to change into (depending on the area being treated).
• A team member will review the consent form, explain procedure details, and answer any questions.
• We will then escort you to our treatment suite where you will meet the radiologist who will clean the skin and inject a local anesthetic, similar to the freezing you get at the dentist.
• The radiologist will typically use X-ray or ultrasound guidance to perform the treatment (tenotomy/fasciotomy) and/or inject the HA solution or inflammatory and long-lasting freezing (for Cortisone injections) using a sterile needle.
• You will be assessed post-injection by our team and, if there are no concerns, you will be free to leave.

POST-PROCEDURE INSTRUCTIONS

• First 24 hours: Keep the treatment area clean. Leave the Band-Aid on. Do not shower.
• First 48 hours: Avoid bathtubs, hot tubs, and pools. Avoid strenuous activity and lifting.
• After one week: You may resume physiotherapy. Be mindful of your pain and stop if it hurts too much. Notify your physiotherapist that you have had this injection so they can modify your exercises if necessary.
• For tenotomy: Avoid any strenuous activity for five days post-injection. A gradual return to activity is advised depending on the underlying issue. Be mindful of your pain and stop if it hurts too much. Although the procedure is gentle, it may temporarily weaken the tendon and put it at risk of rupturing. If possible, please avoid anti-inflammatory medication for two weeks (such as ibuprofen – Advil). It may interfere with the effectiveness of your procedure.
• Watch for infection: If you develop worsening pain, skin redness at the site of injection, or a temperature greater than 38.5°C, please proceed to an urgent care or emergency centre.
• If you have pain or other symptoms beyond 48 hours after your injection, this is a normal reaction. You may apply heat and ice to the treatment area. If you have any questions, please email us at paintherapy@radiology.ca during business hours.
• Diabetics: Note that cortisone can cause a temporary increase in blood sugar. Please monitor your blood sugar closely and, if you have any concerns, consult with your doctor.
• Anti-coagulant therapy: You will be directed when to resume any anti-coagulant (blood thinners) medication.
• For HA injections: This product may take time to distribute in the joint. We encourage you to move the joint and massage the area. Rarely, patients may experience a temporary “flare” of the joint – pain and stiffness – after these injections. This typically occurs between 12-48 hours after the injection and can be managed by Tylenol or aspirin.

WHEN WILL I SEE RESULTS?

• After your injection, the freezing may last for a few hours. Your symptoms may return until the steroid takes effect in 3-7 days (1-2 weeks for HA injections). Please track your symptom response to share with your physician.
• A steroid injection typically provides three months of symptom relief.
• An HA injection typically provides up to 12 months of symptom relief.
• If an injection does not help relieve your symptoms, then you may need further evaluation by your referring doctor for another cause of your symptoms.
• For tenotomy: We will arrange a follow-up ultrasound in six months to evaluate how the tendon is healing. Pain may increase for a few days post-injection as the body mounts an inflammatory response, but this should subside.
• Results can vary from weeks to months depending on the body part involved, severity of the disease and your symptoms. Most patients get complete relief that is permanent while, rarely, others have limited response.
• Please consult with your doctor regarding your results and any follow up exams or questions.

HOW MUCH WILL IT COST?

Steroid injections and tenotomy/fasciotomy exams are covered under your Alberta Health Care Plan. If you have the tenotomy/fasciotomy with PRP, there will be an added cost.

HA medications are provided at cost, but prices vary depending on dosage and manufacturer. Please contact our pain management department at 403-777-3122 for the most current price.

These procedures are only available in Alberta.