Musculoskeletal Corticosteroid Injection

Referrals for USS guided steroid injections to RCHT Clinical Imaging have restarted.  Please note there is limited capacity so referrals should be reserved for patients with significant disabling and persistent symptoms.  Please click here for full details

Covid-19 Update: Corticosteroid Injections During The Coronavirus Pandemic  

Please ensure and document that a discussion has happened that the patient is aware corticosteroid injections pose a possible and quantifiably unknown increased risk of, and complications from, Covid and the possible risk of reduced Covid vaccine efficacy prior to performing.  Secondary care referrals for steroid injection, including image guided injections, require the patient to be counselled and risk assessed prior to referral and this documented in the referral.  Please see guidance available here for detailed information. 

 

Policy

Specification for a local enhanced service for Musculoskeletal Steroid injection Consultations

 

Kernow Clinical Commissioning Group will not fund referral for Musculoskeletal (MSK) injections in Secondary care unless patients meet the criteria set out below.

Exclusions to the above include:

·         Children

·         Patients on a cancer pathway

·         Spinal and facet joint injections

The Referral Management Service (RMS) Orthopaedic guidelines state the number of steroid injections recommended for each MSK condition prior to referral for steroid injection by Secondary care.

For these conditions it is expected that the steroid injection is performed in Primary care either by the patient’s own GP Practice, or another Practice able to perform the injection unless:

·         The recommended number of landmark-sited injections have been undertaken in Primary care have failed

·         A single ‘blind’ attempt has been made and failed in those with indiscernible landmarks

Practices that are unable to provide an ‘in-house’ MSK steroid injection are able to refer to other Practices for the MSK steroidinjections listed here: Inter-practice referral information.

Primary care services are available for the following MSK steroid injections:

·         Hands (Trigger finger, Tenosynovitis, Carpal tunnel syndrome, Thumb 1^st CMCJ OA)

·         Shoulders (Gleno-humeral joint, Sub-deltoid/acromial space, Acromio-clavicular joint)

·         Trochanteric bursa

·         Knee

·         Ankle and foot (Plantar fasciitis, Toe joints, Tendon sheaths, Bursa)

·         Elbow (Golfer’s elbow, Tennis elbow) please note steroid injection for these conditions is not routinely recommended (see RMS guidelines)

 

If steroid injection has failed in Primary care a referral may be considered to Orthopaedic services – as per the condition specific RMS guidelines

-       Eg:

o   The MSK Interface Service – Shoulder / Knee / Soft tissue hip. They are able to arrange ultrasound-guided injections if deemed necessary.

o   Other Orthopaedic services – Hand / Elbow / Foot / Ankle

These guidelines are specific to referrals for steroid injection, the RMS guidelines give detailed information about when referral for specialist input may be appropriate

 

Date reviewed                     25/06/2019

Next review due                  25/06/2020

Sifter name                          Dr Rebecca Hopkins

 

Consultant name + any other contributors           Dr Natalie Dawes

 

Version No. 3.1