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Joint Injections During COVID


USS guided steroid injection service provided by Clinical Imaging

  

Due the current high prevalence of coronavirus infection in Cornwall, the ultrasound guided musculoskeletal steroid injection service provided by the Clinical Imaging Department at RCHT and all other sites in Cornwall has been suspended until at least the end of March 2021. This is due to the risk that the injection of steroid may increase susceptibility or severity of infection and the added uncertainty of the efficacy of the coronavirus vaccine following a steroid injection.

 

Dr Tom Sulkin, Consultant Radiologist, Royal Cornwall Hospitals NHS Trust






Therapeutic Steroid Joint Injections

The Intercollegiate guidance on use of corticosteroids and therapeutic steroid injections during Covid 19 has been updated in the context of phase 3 of the pandemic, please see here for details. 

 

In summary:

Only give a steroid injection if a patient has significant disease activity and/or intrusive and persisting symptoms and there are no appropriate alternatives where the benefits outweigh the risks.  Only consider a steroid injection if a patient has high levels of pain and disability, has exhausted first line conservative measures and continued symptoms will have a significant negative impact on health and wellbeing.  Consider using the minimum appropriate dose possible.  Patients should be given guidance about activity modification and exercise therapy following an injection. 

The patient must be counselled on the potential risks of immunosuppression as a result of the injection and subsequent risk of coronavirus and informed consent documented.  There is a potential risk that a steroid injection given to an asymptomatic patient could put them at an increased risk of adverse outcome from the virus, although this is not known at this stage and the level of risk is not known.  This potential risk will be increased in patients who are more clinically vulnerable such as over 70, patients with BAME ethnicity, chronic co-morbidities and also high BMI.  The guidance advises to adhere to local infection control and public health policies.

All requests for steroid injections including image guided requests such as Mortons require that the patient has been counselled and risk assessment happen prior to referral.  This should be documented including that all other treatment options have been exhausted on the referral letter.

Intercollegiate Guidelines.  Management Of Patients With Musculoskeletal Conditions Who Are On Corticosteroids, Require Initiation Of Oral/IV Corticosteroids, Require A Corticosteroid Injection.  20 November 2020

 

Dr Rebecca Hopkins

GP, Orthopaedic Guidelines Lead Planned Care Advisory Group and CCG Lead MSK Rightcare

27 November 2020