There are many conditions around the wrist and hand that cause significant pain and dysfunction. Many hand and wrist conditions respond well to injection therapy, providing welcome pain relief. Please click on the links below to find out more about each condition:
Commonly asked questions:
When and why should you consider an injection for hand and wrist pain?
Before any successful treatment can be started it is essential that we know exactly where your pain is coming from. Gaining an accurate diagnosis, in a timely fashion, often requires a combination of both clinical testing and diagnostic ultrasound imaging. All clinicians at Complete Injections are experienced clinicians and musculoskeletal sonographers. This unique combination allows us to find out exactly where your problem is on your first visit. After your diagnosis has been confirmed your clinician will be able to discuss with you which injection or treatment option is best for you.
Hand and wrist pain usually responds very well to a course of physiotherapy and rehabilitation. However, there are times when pain and symptoms persist. If you are struggling with continued pain and symptoms, then an injection may be of benefit. Here is a list of situations which may benefit from an injection as part of a management program:
Considerable pain that has been present for over 6 weeks, or pain that is getting worse.
- Pain that is waking you at night or stopping you getting to sleep.
- Pain that is affecting your ability to use your hand and wrist during normal everyday tasks.
- Pain that is reducing your ability to work comfortably, play sport, or remain involved in your hobbies.
If you are unsure whether an injection is right for you and would like to talk to one of our clinical experts, please call 020 7482 3875 or email injections@complete-physio.co.uk.
Why should I choose an ultrasound guided injection over a landmark guided injection?
Ultrasound guided injections have been shown to be more accurate, more effective, and less painful than injections performed without ultrasound guidance. At Complete all injections are performed with ultrasound guidance.
During an ultrasound guided injection, the target tissue (e.g., a joint) is visualised and the needle can be monitored throughout the procedure. This ensures that the medication is delivered directly to the source of your pain safely and efficiently, avoiding any sensitive tissues such as blood vessels, nerves, and tendons.
Furthermore, thinner needles can be used when you use ultrasound guidance which can reduce any pain from the procedure.
If you would like to know more about ultrasound guided injections, please call 020 7482 3875 or email injections@complete-physio.co.uk.
Are wrist and hand injections painful?
At Complete we always use local anaesthetic to reduce the pain associated with the injection. The local anaesthetic provides up to 2 hours of pain relief making the injection and the immediate few hours after the injection more comfortable. Most patients report minimal pain during the injection. Clinicians at Complete carry out hundreds of injections every year and are highly skilled at performing a wide range of injections. The skill of the clinician is an essential component in ensuring the injection is relatively pain free.
How long should I expect the effects of an injection to last for?
Most injections provide pain relief within a few days. However, the duration of the effect does vary.
The longevity of an injection varies between individuals, with some patients experiencing a complete resolution of their symptoms and others experiencing a few months of pain relief. It is therefore essential that you undertake a physiotherapy programme after your injection to ensure maximum benefits are felt.
There are many factors that can influence how long the pain relief lasts for. These can include:
- your specific diagnosis
- how long you have had the pain
- how severe the pain is
- whether you have coexisting complaints
- how many previous injections you have had
Most injections undertaken at Complete are one-off procedures. An injection is designed to combat the pain and inflammation associated with your condition. They provide fast effective pain relief allowing you to address the underlying cause of your pain.
How many injections am I allowed to have?
The Arthritis Research Council (ARC) recommends a maximum of three injections within a one-year period in the same area. Most patients require only one injection. If an injection does not improve your pain, then this could mean that either the underlying condition is not being addressed correctly or has progressed.
If this is the case, then an onward referral to an orthopaedic consultant or sports doctor for further investigations or possible surgical intervention is indicated.
Degenerative conditions such as osteoarthritis often require repeat injections as part of an overall management plan. Undertaking a post injection rehabilitation programme helps to limit the chance of requiring a second injection, or to reduce the frequency of injections required to treat your condition.
Do injections just ‘mask the pain’?
No, injections do not simply ‘mask the pain’. Steroids (also known as corticosteroids) are powerful anti-inflammatory drugs used to control pain and inflammation. Controlling the pain associated with the inflammation allows you to start a rehabilitation programme to treat the cause of your pain. The combination of an injection and rehabilitation provides a successful treatment option for many people suffering with pain.
What should I expect immediately after an injection and how long does the steroid take to work?
All injections undertaken at Complete are accompanied by a short acting local anaesthetic which provides up to two hours of localised numbness. After the numbness wears off you might notice some soreness as you wait for the steroid to take effect. Typically, a steroid injection can take anywhere between one day and a few weeks to start working so a degree of patience is required.
Most patients respond well to injections without any notable side effects. However, there is a small chance that you might suffer from a brief period of pain after the injection. This normally settles within a few days with a little rest, over the counter pain medication, and an ice pack.
How much do wrist and hand injections cost?
A single injection under ultrasound guidance costs £250. This fee includes the clinical assessment and the diagnostic ultrasound scan carried out before the procedure to confirm the exact cause of your pain. Every patient also receives a comprehensive letter for their GP or consultant following the procedure. For a full list of injection costs click here.
How much do wrist and hand injections cost?
A single injection under ultrasound guidance costs £250. This fee includes the clinical assessment and the diagnostic ultrasound scan carried out before the procedure to confirm the exact cause of your pain. Every patient also receives a comprehensive letter for their GP or consultant following the procedure. For a full list of injection costs click here.
What hand and wrist conditions respond well to injection therapy?
Osteoarthritis of the wrist
Osteoarthritis of the wrist is the most common cause of wrist pain affecting people over the age of 40. It is characterised by pain and stiffness in the wrist (typically over the wrist crease) and is prone to intermittent flare ups.
Pain typically starts slowly for no reason but can also develop after an accident or a fall. Osteoarthritis is a progressive degenerative condition which requires management, including injection therapy, physiotherapy, and a rehabilitation programme designed to increase the strength and flexibility of the wrist joint. On occasion a wrist splint or brace can also be helpful.
Signs and symptoms of osteoarthritis of the wrist include:
- A dull ache deep in the wrist which is often diffuse and difficult to locate.
- Stiffness in the wrist joint.
- Pain and stiffness which is worse first thing in the morning.
- Pain when weight bearing through the wrist, for example during a press-up.
The pain and inflammation associated with a flare up of osteoarthritis can be very difficult to manage and can affect many activities of daily living. If you are struggling to perform simple tasks, have pain when playing sport, or pain that is waking you up at night, an ultrasound guided injection can provide significant pain relief.
An injection can reduce your symptoms quickly and effectively allowing you to return to normal activities. Injection options suitable for osteoarthritis of the wrist include steroid injections, platelet rich plasma (PRP), and hyaluronic acid injections.
Trigger Finger/Thumb
Trigger finger/thumb is a very painful, debilitating condition that can affect people of any age. It is characterised by a sharp pain and click of the finger or thumb during bending and straightening. In some cases, the finger or thumb in question can become stuck and need assistance to straighten it out again. It is most commonly seen in women and people who perform repetitive tasks with their fingers and thumb.
Signs and symptoms of a trigger finger/thumb include:
- Swelling, pain, and tenderness on the palm side of the knuckle joint of the symptomatic digit.
- Sharp pain when pressed.
- A clicking sensation when bending and straightening your digit.
- In severe cases the finger or thumb may get stuck in a bent position.
- Pain with lifting and carrying bags, etc.
Activity modification, physiotherapy and rehabilitation exercises can be helpful for trigger finger/thumb. However, this condition can be challenging to resolve especially if it gets stuck in a bent position. If you are experiencing continued pain or your finger or thumb is getting stuck in a bent position, then an ultrasound guided steroid injection is recommended. Following the injection, we would expect the finger or thumb to ‘release’ or stop clicking within a few days.
Carpal Tunnel Syndrome
Carpal tunnel syndrome can be an incredibly debilitating condition which can significantly limit the use of your thumb, index and middle fingers. It often causes pain, pins and needles and numbness, particularly at night (disturbing sleep).
The carpal tunnel is a bony arch topped with a tight ligament and is located on the inside of the wrist. The median nerve passes through this tunnel alongside a group of tendons (used to flex the fingers).
Carpal tunnel syndrome occurs when the median nerve becomes compressed and inflamed as it enters the carpal tunnel. It is often associated with pregnancy as well as people who perform repetitive tasks with their wrists such as builders or computer workers.
Signs and symptoms of carpal tunnel syndrome include:
- An achy pain affecting the thumb, index and middle fingers.
- Pins and needles in the thumb, index and middle fingers, often relieved with vigorous shaking of the hand.
- Pins and needles in the hand that wake you at night.
- Weakness and clumsiness in the thumb and fingers which makes gripping difficult.
Carpal tunnel symptoms can respond well to activity modification, physiotherapy, rehabilitation exercises and night splints. However, if conservative management is not working for you then an ultrasound guided steroid injection should be considered. It normally provides significant pain relief in 2-3 days.
Osteoarthritis of the thumb
Osteoarthritis of the thumb is a chronic condition associated with pain, swelling, stiffness and occasionally clicking at the base of the thumb. Many people suffering from osteoarthritis of the thumb experience weakness and pain when gripping and when conducting fine dexterous tasks, such as using a pincer type grip.
As with osteoarthritis of the wrist, osteoarthritis of the thumb is susceptible to episodes of increased pain and swelling, often developing slowly without trauma but can also be triggered by an accident.
Signs and symptoms associated with osteoarthritis of the thumb include:
- Pain, stiffness and swelling at the base of the thumb.
- Clicking at the base of the thumb during movement or gripping.
- Increased pain and a sensation of weakness when gripping objects, especially when using a pincer type grip.
- The base of the thumb can become thickened or enlarged as the condition progresses.
Osteoarthritis of the thumb requires an ongoing management plan to maintain mobility and strength in the thumb. However, if you are suffering from a flare in symptoms which will not settle down, then an ultrasound guided steroid injection should be considered.
Triangular Fibrocartilage Complex (TFCC)
The Triangular Fibrocartilage Complex (TFCC) is located on the little finger side of your wrist where the ulnar bone of the forearm meets the wrist joint. The TFCC is a small cartilaginous structure which helps to stabilise the wrist joint during movement. It can easily be damaged after falling onto an outstretched hand.
Signs and symptoms of a TFCC injury include:
- Pain over the little finger aspect of the wrist joint.
- Pain with twisting and turning movements of the wrist (e.g., turning a key or opening a jam jar).
- Pain with weightbearing through the wrist (press-up position in particular).
- A painful clicking sensation in the wrist during movement.
TFCC injuries can take a long time to heal and require a combination of activity modification, physiotherapy, and rehabilitation exercises. If symptoms persist despite conservative treatment, then an injection can be used to reduce the pain and allow you to continue with your rehabilitation programme.
De Quervain’s tenosynovitis
De Quervain’s tenosynovitis is a painful condition which affects the thumb and wrist. The tendons which serve the thumb pass by the radial bone of the wrist. They are covered in a sheath which allows for friction-free gliding during movement. De Quervain’s tenosynovitis is a swelling of the sheath which surrounds these tendons. It commonly occurs with repetitive thumb movements and has been associated with pregnancy, caring for babies and small children, and with sports that require excessive gripping.
It is not uncommon that De Quervain’s tenosynovitis requires a steroid injection to control the pain.
Signs and symptoms of De Quervain’s tenosynovitis include:
- Pain and swelling felt over the thumb side of the wrist.
- Pain which increases with thumb movements and gripping.
- Tenderness over the thumb aspect of the wrist joint which can be exquisite when accidently knocked.
De Quervain’s tenosynovitis often resolves with a period of rest, activity modification, a thumb splint, physiotherapy, and thumb exercises. An ultrasound guided injection is recommended for pain that is not improving
Scapholunate ligament injury
The scapholunate ligament is a small but very important ligament of the wrist. It is vital to the stability of the wrist joint and when injured causes the wrist joint to become unstable and painful. A Scapholunate ligament injury most commonly occurs when landing heavily onto the wrist during a fall or whilst playing sport. The scapholunate ligament can also become injured due to heavy chronic overuse (e.g., repetitive heavy lifting).
Signs and symptoms of a scapholunate ligament injury include:
- Pain, and sometimes, swelling at the wrist.
- Increased pain on weightbearing through the wrist.
- A sensation of wrist joint instability and weakness.
Typically, a scapholunate ligament injury requires a period of rest, activity modification, wrist strengthening exercises and, in some cases, a wrist support. If these conservative treatments do not help, then an ultrasound guided steroid injection can provide pain relief. Following the injection, physiotherapy rehabilitation should continue in order to restore full range of movement and strength at the wrist.
If you would like to book an appointment to see one of our expert clinicians call 020 7482 3875 or email injections@complete-physio.co.uk.