Guided injections, explained

A guided injection is a joint injection delivered using precise anatomical landmarks, so the medication is placed accurately into the joint or soft tissue that's causing the pain. No scanner, just a thorough understanding of anatomy built over years of MSK practice.

In short: landmark-guided injection is a well-established, evidence-based technique used across MSK practice for decades. It relies on precise anatomical knowledge and palpation rather than live imaging, and every injection here starts with a full assessment to confirm it's the right joint and the right call.

What conditions can it treat?

Guided injections are commonly used for inflammatory and degenerative musculoskeletal problems where pain is blocking progress, including:

Knees - osteoarthritis, inflammatory flare-ups
Shoulders - rotator cuff related pain, frozen shoulder (see our dedicated guide), ACJ injury/osteoarthritis, subacromial bursitis
Hips - gluteal tendinopathy, trochanteric bursitis (lateral hip pain)
Fingers - osteoarthritis, trigger finger
Thumb - osteoarthritis, De Quervain's tenosynovitis

An injection isn't right for every problem, which is why every appointment starts with a full musculoskeletal assessment, and the injection only goes ahead if it's clinically appropriate.

Two injection options

Depending on the joint and the diagnosis, one of two injections is used:

Cortisone (steroid) injection - reduces inflammation and pain, usually mixed with local anaesthetic. The most common choice for inflammatory flare-ups and bursitis.
Sodium hyaluronate joint injection (Ostenil) - supplements the joint's natural lubricating fluid rather than reducing inflammation directly. Often considered for osteoarthritis-related joint pain.

Which one is appropriate is decided together, after assessment.

What happens at your appointment

Assessment. A focused history and physical examination to confirm the diagnosis and check an injection is the right tool.
Consent. The relevant anatomical landmarks are identified by palpation; risks, alternatives, and which injection type is appropriate are explained properly.
The injection. Skin is cleaned, and the injection is delivered using precise anatomical landmarks. Most take under a minute.
Aftercare and report. You'll get clear aftercare guidance, a written report, and a plan for the rehabilitation that follows.

Risks and side effects

Both injection types are widely used and generally safe, but no injection is risk-free. Common, temporary effects for steroid injections include a post-injection pain flare (24–48 hours), facial flushing, and small skin changes (thinning or lightening) at the injection site. People with diabetes may see a temporary rise in blood sugar. Infection is rare for either injection type. Repeated steroid injections into or near tendons are used cautiously because of the potential to weaken tissue over time, one more reason injections are paired with rehabilitation rather than repeated indefinitely.

What does it cost?

£195 Guided injection includes the assessment, the injection itself, and a written report. Self-funded; no GP referral required.

An injection is a bridge, not a fix

The honest version: an injection settles pain and inflammation. It doesn't rebuild strength, restore movement, or fix the reason the problem started. Its real value is the window it opens. Used well, that window is when rehabilitation does its best work. At this clinic the injection and the rehab plan come from the same clinician, so nothing falls between the two.

Frequently asked questions

Does a guided injection hurt?

Most people describe brief, mild discomfort, similar to any injection. A local anaesthetic is usually mixed with the steroid, so the area often feels numb for a few hours afterwards. Some people notice a temporary flare of pain for 24–48 hours before the steroid takes effect.

How long does a steroid injection take to work?

The local anaesthetic works within minutes but wears off the same day. The corticosteroid typically starts working within a few days, with the full effect at around one to two weeks.

What's the difference between a steroid injection and Ostenil?

Cortisone (steroid) injections reduce inflammation and pain quickly. Sodium hyaluronate injections (Ostenil) work differently: they supplement the joint's natural lubricating fluid, which can help with osteoarthritis-related joint pain. Which is appropriate depends on the joint and the diagnosis, decided together at assessment.

Do I need a GP referral for an injection?

No. You can self-refer. Every injection appointment starts with a full assessment, and an injection is only given if it is clinically appropriate.

How many steroid injections can I have?

There is no fixed maximum, but repeated injections into the same area are used cautiously, typically no more than two or three per year for a given joint or tendon, and always alongside rehabilitation rather than instead of it.

This guide is general information written by a physiotherapist, not a substitute for individual assessment. If you're unsure whether an injection is right for your problem, book an assessment and you'll get an honest answer either way.