This week we spoke with Dr Andrew Jackson, who specialises in musculoskeletal issues in My Specialist GP patients.
We were interested to find out more about him, and more about the hyaluronic injections offered to patients with joint issues.
Hello! Could you tell us more about yourself?
I'm Doctor Jackson and I have a special interest in Sports, Exercise and Musculoskeletal (MSK) injuries. I completed medical school in Nottingham and have undertaken hospital training jobs, including at King’s College Hospital, London. I completed my GP training in the Oxford Deanery, including placements in South Bucks Hospital Trust and GP surgeries. I completed a postgrad sports & exercise medicine diploma through Bath University, which has the associated Institute of Sport.
I now work at My Specialist GP and also do NHS GP work. I am involved in professional sports cover for an English Premiership Rugby Union Team, which I have been doing for 7 years, as well as providing past cover for Jockeys through the British Horse Racing Association at Royal Windsor & Royal Ascot Racecourses. I have also worked in a ski resort medical centre in The French Alps!
What interests you the most about MSK therapies?
The huge variety of issues that can be experienced by patients, and how each patient and condition is unique and therefore the management plan is tailored to that individual as such.
Why is it important to look after the health of our joints?
They are what we need to mobilise and function physically, and not looking after them can impact our overall health both physically and mentally.
What frequently asked questions or worries have you been asked when it comes to joint pain?
Queries are often related to pain control and exercises and other management, as well as diagnosis of MSK bone and joint disorders and about whether injections would be helpful. Injections are usually a short-to-medium term solution that requires an additional form of treatment; such as exercises, adequate pain control medication, physiotherapy guidance and safe lifting and moving techniques.
What happens during a joint pain consultation?
A full assessment, including history/details of the symptoms and full background, focussed examination to tailor the management plan e.g. to decide if further investigations would be helpful, including to help ascertain the underlying cause/diagnosis and guide its further management. If considering a joint injection as part of this treatment plan, there may be a recommendation to have imaging (eg. x-rays) beforehand, [which you can be referred for privately by Myspecialist GP]. There are many reasons for this, including to confirm the suspected diagnosis, to check it is safe to inject in future and so that we have a baseline to compare with for future issues. Some patients however may not need this as each treatment is tailored to a patient's specific needs.
It is ideal for those looking into joint treatment and minor procedures to have an initial consultation to discuss all issues and how we can help, a week or two cool off period for the patient to digest all information and make an informed decision, then have the procedure. In exceptional circumstances, eg. when a comprehensive assessment has already been carried out and any diagnostics have already been completed and reviewed, we are able to do the procedure quicker than before two weeks.
What joints can be assessed for injections?
Injections can be assessed for mostly every joint, and I am able to inject most joints if considered appropriate, with the exception of the spine (which would be referred onto a spinal specialist to consider).
Joint injections can be especially helpful for knee, shoulder, or the thumb base in osteoarthritis, and for carpal tunnel syndrome and trochanteric bursitis (pain on the outside of the hip).
How painful is it?
The actual procedure only takes a few minutes, and in general, aren’t usually too painful, but there is this possibility. However, it should be kept in mind that injections are aimed at relieving pain - so short term pain for hopefully longer term gain!
What's the recovery period like?
For steroid injections it is usually advised to rest the injected site for 48 hours at least as much as you can. It is also recommended not to drive for 3 hours afterwards so that the local anaesthetic part of the joint injection can wear off - as this part of the injection may affect the way you drive. You should relatively rest the affected area for 1-2 weeks afterwards, especially avoiding and activity which may result in heavy impact or strain to the joint/injected area.
Is there a difference between steroid and hyaluronic treatment?
One of the main difference is that hyaluronic acid is not a steroid so does not have any of the potential steroid related side effects- including concerns about suppressing immunity for a period of time after a steroid injection- which is a particular consideration when balancing benefit vs risk of a steroid injection in the current COVID-19 pandemic.
Also, a recent study found that hyaluronic acid may be more effective than steroid as an injection for managing knee osteoarthritis.