Mr. Robert Mast
Extended Scope Physiotherapist
MSK Sonographer PgCert.
Robert Mast BSc Physiotherapy HCPC, MCSP, PgCert Musculoskeletal Sonography, Non-Medical prescriber
Rob is a specialist extended scope Physiotherapist who has 20 years' experience in managing complex musculoskeletal conditions. He is employed as an expert clinician in the NHS providing both clinical diagnosis as well a point of care diagnostic- and Interventional musculoskeletal ultrasound.
He is an expert in musculoskeletal Ultrasound and obtained a Pg.Cert. in Musculoskeletal Ultrasound through Canterbury and Christchurch University.
He also works one day per week in a Radiology-department in the NHS performing diagnostic ultrasound scans as well as carrying out many ultrasound guided injection procedures every week. In the past 8 years he has successfully performed thousands of Ultrasound guided procedures for a range of musculoskeletal conditions.
Rob is an experienced tutor on Ultrasound courses teaching fellow AHPs and medical professionals in MSK ultrasound diagnostics as well as ultrasound guided interventions. He is an integral part of the teaching faculty of The Ultrasound site which is also an extensive online learning resource for all things MSK ultrasound www.theultrasoundsite.co.uk He is an honorary lecturer at Brunel university where he and the ultrasoundsite team have created a Post graduate certificate in musculoskeletal Ultrasound. This module is open to medical and allied health professionals wanting to gain competency in Musculoskeletal ultrasound diagnostics. This program has been accredited by (CASE) Consortium of Academic Sonographic Eduction.
Rob adds to the knowledge base in MSK Ultrasound by frequent contributions of interesting ultrasound cases and video clips many of which appear on www.theultrasoundsite.co.uk as well as his own YouTube channel https://www.youtube.com/channel/UCGxgRgb4pP1P75uyUJPGJmg
Rob has completed training as a non-medical prescriber and gained independent prescriber rights via London Southbank University.
What is included in this one stop shop clinic?
ABOUT THE CLINIC
Welcome to the SonoScope ultrasound guided injection clinic
One stop shop
Sonoscope provides a comprehensive clinical physiotherapeutic, diagnostic and therapeutic “one stop shop" package for those requiring ultrasound guided injections. This will all be provided within the one session.
The session starts with a clinical consultation which includes a physical examination of the painful area. This will help the clinician to understand the nature of the problem. This is followed by a diagnostic ultrasound scan of the problematic area which will provide additional information to help form a clinical diagnosis and to decide if injection therapy is the correct treatment for you. It will also help identify the structure to be injected.
Ultrasound guided injection therapy provides a high degree of accuracy which in many cases also improves the effectiveness of injection therapy when compared with unguided injections (Aly et al, 2015; Finnoff et al, 2015).
Included in the package is a clinical report which will contain information gained from the clinical assessment as well as any additional diagnostic information from the ultrasound scan and further specific information about the injection procedure performed.
Expert clinical staff
The clinic is provided by Robert Mast who is an Extended Scope Physiotherapist (ESP), musculoskeletal sonographer and educator.
He is employed as an expert clinician in the NHS providing both clinical diagnosis as well a point of care diagnostic- and Interventional musculoskeletal ultrasound. He also works in an NHS Radiology-department performing diagnostic ultrasound scans as well as carrying out many ultrasound guided injection procedures every week.
High performance ultrasound scanner
The clinic boasts a high-quality ultrasound scanner which provides exceptional high-resolution images further improving diagnostic accuracy as well as accuracy of injections under ultrasound guidance.
ABOUT INJECTION THERAPY
What is included in the consultation?
Diagnostic ultrasound scan
Ultrasound guided injection
Why should I have an injection under ultrasound guidance?
There is overwhelming evidence that ultrasound guided steroid injections are much more accurate than unguided steroid injections. As needle placement can be monitored under ultrasound guidance it reduces the risk of trauma to structures which improves the injection safety significantly.
Ultrasound guided injections are delivered by Rob Mast a highly experienced and qualified Extended Scope Physiotherapist with extensive expertise in delivering ultrasound guided injections both in the clinical- as well as the Radiological setting. Rob has a wealth of knowledge and experience in managing complex musculoskeletal conditions.
You will receive an expert clinical assessment followed by a diagnostic ultrasound scan to determine whether injection therapy is the correct treatment for you. This will help to evaluate the source of your pain symptoms and to identify the correct area to inject.
If injection therapy is not thought to be appropriate for you will be given a full explanation of the assessment findings including advice regarding appropriate management. In that case you will only be charged a fee for the ultrasound scan but not for the injection.
Injections can be provided for the following areas:
Hand/wrist, elbow, shoulder, Hip, knee, ankle, foot.
Common conditions for which injection therapy is used:
Carpal Tunnel Syndrome
Tenosynovitis of the flexor tendons
De Quervains tenosynovitis,
1st carpo-metacarpal joint osteoarthritis (1st CMC joint osteoarthritis)
Osteoarthritis of the Meta-carpo-Phalangeal joints (MCP joints)
Osteoarthritis of the Proximal Inter-phalangeal joints (PIP joints)
Osteoarthritis of the distal interphalangeal joints (DIP joints)
Gleno-humeral joint osteoarthritis
Ankle osteoarthritis (Talo-crural-joint osteoarthritis)
Subtalar joint osteoarthritis,
mid-tarsal joint osteoarthritis
Morton’s Neuroma, Plantar fasciitis
Bakers cyst knee
Pre patellar bursitis
Injections are not given to any person of 16 years of age or younger. Unfortunately we cannot provide injections for professional football players for reasons of insurance.
Please make sure that you have read the relevant patient information leaflet (available from Sonoworld.co.uk) on the relevant type of injection (steroid or Hyaluronic acid) to ensure that injection therapy is appropriate for you. Please fill out the completed form (available from Sonoworld.co.uk) with questions about your medical health and email or take with you to your appointment.
Areas in red are often areas of referred pain from the spine and injections in these areas may not target the source of the pain (the spine).
If unsure about the source of your pain please discuss further wih us
What is a corticosteroid injection?
A corticosteroid (or ‘cortisone’) is an anti-inflammatory medicine, which can be injected directly into the tissues that are causing your pain symptoms. It is generally safer than being on long term steroid tablets which is more likely to lead to unwanted side effects. It is also safer than taking high dosages of non-steroidal anti-inflammatory tablets for longer periods of time. It acts directly in the area injected and is not the same as the steroids taken by bodybuilders or athletes.
What are the benefits?
The injection can help to relieve swelling, pain and stiffness caused by inflammation. This may in turn help you to start your rehabilitation and return to normal activities sooner by ‘breaking the cycle’ of pain and inflammation. It can also be helpful to aid in the diagnosis of your condition if it is not clear which structures are responsible for your pain. You may also have a local anaesthetic injected at the same time, which allows for temporary pain relief.
What are the risks?
Generally speaking ultrasound guided steroid injections are low risk. However there are a number of potential side-effects and risks that you should be aware of prior to the injection. Please refer to our patient information leaflet which explains the potential risks and side-effects associated with steroid injections.
Medicines that can interfere with steroid injections:
Certain medications might interfere with steroids. When you are taking medications for conditions such as diabetes, cancer, or HIV please check with your specialist whether a steroid injection is appropriate. Blood thinning medications such as warfarin may require a blood test and a temporary adjustment/change of your medication to make sure the blood is not too thin which might cause bleeding in the joint. If you are on blood thinning medication such as warfarin you should consult your specialist first to obtain his/ her advice before having an injection.
Please include any information regarding your health and or medication that you are taking to your appointment.
What happens during the injection?
You will be placed in a comfortable position. The skin is cleaned with antiseptic. A needle is positioned into the affected area whilst the procedure is monitored by means of ultrasound guidance. The steroid (plus possibly a local anaesthetic) is injected through the needle. A plaster will be placed over the site to keep it clean.
Is the injection painful?
The injection is not particularly painful as the clinician is thoroughly trained in this procedure. Sometimes it can be sore for a few hours after the procedure.
HYALURONIC ACID INJECTIONS
Hyaluronic acid injections
Your body makes hyaluronic acid. It's a natural part of the fluid that lubricates and has been shown to improve shock absorption in your joints and it keeps them working smoothly.
When you have osteoarthritis (OA), the hyaluronic acid in the affected joint becomes thinner. Hyaluronic acid injections add to your body's natural supply. They can reduce joint pain and improve nutrition to the joint surfaces. When effective the benefit can last for many months sometimes more than 6 months and the benefit in some cases can last for up to a year.
Why are Hyaluronic Acid Injections offered to patients?
Health professionals can’t predict who will benefit from hyaluronic acid injections. But many doctors and qualified allied health professionals give hyaluronic acid injections to people with osteoarthritic joints who are active and want to continue to maintain an active lifestyle and whose symptoms have not responded to non-drug treatments such as exercise heat or ice, and who have not been getting better with painkillers such as Paracetamol, Ibuprofen, Naproxen or other non-steroidal anti-inflammatories.
Hyaluronic acid injections are often tried by people who can't take painkillers. It is also useful in for those who don’t want or can't have invasive surgery.
How Effective are Hyaluronic Acid Injections for Osteoarthritis?
Studies show that hyaluronic acid injections may work better than painkillers for some people with OA. Other studies have shown they also may work as well as corticosteroid knee injections.
Hyaluronic acid injections seem to work better for some people than others. From my extensive experience in using hyaluronic acid injections for osteoarthritis joint conditions patients who have pain induced by loadbearing or activity tend to respond more favourably than those who have very high levels of pain even during rest (i.e non-mechanical pain). In the second group steroid injections (if appropriate) are more likely to lead to pain reduction.
What happens during the injection?
You will be placed in a comfortable position. The skin is cleaned with antiseptic. A needle is positioned into the affected area whilst the procedure is monitored by means of ultrasound guidance. The hyaluronic acid is injected through the needle. A plaster will be placed over the site to keep it clean.
Is the injection painful?
The injection is not particularly painful although due to the higher volume injected and the gel like consistency it can be slightly more uncomfortable than a steroid injection. The clinician is thoroughly trained in this procedure. Sometimes there could be several days of pain following the procedure.
Further information on hyaluronic acid injections
Before your appointment you will receive an information leaflet on hyaluronic acid injections. Please read this carefully. Also please fill out and return the questionnaire we will provide on your general health so that we can be sure this treatment is right for you.
What are hydrodistension/High volume injections?
Hydrodistension or High Volume injections are performed under ultrasound guidance with the aim of precisely depositing anti-inflammatory steroid, local anaesthetic and saline to give pain relief whilst also deliberately stretching the lining of the joint (joint capsule). This procedure is increasingly used in the treatment of ‘frozen shoulder’ (adhesive capsulitis) and has been shown to be effective in the majority of patients by giving pain relief and also helping them to regain movement. These injections can give rapid and effective reduction in pain and inflammation; however, improvements are usually temporary. As with all medicines, some people may experience side effects.
How successful is it?
Several studies have shown that ultrasound guided shoulder joint hydrodistention can help reduce patients’ pain and improve their range of motion. This technique is performed under aseptic conditions and a local anaesthetic is injected into the shoulder joint usually combined with a steroid joint and the needle is guided by the ultrasound images.
Will it be painful?
You may feel mild discomfort during the procedure and a fullness or heaviness as the joint is filled. After the examination, you may experience swelling and discomfort. These symptoms usually disappear after 48 hours and, if necessary, you may take your usual painkillers.
What are the risks and benefits of this procedure?
The benefit of this treatment is that it should reduce the pain and discomfort in your shoulder and help with movements. There is a small risk of infection when a needle is placed in a joint but we minimise the risk by using an aseptic technique. However, if you experience redness, persistent pain or swelling after the procedure, you should contact your GP or go to your nearest accident and emergency department.
Everything you need to know about Hydrodistension injections is in the information leaflet that you will be sent prior to your appointment.
The clinic takes place in the state of the art diagnostic ultrasound facility of sonoworld diagnostic services
Steroid Injection £249
Hydrodistension Injection: £299
Hyaluronic Acid Injection
High Molecular weight (Durolane) £349
Sonoworld diagnostic services
29 Weymouth Street
020 3633 4902
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