Joint Injection Therapy – Core Physio – Ostenil Injections

Ostenil Injections at Core Physio

Ostenil Injections with Ostenil® Plus is a treatment for the symptoms of Osteoarthritis. It can be used in the knee, or in any other joints in the body that are classified as ‘synovial joint’. These are clinically proven to reduce the pain associated with Osteoarthritis

OSTENIL® TENDON was developed to treat painful tendinopathy. It also helps to restore restricted mobility in tendon disorders caused, for example, by overuse or inappropriate biomechanical stress. It is highly concentrated sodium hyaluronate (2%).

How does Ostenil® Plus work?

Ostenil® Plus is a solution containing sodium hyaluronate. It is injected into the space in the joint that contains synovial fluid and works by restoring the normal balance between the breakdown and production of sodium hyaluronate. This procedure is known as ‘viscosupplementation’, and the effect of Ostenil® Plus means that it can decrease pain and stiffness and improve the other symptoms of osteoarthritis.

The sodium hyaluronate in Ostenil® Plus is very pure and is manufactured using a process called fermentation. It contains no animal proteins, which means that it is very unlikely to cause an allergic reaction. Ostenil® Plus has been given to thousands of patients and has not been found to cause any serious side effects. The exact make-up of the sodium hyaluronate in Ostenil® Plus has been carefully chosen so that it is as effective as possible in treating osteoarthritis.

OSTENIL® TENDON INJECTIONS – for painful tendinopathy

OSTENIL® TENDON was developed to treat pain and restricted mobility in tendon disorders caused, for example, by overuse or inappropriate biomechanical stress. It is highly concentrated sodium hyaluronate (2%).

How does OSTENIL® TENDON work?

The lubricating characteristics of sodium hyaluronate increase tendon gliding and reduce agglutinations (stickiness). The tendon can work again as if well-oiled. Furthermore, sodium hyaluronate blocks pain receptors, hinders inflammatory mediators, and is a good transport medium for nutrients.

OSTENIL® TENDON ensures a harmonisation of the tendons and the surrounding structures, reduces pain, and increases joint function.

How is OSTENIL® TENDON administered?

The treatment itself takes very little time. Your doctor will give you an injection into the area around the most damaged part of the affected tendon, usually employing some form of visual guidance equipment such as Ultra-Sound, which helps ensure the injection is placed correctly. In the case of tendons within a tendon sheath, Your Therapist will inject OSTENIL® TENDON into the tendon sheath itself. In either case, the lubricant will be distributed through natural movement along the entire tendon. A repeat injection, normally given a week after the first, may be required in more established and persistent tendon disease.

What can you expect from treatment with OSTENIL® TENDON?

In studies done in Germany, the treatment scheme described above has proved to be effective and safe. In most cases, there is a quick and long-lasting improvement of joint function. Several tendons may be treated at the same time. If symptoms return the treatment can be repeated.

What you should know about private medical insurers?

Private medical insurers may sometimes give the impression that they will not reimburse OSTENIL® or OSTENIL® PLUS injections, and, as a result, you may be led to offer OSTENIL® injections only for self-funding patients.

However, the fact is that Bupa, Aviva, AXA-PPP, and VitalityHealth will fund viscosupplementation if you use the correct specific code that the insurers require. Please have a look at this website: The “Clinical Coding & Schedule Development Group” provides the specific codes used by the four major insurers (BUPA, Aviva, AXA-PPP, and VitalityHealth) for injecting a viscosupplement into a joint with or without guidance.

The relevant codes for AXA-PPP, Aviva, and VitalityHealth can be found by clicking the ‘procedural’ (green) tab and entering ‘Viscosupplement’ in the search box. The codes that come up are:

W9032 – Injection of viscosupplement into joint WITH image guidance 
W9033 – Injections of viscosupplement into joints WITH image guidance (bilateral) 
W9042 – Injection of viscosupplement into joint 
W9043 – Injections of viscosupplement into joints (bilateral)


The code for BUPA for Ostenil Injections is AA663, which has to be used in conjunction with W9030 (joint injection under guidance), or W9040 (joint injection without guidance). If you go to the individual insurer’s websites then you can also see how much they pay for using each of the codes and what restrictions there are.

Do insurers only fund knee injections?

Sometimes an insurer may say that they will only cover the cost of a viscosupplement injected into the knee and not any other joint. However, on the codes schedule, it does not specify that the related codes are only for the knee. This means injections into other joints, i.e. hip, shoulder, ankle, etc, should also be covered by the insurers. However, the insurers will have their own specific policy regarding applicable clinical circumstances and products to be used.

Frequently asked Questions:

Q: When should I not have an injection?

A: Yes, if you:

  • Are hypersensitivity or allergy to any of the drugs used: risk of anaphylaxis
  • Have sepsis – local or systemic infection
  • Are reluctant to have the injection
  • If you are under 18
  • Had a recent fracture
  • Have a prosthetic joint
  • Are pregnant

Q: What are the possible side-effects?

A: These are very rare and your clinician will discuss them with you:

  • Post injection flare
  • Skin bleeding
  • Infection – if the area becomes hot, swollen, and painful for more than 24 hours you should contact your clinician or doctor immediately
  • Temporary bruising if you are taking blood-thinning medication

Q: Is the injection painful?

A: Not particularly, as your therapist has had intensive training in the technique. Sometimes it can be sore for a few hours, but you will be told what to do about this.

Q: How fast does the injection work?

A: If local anaesthetic is also used the pain should be less within a few minutes, though it may return after about an hour. The steroid usually starts to work within 24-48 hours but may take longer.

Q: How long does the effect last?

A: This varies from person to person and the condition being treated, but the steroid usually continues working for 3 to 6 weeks.

Q: How many injections can I have?

A: This depends on the part of the body involved and will be decided by your therapist and yourself. Usually one injection is sufficient, but if the pain is severe or has been there for a long time, you may need more.

Q: What should I do after the injection?

A: If the problem was caused by overuse, you will probably be told to rest the area for about a week; if it is a joint pain, you may start early gentle movement.

Q: When will I have to be seen again?

A: Here at Core Physio, your therapist will want to see you again about a week or ten days after the ostenil injections. You will then be given appropriate physiotherapy treatment and probably some exercises for you to do at home. You will also usually be reviewed a month after the injection to monitor the long term effect of the treatment.
David Thompson explains the benefit of Ostenil Injections