Advanced Ultrasound-Guided Injections for Pain Relief

Ultrasound, also known as sonography, is an imaging method that uses high-frequency sound waves to produce real-time and dynamic images of the body. Ultrasound is increasingly being used to assist Physiatrist, Sports Medicine Physicians, Orthopedists, and Primary Care Physicians in performing evaluations and injections of different muscles, tendons, ligaments and joints. Ultrasound machines have become smaller and more portable. and this has allowed treating clinicians to be able to use real time, point of care ultrasound, to assist in the diagnosis and treatment of their patients. Although ultrasound is frequently used to identify injuries or abnormalities; it is also used when performing injections into the knee, shoulder and hip.

Injections can be beneficial for both the diagnostic and therapeutic treatment of a variety of problems involving the shoulder, elbow, hip and knee. Typical problems treated include tendinitis, bursitis, osteoarthritis, ligament and labral tears.

The use of ultrasound improves the accuracy of the injection by allowing the doctor to visualize the needle in real time as it is guided to painful structure being treated. This assures that the medication is accurately injected at the intended site. Despite good intentions, even in the most experienced hands, blind (injections performed without imaging) injections are not 100% accurate and in some joints accuracy is as low as 30%-40%. With ultrasound guidance the accuracy of nearly every joint injection exceeds 90% and approaches 100% in many.

Ultrasound can be used to not only inject corticosteroids, hyaluronic acid and platelet rich plasma (PRP) but also to remove fluid from a joint to relieve pain, or to assess for an infection or gout. Guided injections can additionally help to diagnose what is the structure(s) that are causing the patient’s pain.

Although there are many different types of imaging that can be used to assist with injections, ultrasound has a few distinct advantages.

1. Ultrasound has no radiation. Flouoroscopy (a type of real time X-ray) allows the provider to easily visualize the joint making injections easier, however, fluoroscopy is associated with repeated doses of radiation. Fluoroscopy is better suited for performing spinal injections such as epidurals and facet joint injections.

2. Ultrasound allows the doctor to visualize the joint as well as all of the surrounding structures. Moving the ultrasound probe the practitioner can visualize what may be in the path of the needle and avoid any unwanted complications before they happen.

3. Ultrasound is able to identify fluid better than x-rays and can see fluid that may have accumulated in and around joints, tendons, muscles, nerves and other soft-tissue structures.

The risks associated with these procedures are the same as any type of injection: incomplete reduction of pain, bleeding, damage to surrounding structures and infection. The overall risks for injections are very low and the use of ultrasound guidance may further reduce some of these risks.

Ultrasound is beneficial when performing injections in the knee, shoulder and hip; as well as many other structures throughout the body.

In the article: Existing Evidence on Ultrasound-Guided Injections in Sports Medicine- Orthop J Sports Med. 2018 Feb; 6(2)

“A comprehensive review of the literature was conducted to demonstrate increased accuracy of ultrasound-guided injections regardless of anatomic location. In the upper extremity, ultrasound-guided injections have been shown to provide superior benefit to landmark-guided injections at the glenohumeral joint, the subacromial space, the biceps tendon sheath, and the joints of the hand and wrist. In the lower extremity, ultrasound-guided injections at the knee, ankle, and foot have superior efficacy to landmark-guided injections. Conclusive evidence is not available regarding improved efficacy of ultrasound-guided injections of the hip, although landmark-guided injection is performed less commonly at the hip joint. Ultrasound-guided injections are overall more accurate than landmark-guided injections.” Click here to read more