Ultrasound Guided Injections
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 physicians in performing evaluations and injections of different muscles, tendons, ligaments and joints. With the advancement of this technology, ultrasound machines have become smaller and more portable. 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.
Injections can be beneficial for both the diagnostic and therapeutic treatment of a variety of problems involving the hip, shoulder, and knee. Typical problems include osteoarthritis, rheumatoid arthritis, labral tears, muscle tears, ligament tears and tendonopathies. Injections have been used in the management of inflammatory and degenerative conditions when rest, ice and anti-inflammatory medications fail to provide adequate relief. The use of ultrasound improves the accuracy of the injection of corticosteroids, hyaluronic acid or other therapies such as Platelet Rich Plasma, Prolotherapy or Stem Cells. Ultrasound can also be used for joint aspirations to rule out joint infection or gout. Lastly, guided injections can be used diagnostically to help determine which structures are generating 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:
- Ultrasound has no radiation. Fluoroscopy (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. Additionally with fluoroscopy the providers are unable to visualize surrounding soft tissue structures including tendon, blood vessels or nerves that may be in the path of the needle. This could lead to increased pain or other complications from the injection.
- Ultrasound allows us to visualize the bony 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.
- Ultrasound is able to identify fluid better than conventional radiographs and can see fluid that may have accumulated in and around joints, tendons, muscles, nerves and other soft-tissue structures. CT-guided (or CAT Scan) injections are also frequently used to assist in delivering treatments. With the CT we are able to get a 3-D view of the joint to be injected and can accurately deliver the intended medication, however, these tests come with an increasingly large dose of radiation, they are expensive and time-consuming. Ultrasound injections have been shown to be as accurate as these other imaging-modalities with less cost, improved soft tissue visualization and without the associated radiation.