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 Sports Medicine Physicians, Rheumatologists, Orthopedists, and Primary Care 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 into the knee, shoulder and hip.
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.
Ultrasound is beneficial when performing injections in the knee, shoulder and hip; as well as many other structures throughout the body.
Ultrasound can help evaluate a variety of structures within the knee including the quadriceps and patellar tendons, the extra-articular (outside the joint) ligaments, and some meniscus injuries. It can also be used to see if there is fluid within the knee joint. Although knee injections are typically performed without imaging, imaging can be particularly helpful in patients with difficult anatomy or in overweight patients.
Hip joint injections may be performed for osteoarthritis of the hip and the diagnosis and management of labral tears. Imaging is nearly always used when performing injections into the hip joint due to the deep location of the joint and the proximity of blood vessels and nerves. It is estimated that blind injections are accurate 50% to 80% of the time. Ultrasound allows us to visualize the hip joint, bursa, muscles and tendons surrounding the hip. The use of ultrasound when performing a hip injection increases the accuracy to up to 96%. Whereas in the past, hip injections were mainly performed using Fluoroscopy, ultrasound- guided injections have become more popular due to its ease of use, lower cost and ease of perform in the office setting.
Studies have shown that Ultrasound of the shoulder is just as sensitive and specific as MRI in the diagnosis of rotator cuff injury. Ultrasound can facilitate the more accurate injection of multiple different structures in the shoulder including the Acromioclavicular (AC) joint, the Glenohumeral joint (the true shoulder joint), the biceps tendon, and the subacromial bursa. All of these can be injected with or without guidance, however, as noted above the accuracy of these injections is significantly improved with the use of ultrasound guidance
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