Ultrasound guided joint / soft tissue injections

Ultrasound-guided joint and tendon injections are minimally invasive procedures used to deliver medications directly into joints or around tendons with the assistance of ultrasound imaging. This technique ensures precise placement of the needle, increasing the effectiveness of the injection and reducing the risk of complications.

Indications

These injections are commonly used to treat:

1. Arthritis: Osteoarthritis, rheumatoid arthritis, and other inflammatory joint conditions (Click here to read more on Infective Arthritis)
2. Tendinitis and Tenosynovitis: Inflammation of tendons and the sheath surrounding them.
3. Bursitis: Inflammation of the bursae (small fluid-filled sacs that cushion bones, tendons, and muscles).
4. Plantar Fasciitis: Inflammation of the plantar fascia (the thick band of tissue on the bottom of the foot).
5. Frozen Shoulder (Adhesive Capsulitis): Stiffness and pain in the shoulder joint (Click here to read more on Frozen Shoulder)
6. Other Soft Tissue Disorders: Such as ganglion cysts and neuromas.

Procedure

1. Pre-procedure Assessment:
   • Medical History and Physical Examination: To confirm the diagnosis and determine the appropriate injection site.
   • Consent: The patient is informed about the procedure, potential benefits, and risks, and consent is obtained.
2. Patient Positioning:
   • The patient is positioned to allow easy access to the injection site.
   • The area is cleaned and sterilized to prevent infection.
3. Ultrasound Guidance:
   • A sterile ultrasound probe is placed over the injection site to visualize the anatomy in real-time.
   • The ultrasound helps identify the exact location of the joint or tendon and adjacent structures, such as blood vessels and nerves.
4. Needle Insertion:
   • Using the ultrasound images as a guide, the clinician inserts the needle into the precise location within the joint or around the tendon.
   • The real-time imaging ensures accurate placement of the needle, avoiding surrounding tissues and structures.
5. Injection:
   • Once the needle is correctly positioned, the medication is injected. Commonly used medications include corticosteroids, hyaluronic acid, platelet-rich plasma (PRP), or local anesthetics.
   • The ultrasound helps confirm that the medication is delivered to the intended area.
6. Post-procedure Care:
   • The needle is removed, and a small bandage is applied to the injection site.
   • The patient is monitored for a short period to ensure there are no immediate adverse reactions.
   • Post-procedure instructions are given, including activity modifications and follow-up care.

Benefits

• Precision: Increased accuracy in needle placement ensures the medication is delivered exactly where needed.
• Effectiveness: Enhanced precision leads to better therapeutic outcomes and symptom relief.
• Safety: Reduced risk of damaging surrounding structures, such as nerves or blood vessels.
• Patient Comfort: Minimally invasive and often associated with less discomfort than blind injections.

Risks and Considerations

• Infection: Although rare, there is a small risk of infection at the injection site.
• Bleeding: Minor bleeding or bruising can occur.
• Pain: Temporary pain at the injection site is possible.
• Allergic Reactions: Rarely, patients may have allergic reactions to the injected medication.
• Tendon Rupture: Particularly with repeated corticosteroid injections around tendons.

Conclusion

Ultrasound-guided joint and tendon injections are a valuable tool in the management of various musculoskeletal conditions. By utilizing real-time imaging, healthcare providers can deliver medications with high precision, enhancing the efficacy and safety of the procedure. This approach is particularly beneficial for patients who have not responded to conservative treatments and are seeking effective relief from pain and inflammation.