ORTHOPEDICS + SPORTS MEDICINE
Ultrasound-Guided Injections
Real-time imaging so every injection reaches exactly the joint, tendon, or nerve it is meant to treat.
An injection can only reach its intended purpose when the medication or biologic preparation is placed in the correct location. This can be challenging around small joints, deep structures, or areas where tendons, nerves, and blood vessels lie close together. Ultrasound guidance provides a live image of these structures while the needle is advanced.
Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine may use ultrasound guidance to improve visibility during selected joint and soft-tissue injections. Ultrasound is not the treatment being injected and is not itself an orthobiologic. It is an imaging method that helps the provider direct corticosteroid, local anesthetic, platelet-rich plasma, or another prescribed substance toward the intended target.
Orthobiologics
Real-Time Imaging
Targeted Placement
What Ultrasound Shows During an Injection
Musculoskeletal ultrasound uses high-frequency sound waves to create images of structures beneath the skin. A handheld device called a transducer sends sound waves into the body and receives the echoes that return.
A computer converts those signals into a moving image. Depending on the area, ultrasound can show:
- Muscles
- Tendons
- Ligaments
- Joints
- Bursae
- Nerves
- Fluid collections
- Blood vessels
- The surface of certain bones
Because the image appears in real time, the provider can watch the needle move toward the target. Nearby structures can also be identified and avoided during placement.
Ultrasound does not use ionizing radiation.
Why Image Guidance May Be Recommended
Some joints and soft-tissue structures can be injected using anatomical landmarks alone. Ultrasound guidance becomes particularly useful when the target is deep, small, difficult to feel, or positioned close to a nerve or blood vessel.
It may also be selected when a previous injection did not provide the expected response and there is concern about whether the substance reached the intended location.
Ultrasound-guided injections may be used around the:
- Shoulder
- Elbow
- Hand and wrist
- Hip
- Knee
- Foot and ankle
- Tendons and tendon sheaths
- Inflamed bursae
The need for guidance depends on the anatomy, diagnosis, treatment being delivered, and provider’s clinical judgment.
Medications and Treatments Delivered With Ultrasound
Ultrasound describes how the needle is guided, not what is placed through it. The injected substance is selected according to the condition being treated.
Corticosteroid
Corticosteroid medication may be used to reduce inflammation within a joint, bursa, or selected area around a tendon. It does not repair a tear or reverse structural damage.
Local Anesthetic
A local anesthetic may be used to numb an area temporarily. It can also provide diagnostic information. If pain decreases after anesthetic reaches a particular joint or structure, that response may help identify where the symptoms originate.
Hyaluronic Acid
Hyaluronic acid may be injected into selected arthritic joints to supplement the joint’s natural lubricating fluid. Recommendations and insurance coverage vary according to the joint and diagnosis.
Platelet-Rich Plasma
PRP is prepared from a patient’s blood and injected into a selected joint or soft-tissue structure. Ultrasound can help guide the preparation to the intended location, but it does not determine whether PRP is appropriate or guarantee a response.
Other substances may be used when medically indicated. The patient should understand what is being injected, why it was chosen, and what evidence supports its use for the diagnosed condition.
How the Procedure Is Performed
The patient is positioned to give the provider a clear view of the treatment area. The skin is exposed and cleaned, and sterile precautions are used.
Ultrasound gel is applied, and the transducer is placed against the skin. Before inserting the needle, the provider examines the area and identifies the target along with nearby tendons, nerves, and blood vessels.
The needle is then advanced while its position is monitored on the screen. The provider may view the needle along its length or in cross-section, depending on the approach.
Once the needle reaches the intended location, the prescribed substance is delivered. The needle is removed, and a small bandage is placed over the injection site.
The ultrasound portion does not produce pain, although pressure from the transducer may be uncomfortable over a tender area. Patients may feel a brief pinch, pressure, or fullness during the injection.
Ultrasound-Guided Aspiration
Ultrasound may also guide aspiration, a procedure that removes fluid rather than delivering medication. A needle can be directed into a swollen joint, bursa, cyst, or other fluid collection.
Removing fluid may reduce pressure or allow the sample to be examined for infection, crystals, blood, or other abnormalities. Medication may sometimes be injected after aspiration, depending on the diagnosis.
The decision to aspirate is separate from the decision to inject. Not every fluid collection should be drained.
Preparing for the Appointment
Most ultrasound-guided injections require little preparation, but instructions vary according to the treatment and location.
Patients should tell the practice about:
- Blood-thinning medication
- Medication or anesthetic allergies
- Diabetes
- Pregnancy or possible pregnancy
- Active infection or current antibiotic use
- Previous reactions to injections
- All medications and supplements
- Upcoming surgery or vaccination
Patients should not stop prescribed blood thinners or other medication without guidance from the clinician who manages them.
Loose clothing that allows access to the treatment area may be helpful. Additional preparation may be required when nitrous oxide or another comfort measure will be used.
After the Injection
Recovery is determined mainly by the substance injected and the structure treated. Some patients can resume routine activity shortly afterward, while others need to protect the area from strenuous use.
Temporary soreness, pressure, or bruising may occur at the needle site. A short flare in pain is also possible after certain injections.
Instructions may include:
- Limiting strenuous activity
- Monitoring the injection site
- Using medication as directed
- Avoiding specific anti-inflammatory drugs after PRP
- Checking blood sugar more frequently after corticosteroid
- Gradually returning to exercise
Patients should contact the practice for increasing redness, warmth, drainage, fever, severe swelling, or pain that continues to worsen.
Physical Therapy After an Injection
An injection may reduce symptoms or support the local treatment response, but it does not automatically correct weakness, stiffness, or poor movement mechanics. Physical therapy may therefore remain an important part of care.
The period after an injection can create an opportunity to work on:
- Joint motion
- Muscle strength
- Tendon loading
- Balance
- Movement technique
- Return to work or sports
The timing depends on the medication or biologic preparation used. Therapy may resume quickly after some injections, while PRP and certain tendon procedures require a more controlled progression.
When to Consider an Ultrasound-Guided Injection
An image-guided injection may be discussed when a joint, tendon, bursa, or other structure has been identified as the likely source of persistent symptoms. It may also help when a diagnostic injection is needed to distinguish between two possible sources of pain.
A specialist should establish the diagnosis before selecting the injection. Using precise guidance does not make an unnecessary medication appropriate or turn an uncertain diagnosis into a clear one.
Summary
The value of ultrasound guidance lies in direct visualization. The provider can identify the treatment area, watch the needle advance, and account for nearby structures throughout the procedure.
Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine uses that information alongside the patient’s examination and diagnosis to determine both where an injection should be placed and whether it should be performed.