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Dr Lorenzo Masci: Are ultrasound-guided injections better for joints and soft tissue?

We use injections in sports medicine to reduce pain. Drugs injected include cortisone, hyaluronic acid and platelet-rich plasma (PRP). In most cases, we perform these injections without direct vision. We use landmark-guidance where we direct the needle based on our knowledge of the position of bone, tendons and joints. Recently, doctors are using imaging such as ultrasound-guided injections. Image guidance allows us to see the needle directed to the target.

What are our options for imaging-guidance?

We perform guided injections with either ultrasound or X-ray. Ultrasound has many advantages compared to X-ray such as lower cost and no radiation. In addition, ultrasound can be performed simply in an office rather than a hospital saving time and money.

Why perform ultrasound-guided injections?

Evidence suggests that ultrasound is more accurate for most joint and soft tissue injections. There is also evidence that using ultrasound improves pain relief. For example, using ultrasound in carpal tunnel, shoulder tendons and knee joint leads to greater pain relief.  Finally, there is some evidence that using ultrasound is less expensive overall in the knee and hip joints. This make sense as greater pain reduction will mean that patients see their doctor less ultimately reducing cost.

In addition, many doctors believe that ultrasound-guided injections also reduce side effects and can give more information about the source of pain.

So, in summary, there is greater accuracy in ultrasound-guided injections. There is also good evidence that injections under ultrasound are more effective.  Finally, there is some evidence of less cost associated with ultrasound. While further studies are needed, there is enough evidence to recommend the use of ultrasound for most injections.

Dr Masci is a Sports and Exercise Medicine doctor with an expertise in the management of general musculoskeletal injuries including muscle injuries. An expert in MSK ultrasound with a specialisation in ultrasound-guided injections for joints and tendons, he has written over 20 peer-reviewed papers. He has presented at international conferences including Arsenal football conference. Dr Masci consults at OneWelbeck. For enquiries, please contact or visit his website