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Writer's pictureFrancesco Bruno Tagliaferro

Ultrasound-Guided Joint Injections: A Complete Guide

Updated: 7 days ago


Infilitrazione articolare

Ultrasound-guided joint injections are a minimally invasive therapeutic option for the treatment of various joint conditions.


Joint injections involve the administration of medications (corticosteroids, hyaluronic acid, local anesthetics) into one or more joints and pathological musculo-tendinous tissues to treat inflammatory, degenerative, or traumatic conditions. The primary goal is to reduce pain, improve mobility, and, in some cases, slow the progression of the disease.


Compared to traditional methods, which rely solely on anatomical landmarks to determine the injection site, the use of ultrasound guidance significantly increases treatment accuracy and reduces potential complications. With ultrasound guidance, precision reaches 95%, while traditional, non-ultrasound-guided injections have a lower success rate, with accuracy ranging from 60% to 80%.

  

Indications


Ultrasound-guided joint injections are indicated in several situations:

  • Acute or chronic joint pain that does not respond to conservative treatments.

  • Functional limitation of the joint.

  • Persistent intra-articular inflammation.

  • Acute phase of inflammatory conditions such as rheumatoid arthritis or gout.

  • Post-traumatic outcomes with residual inflammation.


Conditions Benefiting from Joint Injections


Ultrasound-guided joint injections are useful in many pathological conditions, including (this list is indicative and not exhaustive):

  • Osteoarthritis: Symptomatic treatment to reduce pain and improve joint function.

  • Rheumatoid Arthritis: Relief of acute inflammation in affected joints.

  • Tendinitis and Bursitis: Reduction of inflammation and pain in tendons and bursae.

  • Subacromial Impingement Syndrome: Treatment of shoulder conditions with chronic inflammation.

  • Post-Traumatic Joint Conditions: Reduction of pain and post-traumatic inflammation.

  • Gout and Pseudogout: Management of acute flare-ups through the injection of anti-inflammatory medications.


Contraindications


Absolute

  • Current infection in the injection area.

  • Sepsis or uncontrolled systemic infections.

  • Known allergy to the medications used (e.g., corticosteroids or anesthetics).

  • Recent joint fracture.


Relative

  • Ongoing anticoagulant therapy. Risk of bleeding should be assessed. If possible, anticoagulant therapy should be suspended.

  • Severe renal or liver insufficiency (increased risks with certain medications).

  • Uncontrolled diabetes mellitus (due to the risk of glycemic imbalance with corticosteroids).


Drugs used


Ultrasound-guided joint injections can utilize various classes of medications, each with specific indications, benefits, and potential risks.


Corticosteroids


Corticosteroids are anti-inflammatory drugs used to quickly reduce inflammation and pain.


  • Indications: Acute and chronic inflammatory conditions, such as rheumatoid arthritis, osteoarthritis, and bursitis.

  • Benefits: Rapid reduction of pain and inflammation.

  • Duration: Effects last from a few weeks to several months.

  • Risks: Infection, long-term cartilage deterioration, glycemic imbalances in diabetic patients.



Hyaluronic Acid is used as viscosupplementation to improve joint lubrication. It also has anti-inflammatory properties.


  • Indications: Mild to moderate osteoarthritis.

  • Benefits: Pain reduction and improvement in joint mobility.

  • Duration: Ranges from a few weeks to a year. The duration depends on the type of hyaluronic acid used, the severity of the condition, and other individual factors.

  • Risks: Temporary local reactions such as swelling or pain.


Local anesthetics


Local Anesthetics are often used in combination with other medications to provide immediate pain relief.


  • Indications: Acute joint pain.

  • Benefits: Temporary pain relief.

  • Duration: Lasts for hours or a few days.

  • Risks: Rarely, allergic reactions or systemic toxicity.


How to prepare for the procedure


Before undergoing an ultrasound-guided joint injection, the patient should:

  • Discontinue any anticoagulant medications as directed by the doctor.

  • Inform the doctor of any allergies or chronic conditions.

  • Undergo blood tests (e.g., coagulation tests) if required.

  • Avoid eating for several hours before the procedure, if specified.


How ultrasound-guided joint injections are performed


The procedure for ultrasound-guided joint injections involves the following steps:

  • Patient history and clinical evaluation.

  • Preparation of the injection site with thorough disinfection.

  • Positioning of the ultrasound probe on the joint to identify the precise injection site.

  • Insertion of the needle under ultrasound guidance.

  • Injection of the medication with continuous visualization of the needle and the injected fluid.

  • Removal of the needle and application of a bandage.


Infiltrazione di ginocchio ecoguidata
Ultrasound-guided injection of the knee

What to expect after the procedure


After the injection, the patient may experience:

  • Mild pain and transient swelling at the injection site.

  • Pain relief within 24-48 hours, depending on the medication used.

  • Limitation of physical activity for a few days.


Follow-up


Post-procedure follow-up includes:

  • Clinical evaluation after 1-2 weeks to monitor the response to treatment.

  • Long-term monitoring if corticosteroids or hyaluronic acid are used, to plan any further injections.


It is possible to repeat the procedure if the benefit is insufficient or if symptoms return after a few months, especially in chronic conditions such as osteoarthritis.


Complications


Complications from ultrasound-guided joint injections are rare and are classified as major or minor.


  • Major complications: Joint infections (septic arthritis), vascular or nerve damage, severe allergic reactions.


  • Minor complications: Swelling, bruising, transient pain.


In conclusion


Ultrasound-guided joint injections offer a safe and effective therapeutic option for numerous joint conditions, with rare and mostly transient complications.

Ultrasound guidance is now considered essential, as it has been widely proven to significantly improve the precision and efficacy of the procedure compared to traditional methods.

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