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Ultrasound Guided Injections
MSK Ultrasound has become extremely popular for not just diagnostic imaging, but now is being routinely used for needle guidance. Various nerve blocks, intra-articular injections, trigger point and muscular injections are now being done under ultrasound guidance.
Recent Studies Show Ultrasound Guidance is More Accurate
“They found that approximately one third of knee and ankle injections were extra-articular, only half of the wrist injections were definitely intra-articular, with even less accuracy reported for shoulder injections. Remarkably, even the ability to aspirate synovial fluid was not a perfect predictor of intra-articular placement of steroid injections with almost half of extra-articular injections having been associated with successful aspiration of synovial fluid. Experience beyond advanced trainee/registrar level did not appear to influence the accuracy of injection placement.” Ann Rheum Dis 2004;63:1007-1008 doi:10.1136/ard.2004.020685
Ultrasonographic guidance boosts joint injection accuracy
September 3, 2010
Cunnington J, Marshall N, Hide G, et al, Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK, and other centers. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum. 2010;62:1862-1869.
Corticosteroid injection in the joints of patients with inflammatory arthritis results in significant alleviation of symptoms and improvement in functional status. Ultrasonography (US)-guided injections are significantly more accurate than clinical examination (CE)-guided injections.
Cunnington and colleagues compared the effects of corticosteroid injections delivered via US or CE guidance in 184 patients with inflammatory arthritis. Treatment outcomes were measured with serological markers of inflammation and patient assessment questionnaires.
US-guided injections were accurate in 83% of patients, compared with 66% of patients who had CE-guided injections. There was a trend toward increased accuracy with US-guided injections for all joints, particularly the shoulder, elbow, and ankle. The greater accuracy of US-guided injections held true regardless of the physician’s level of experience—junior trainees were more precise with US than senior physicians were with CE. Joint function at 6 weeks was better in the US group than in the CE group, although overall clinical outcomes were similar.
The authors noted that injection with US guidance may be considered for joints that frequently are injected inaccurately, when less soluble preparations are used, if the anatomy is distorted by the disease process or by obesity, and to reduce the systemic adverse effects of corticosteroids.
The Journal of Musculoskeletal Medicine. Vol. 27 No. 9
MUSCULOSKELETAL Citations
Concise summaries of recent journal articles chosen for clinical significance
November 1, 2009
Sibbitt WL Jr, Peisajovich A, Michael AA, et al, University of New Mexico Health Sciences Center, Albuquerque, and other centers. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J Rheumatol. 2009;36:1892-1902.
Intra-articular injections performed with sonographic image guidance are significantly superior to palpation-guided methods in all outcome measures. They significantly reduce procedural pain, reduce pain scores at outcome, increase responder rates, and reduce nonresponder rates.
Sibbitt and colleagues randomized 148 patients with painful joints (100 with rheumatoid arthritis and 48 with osteoarthritis) to corticosteroid injection via palpation or sonographic guidance. Pain was measured with the standardized and validated Visual Analog Scale (VAS) pain score.
The patients injected with ultrasonic guidance had significantly less pain during the injection and better outcomes than those managed conventionally. Injection pain was reduced by 43%, and absolute pain scores at 2 weeks were reduced by 58.5% (as assessed by the VAS pain score). Significant pain was cut by 75%. The difference in response rate weighed favorably toward sonographic guidance; there was a 25.6% increase in responders and a 62% decrease in nonresponders. The amount of fluid withdrawn was greater in the ultrasonography group.
The authors suggested that their findings strongly support the use of sonography for intra-articular injections in outpatient musculoskeletal practices and that research is needed to address the effects of such procedures on long-term outcomes.
The Journal of Musculoskeletal Medicine. Vol. 26 No. 11
MUSCULOSKELETAL Citations
Introducing iNeedle!
iNeedle is a revolutionary new way
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Welcome
Diagnostic Instruments, Inc. is focused solely on Musculoskeletal Ultrasound (MSK Ultrasound). Our team has over 48 years of combined experience in MSK Ultrasound. So... whether you are just getting started or already have an ultrasound system, our team has the knowledge to make your portable ultrasound purchase "Turn-Key". Put our experience to work for you!
MSK Ultrasound can truly be a practice builder. Patients love to see the dynamic ultrasound images and you will appreciate the additional revenue stream and diagnostic information it provides. Ultrasound Guided Injections may improve your outcomes and the patients can see on the screen the needle being directed to the exact location. See the Indications and Reimbursement pages for more information. We would be happy to set up a time when we can go over all the benefits MSK Ultrasound can add. Call us at (800-516-2663) or email us today.
Clinical Benefits of MSK Ultrasound
- Same day diagnosis
- Moves patients to treatment phase faster
- Increases interactive nature of the examination
- The dynamic, real-time nature of sonography requires personal interaction with the patient, often resulting in a more directed examination, specific for each individual.
- Better Visualization
- See the needle and the injectate in precise location
- Visualize blood vessels and nerves before advancing needle
- Many Applications
- Tendons, Ligaments, Bone Surface, Nerves, Bursa, Synovium, Cartilage, Foreign Bodies, ect.
- Interventional Procedures
- Ultrasound can be used to guide needles for biopsy, aspiration, injections and dry needling
Proven clinical benefits
- High treatment compliance rate
- No wait for imaging results
- Patients in pain get treated faster
- Enhanced patient perception
- Affordable technology exists
Diagnostic Musculoskeletal Ultrasound
US shows full spectrum of shoulder injuries
September 29, 2006 -- When it comes to the frozen shoulder, MRI is good as long as you are happy with static information. But if it's more dynamic information you're after, ultrasound may be a better bet, according to two recent studies. A third paper offered a crash course on making the most of sonography in shoulder disorders, as well as how to identify abnormalities on these exams.
Adhesive capsulitis
Tendons
Joints and ligaments
Rotator cuff disorders
Calcium deposits
Non rotator cuff disorders
Synovial disorders: Multiple small, uniform, echogenic nodules with the joint or bursae, or along the LHBT sheath, on ultrasound.
Degenerative disorders: On sonography, look for the presence of intra-articular loose bodies and narrowing of joint space in osteoarthritis.
Chronic hemophilic arthropathy: Ultrasound can assess synovial proliferation, joint effusion, degenerative subchondral erosions, and cysts.
Benign and malignant tumors: Ultrasound appearance is that of a mass in superficial lipomas and other soft-tissue tumors. For elastofibroma dorsi pseudotumors, sonography shows a mass with a striated appearance and alternating hypoechoic fat strips, surrounded by echogenic fibroelastic tissue.
By Shalmali Pal
AuntMinnie.com staff writer
September 29, 2006