Injections are essential for treating joints and tendons — commonly cortisone, hyaluronic acid, and PRP. Hitting the target is critical to a good result, and it’s harder than it looks. That’s why we use ultrasound to improve our hit rate. But not everyone who offers injections has the same training. So, before you have an ultrasound-guided injection, here are the four questions to ask.

For evidence that guidance works, see whether an ultrasound-guided injection is better; for fees, see the one-stop injection page.

Why does guidance matter?

wrist injection under ultrasound

Traditionally, injections are done “blind”, relying on the practitioner’s knowledge of the anatomy. Even with experience, hitting the right site can be a little better than a coin toss. A US-guided injection improves the hit rate, and an improved hit rate means a better, longer-lasting effect. In one study, patients with knee arthritis who received ultrasound-guided hyaluronic acid injections had far lower rates of knee replacement than those who received injections blindly.

But the result still depends on who’s holding the needle. In the UK, ultrasound-guided steroid injections are performed by specialists, general doctors, physiotherapists, podiatrists, and even beauty therapists — with very different levels of training. Doctors generally have the most. So it pays to ask questions.

Question 1: Is your practitioner skilled in ultrasound-guided injections?

See someone with genuine ultrasound experience. A specialist doctor is ideal, though some general doctors have strong injection experience. Physiotherapists and podiatrists generally have less training than doctors. Ask directly about their training and how long they’ve been using ultrasound.

Question 2: Does your practitioner take pictures of the injection?

Saved ultrasound images prove the needle reached the exact spot. Accurate injections are more effective and carry a lower risk of side effects, such as skin thinning or tendon rupture. These pictures should be given to you as part of a medical report.

Question 3: Does your practitioner inject safely?

A sterile field provides the lowest possible risk of infection — best practice uses sterile packs, gloves, and ultrasound probe covers. Be cautious if your practitioner doesn’t take these basic precautions.

Question 4: How many injections does your practitioner perform?

Practice makes perfect, and some injections are more complex than others — tendon injections and shoulder procedures such as hydrodilatation or barbotage need more training. We suggest a practitioner who performs at least 500 injections a year.

Dr Masci’s ultrasound injection experience

Dr Masci uses ultrasound for injections and has over 15 years of experience, teaching other doctors how to inject. He performs about 500–1,000 injections a year, has developed an online ultrasound injection course, written scientific papers on ultrasound-guided injections, and speaks at international conferences. He also runs an advanced ultrasound injection course for other clinicians.

Frequently asked questions about choosing an injection practitioner

Who should perform an ultrasound-guided injection?

Ideally, a doctor with specialist ultrasound training who the GMC and CQC regulate. Other practitioners — physiotherapists, podiatrists — vary in training, so always check experience, sterile technique, and injection volume.

Should my injection always be done under ultrasound?

For most joint and soft-tissue targets, yes — ultrasound improves accuracy and effectiveness. (Spine injections are an exception, usually done under X-ray.) If your current practitioner injects unthinkingly, it’s reasonable to ask why.

Is a cheaper injection a worse injection?

Not necessarily — but a low price shouldn’t be the deciding factor. Some low-cost injections are done by non-doctors in unregulated settings. Use the four questions above to judge quality rather than price alone.

What if my practitioner won’t give me injection pictures?

That’s a reasonable concern. Saved images are proof that the right spot was injected. A practitioner confident in their accuracy should be happy to provide them in a report.

Final word from Sport Doctor London about having an ultrasound-guided injection

You wouldn’t trust just any doctor with complex surgery, so why trust just anyone with a challenging ultrasound injection? Do your homework first — choose a practitioner with the right experience, sterile technique, and track record.

To book a one-stop ultrasound-guided injection with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.

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