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. Instead, we direct the needle based on our knowledge of the position of bone, tendons, and joints. However, delivering an injection into a tendon or joint is not as easy as it sounds. For example, in tendons, we must inject them into the tendon sheath. Moreover, joint injections must be administered into the joint, not into the surrounding soft tissue. Recently, physicians have been using techniques to direct the needle to the correct site. For example, ultrasound-guided injection allows visualisation of the needle as it is directed to the target. Why perform an ultrasound-guided steroid injection, and where can you get an ultrasound-guided injection in London? 

What are our Options for guidance: X-ray or Ultrasound-Guided injection? 

Generally, we perform guided injections with either ultrasound or X-ray. Ultrasound-guided injections have several advantages over X-ray-guided injections, including lower cost and the absence of ionising radiation. Previously, doctors used ultrasound infrequently due to the cost. Now, ultrasound devices are portable and more affordable, allowing physicians to perform ultrasound-guided injections in their offices rather than in a hospital, saving time and money.

How do We Perform an Ultrasound-Guided Injection?

Generally, physicians perform ultrasound-guided injections as with traditional injections. First, we apply sterile gel to the skin. Then, we use the ultrasound probe to visualise the target. Finally, we direct the needle tip to the target site using an ultrasound picture. For example, the video below shows a needle carefully directed to the shoulder bursa above the rotator cuff tendons. This injection is commonly used to treat rotator cuff tendonitis.

Is an Ultrasound-Guided Injection Better?  

Studies show that ultrasound-guided injections are more accurate for most joint and soft-tissue problems. For example, we perform ultrasound-guided knee joint injections with 100% accuracy, compared to standard injections, which achieve only 75%. In addition, evidence indicates that ultrasound improves pain relief. For example, ultrasound in carpal tunnel syndrome, rotator cuff tendonitis, and knee joint arthritis leads to more significant pain relief. Finally, evidence indicates that ultrasound-guided injections are less expensive than non-ultrasound-guided injections for knee and hip joints. This point makes sense, as greater pain reduction means patients see their physician less frequently.

A recent study confirms the better effect of ultrasound guidance. In a study of more than 1,000 patients with knee arthritis who underwent hyaluronic acid injections, those who received ultrasound-guided injections had substantially lower rates of knee replacement (over 30% lower) than those who received blind injections.

Moreover, because ultrasound is more accurate, it offers additional advantages, such as reduced side effects and more reliable localisation of the pain source.

Fluoroscopy vs. ultrasound: which is better?

Most studies suggest that fluoroscopy and ultrasound injections are equally accurate and effective. However, we know that ultrasound is much cheaper. Also, most people prefer ultrasound to fluoroscopy. The primary reason for this preference is that we perform the ultrasound in a clean office setting, which takes less time. On the other hand, doctors perform fluoroscopy in an operating theatre, which takes many hours. Moreover, fluoroscopy uses radiation, whereas ultrasound is radiation-free.

Can Anyone Perform an Ultrasound-Guided Injection? 

It takes many years to learn to do an ultrasound injection, as with any skill.

Doctors, physiotherapists, and podiatrists perform musculoskeletal ultrasound-guided injections in London and the UK. Overall, skill level can vary, which can affect the success of an injection. You must undergo an injection performed by a practitioner with excellent skills. Doctors generally have more training in ultrasound and ultrasound-guided injection than other practitioners. You should inquire about your practitioner’s experience and training.

While cost is an important factor, always be wary of non-doctor practitioners who charge less for injections. Some non-doctor practitioners in the UK perform ultrasound-guided injections in an unregulated environment. Conversely, doctors are tightly regulated by the government body called the CQC or Care Quality Commission and the General Medical Council. Both bodies strive to ensure safe and effective health care delivery.

How do you know whether your practitioner is a specialist doctor? 

Verify whether your practitioner is registered with the General Medical Council. Ideally, the doctor should be part of the specialist register, although some general practitioners also have training in ultrasound and ultrasound-guided injections.

Other Frequently Asked Questions about an Ultrasound-Guided Steroid Injection

Are ultrasound-guided steroid injections painful? 

Yes. However, research suggests that ultrasound-guided injections are less painful than non-ultrasound-guided injections. We think this is because ultrasound allows the doctor to be more accurate and less likely to hit other structures, such as nerves and blood vessels.

How long does an ultrasound-guided steroid injection take? 

Generally, ultrasound-guided injections take slightly longer than blind injections. However, this additional time is worthwhile due to improved accuracy and effectiveness. 

Does the use of ultrasound increase the risk of infection? 

Using ultrasound for an injection makes the injection more complex. But it doesn’t necessarily mean the risks are increased. However, you should ensure your doctor takes the necessary steps to safeguard against infection. 

Select the area on the body below and explore injection options for your pathology.

SHOULDER INJECTIONS ELBOW INJECTIONS WRIST AND FINGER INJECTIONS HIP AND GROIN INJECTIONS KNEE INJECTIONS FOOT AND ANKLE INJECTIONS

Final Word from Sportdoctorlondon about Ultrasound-guided Steroid Injection

In summary, ultrasound is accurate and effective for joint and tendon injections. Also, ultrasound reduces side effects. Most importantly, you should ask about your practitioner’s skill level. Doctors generally have excellent training and skill levels in performing ultrasound-guided injections. They are also regulated by government bodies, the CQC and the GMC, while other practitioners are not. 

If you’re looking for an ultrasound-guided injection in London, Sportdoctorlondon provides an excellent service at a reasonable price. Dr Masci performs ultrasound-guided injections in central London. He has over 15 years of experience using ultrasound to guide injections and teaches other doctors how to perform injections under ultrasound guidance. In addition, he has developed an online course on ultrasound-guided injections and authored scientific papers on the topics.

If you are interested in seeing Dr Masci for an ultrasound-guided injeciton, don’t hesitate to contact his administrative staff for further information. His fees are outlined here. 

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