We use injections in sports medicine to reduce pain — commonly cortisone, hyaluronic acid, and PRP. Traditionally, these are given “blind”, with the needle directed without knowledge of the anatomy. But hitting a tendon sheath or the inside of a joint is harder than it sounds. An ultrasound-guided injection lets us see the needle reach the target. So why have an ultrasound-guided steroid injection? Is it actually better, and where can you get one in London? For the practitioner-vetting questions to ask first, see the four questions before an injection; for cortisone specifically, see ultrasound-guided cortisone injection.
Guidance options: X-ray or ultrasound?
Guided injections use either ultrasound or X-ray. Ultrasound has clear advantages: it’s cheaper, uses no ionising radiation, and can be done in a clinic rather than a hospital, saving time and money. Portable, affordable ultrasound now makes this routine.
How do we perform an ultrasound-guided injection?
The process is much like a traditional injection, with one key difference — we see the needle and target throughout. We apply sterile gel, use the probe to visualise the target, then direct the needle tip to the exact site under live imaging. The key is watching the injectate flow through the needle into the target.
Is an ultrasound-guided injection better?
The evidence says yes for most joint and soft-tissue problems. Ultrasound-guided injections are more accurate — for example, ultrasound-guided knee injections reach the joint with about 100% accuracy, compared with roughly 75% accuracy with blind injections. Ultrasound also improves pain relief in carpal tunnel syndrome, rotator cuff tendonitis, and knee arthritis, and it works out cheaper overall for knee and hip joints — better accuracy means fewer repeat visits.
A large study reinforces this: among more than 1,000 knee arthritis patients receiving hyaluronic acid injections, those receiving injections under ultrasound had over 30% lower rates of knee replacement than those receiving blind injections. Better accuracy also means fewer side effects and more reliable targeting of the pain source.
Fluoroscopy vs ultrasound: which is better?
Most studies show fluoroscopy (X-ray) and ultrasound are equally accurate and effective. But ultrasound is much cheaper, radiation-free, and most patients prefer it — it’s done in a clean clinic room in minutes rather than a hospital theatre.
Can anyone perform an ultrasound-guided injection?
It takes many years to learn. In the UK, doctors, physiotherapists, and podiatrists all perform MSK ultrasound-guided injections, and skill levels vary, which affects success. Doctors generally have the most training. Be wary of cheaper injections from non-doctor practitioners: some work in unregulated settings, whereas the CQC and the General Medical Council tightly regulate doctors. Always ask about your practitioner’s training and experience — the four key questions are here.
Frequently asked questions about an ultrasound-guided steroid injection
Are US-guided steroid injections painful?
Less so than blind injections, research suggests — better accuracy means the needle is less likely to catch nerves or vessels.
How long does an ultrasound-guided steroid injection take?
Slightly longer than a blind injection, but the added accuracy and effectiveness make the extra minutes worthwhile.
Does ultrasound increase the infection risk?
Not inherently — though the extra equipment means your doctor must use a strict sterile technique (sterile gel, covers, gloves) to keep the risk minimal.
Where can I get a US-guided steroid injection in London?
Dr Masci performs ultrasound-guided injections at his central London clinics as one-stop visits. See the fees here, with Chelsea being the most cost-effective location.
Final word from Sport Doctor London about an US-guided steroid injection
Ultrasound is accurate and effective, and it reduces side effects for joint and tendon injections. Most importantly, ask about your practitioner’s skill level — doctors have excellent training and are regulated by the CQC and GMC. If you’re looking for an ultrasound-guided injection in London, Dr Masci offers an excellent service at a reasonable price, with over 15 years of experience and a record of teaching other doctors.
To book, contact the team here or call +44 (0) 203 488 0350. Fees are outlined here.
I made an appt with an orthopedic doctor to review my MRI (shoulder.) Very painful. I was told by the nurse at my primary dr. that I may get an injection during the visit. My sister also has been seeing a dr. about her knee. She gets these injections all the time and says they use lidocaine and ultrasound to do the injection. I am a ball of nerves thinking about having this done. Now I found out I will be seeing the physician’s assistant for the appt. I may not have the person do it as I am so fearful. Am I overreacting?
Hi thanks for your comments. Generally, shoulder injections done with ultrasound are less painful than other injections ie heel. So perhaps you might be overreacting a little. In any event, you should see what they have to say. I’d suggest having the injection done with an ultrasound. All the best. Lorenzo
should I have my wrist injected under ultrasound? My orthopaedic doctor does not do my injections guided.
Hi Denise, Thank you for your comment. Overall, as I comment in my blog, I think injections should be done under ultrasound. We think that ultrasound improves the accuracy and effectiveness of most injections. I’d also suggest you see a doctor who has experience in ultrasound-guided injections. It would be worth asking 4 questions to your doctor before you have a procedure:
see this blog:
https://sportdoctorlondon.com/having-an-ultrasound-guided-injection/
Lorenzo
I am having my injection with NHS practice will they use ultrasound
some centres do, others don’t. Lorenzo
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