Ultrasound-guided injections play a key role in treating musculoskeletal (MSK) pain. They provide pain relief, so people can begin and progress with exercise. But injections don’t cure most MSK disorders — so they shouldn’t be the only treatment. They work best combined with exercise therapy.
Evidence shows ultrasound improves the accuracy and effectiveness of injections. Shoulder disorders such as frozen shoulder and knee arthritis are good examples where guided injections work better. There are four main types, based on the drug injected.
Cortisone injections
Cortisone is the most common injection, working well in arthritis and tendonitis. It’s a potent anti-inflammatory that reduces swelling in joints and tendons. Ultrasound accurately locates it, which boosts its effectiveness and reduces side effects. The benefit usually starts after about a week and lasts up to three months. Before having one, understand the actions and side effects of cortisone and how long it takes to work.
Cortisone helps conditions including:
- Arthritis, including hip and knee osteoarthritis
- Foot and ankle conditions — plantar fasciitis, Morton’s neuroma, big toe arthritis, chronic ankle sprains
Hyaluronic acid injections
We use hyaluronic acid for arthritis — commonly in the knee, hip, elbow, shoulder, ankle, foot, and hand. It’s a natural, gel-like joint lubricant that reduces arthritis pain and inflammation. It’s safer than cortisone, and its effect lasts much longer — up to 400 days. Ultrasound ensures it reaches the joint, reducing side effects such as a flare.
Not all hyaluronic acids are equal — high-molecular-weight types such as Durolane work better. Occasionally, we use it for specific tendon problems, such as plantaris-associated Achilles tendonitis, injecting between the two tendons to allow a return to running.
Platelet-rich plasma (PRP) injections
PRP uses your own blood. We take a sample, spin it in a centrifuge to concentrate the platelets, and inject the concentrated platelets into the joint or tendon under ultrasound guidance. Platelets release growth factors that improve the local environment, lowering pain and aiding healing — though there’s no evidence PRP regenerates tissue.
Evidence supports PRP for a few conditions:
- Knee osteoarthritis — 23 trials show PRP beats other injections, including hyaluronic acid
- Tennis elbow — better than cortisone in some studies
- Plantar fasciitis — beats cortisone, safer than surgery
- Hip tendonitis — more effective than cortisone
- Shoulder tendonitis — beats cortisone at 3 months.
PRP doesn’t help other joints and tendons, such as the ankle or Achilles. Dr Masci co-authored a study summarising the effectiveness of injections for tendonitis, and we answer common PRP-and-knee questions here.
Arthrosamid injections
Arthrosamid is a unique, non-degradable hydrogel — water bound to a polyacrylamide backbone. The body doesn’t break it down. It coats the knee’s synovial lining, reducing inflammation and adding lubrication, and it’s licensed only for knee arthritis. Studies show pain relief lasting up to four years, with a bigger effect in younger, slimmer patients. Because it’s non-degradable, accurate ultrasound placement is essential.
Why ultrasound guidance matters
Guidance is the difference between a drug reaching its target and missing it. Ultrasound lets the doctor see the needle and the structure in real time — improving accuracy, boosting the drug’s effect, and reducing side effects such as a joint flare or injecting into the wrong tissue. Before any injection, it’s worth asking these questions about ultrasound guidance.
Frequently asked questions about ultrasound-guided injections.
Are ultrasound-guided injections better than blind injections?
Generally yes. Ultrasound improves accuracy, which improves the drug’s effect and lowers the risk of side effects — particularly for deep or hard-to-reach targets such as the hip, shoulder, and small hand joints.
Do ultrasound-guided injections cure my condition?
No. Injections relieve pain so you can rehabilitate — they’re a tool to enable exercise therapy, not a stand-alone cure for most MSK problems. The best results are achieved by combining an injection with a structured exercise programme.
Which injection is right for me?
It depends on the diagnosis. Cortisone suits an acutely swollen, painful joint; hyaluronic acid and PRP suit longer-term arthritis; Arthrosamid suits knee arthritis wanting a durable effect. An assessment with diagnostic ultrasound determines the best choice.
How much do ultrasound-guided injections cost?
Costs depend on the injection and clinic. Dr Masci performs them as one-stop visits — assessment, diagnostic ultrasound, and injection in a single appointment, with Chelsea being the most cost-effective location. Review the current fees here.
Ultrasound-guided injections are a valuable part of MSK care — but they work best alongside exercise therapy, not instead of it. Accurate, guided placement gives the best result and the fewest side effects.
Dr Masci is a specialist in ultrasound-guided injections, performing them across his London clinics. Book or ask a question here or call +44 (0) 203 488 0350.
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