Ultrasound-guided injection therapy: What are the options?

Overall, the use of ultrasound is an important advance in injection therapy.   Ultrasound gives a clear picture of the target.  Thus, your doctor is able to guide the drug directly to the exact target.   As a result, this combination makes the injection more accurate increasing the effect.

Undoubtedly, injections play an important role in MSK treatment.  First and foremost, injections provide pain relief.  With less discomfort, people can begin and progress with exercise.  However, it is important to note that injections don’t cure most MSK disorders.  In other words, it should not be the only form of treatment: it must be combined with rehab.

In general, evidence suggests that using ultrasound improves the accuracy and effectiveness of injection therapy.   Shoulder disorders, such as shoulder tendonitis or frozen shoulder, and knee disorders such as knee arthritis are good examples.  Last but not least, there is also evidence of less cost.  Ultrasound improves hip joint treatment as compared to X-ray.

There are three main types of ultrasound-guided injections based on the drugs injected.

Cortisone injections

cortisone shot

Generally, cortisone is the most common type of injection.  It works well in both arthritis and tendonitis. When injected, cortisone is a powerful anti-inflammatory drug that will reduce inflammation and swelling in tendons and joints.   Ultrasound ensures that the cortisone is injected into the right area.  In addition, accuracy improves the effect of the drug and reduces side effects.  In general, cortisone injection benefits begin after about 1 week and can last for up to 3 months.  Before having a cortisone shot, it is important to understand the actions and side effects of cortisone. Also, you need to understand how long it takes for a cortisone shot to work.

In general, cortisone injections are useful for the following conditions:

Hyaluronic acid

hyaluronic acid injection

Next, we use hyaluronic acid injections for arthritis treatment.   Common locations include the knee, hip, elbow, shoulder, ankle, foot, and hand.  Essentially, hyaluronic acid is a clear, gooey substance that is produced naturally by our bodies.  Specifically, we find it in in skin, eyes and connective tissues.  It acts as a lubricant to reduce pain and swelling in arthritis.

On the whole, there are a few notable benefits to using Hyaluronic acid.   One of the advantages of using Hyaluronic acid is the safety profile, which is much better than cortisone.  In addition, the effect of hyaluronic acid is much longer than cortisone, usually up to 6 months.  Ultrasound should always be used to make sure the drug is placed in the joint.  This accuracy reduces the potential for side effects, such as a joint flare.

Occasionally, doctors use hyaluronic acid for specific tendonitis. For example, a specific type of Achilles tendinitis called plantaris-associated Achilles tendonitis, responds well to a hyaluronic acid injection. In these cases, the hyaluronic acid is injected between the two tendons allowing the person to return to running or sport.

Platelet-rich plasma or PRP

Platelet-rich plasma injections

Finally, one of the newest types of injection is Platelet-Rich plasma or PRP.  As the name implies, we use the patient’s own blood to treat a condition.  Firstly, we take a blood sample.  Similar to a normal blood test, we draw blood from a vein in the elbow.  Next, we place the blood in a centrifuge.  Gradually, the cells separate into two components: serum and cells.  This serum contains platelets. Platelets contain a high number of growth factors. Finally, we remove the serum and platelets from the red cells and inject them into a joint or tendon.  Once again, we use ultrasound to improve accuracy.

How does platelet-rich plasma work?   

Platelets are important cells that control clotting. Also, they contain a high concentration of growth factors. These growth factors control inflammation and healing. Injecting platelet-rich plasma into a joint or tendon leads to the release of growth factors improving the local tendon or joint environment. Ultimately, this leads to a lower level of pain and tissue healing. However, there is no evidence that PRP regenerates tissue.

What is the evidence for PRP?

Evidence for the effectiveness of PRP exists only for a few common conditions:

However, Platelet-rich plasma is not effective for other joints and tendons such as the hip joint, ankle joint, Achilles tendon, or shoulder tendon. Finally, there is no evidence that platelet-rich plasma regenerates new cartilage or tendon tissue.

Dr Masci co-authored a study summarising the effectiveness of injections in tendonitis including PRP.

This blog answers the common questions asked about PRP and knee arthritis.

Dr Masci performs injections of cortisone, hyaluronic acid, and PRP in central London.

One-Stop Injection Therapy Information
A Specialist in Ultrasound Guided Injections