Orthopedic surgeons use Ultrasound injections to treat a variety of medical conditions. It is common practice to inject medications such as cortisone, local anesthetics, and joint lubricants such as hyaluronic acid. However, injections are not always as simple as they initially appear. The target must be hit precisely, often with a very slim margin of error.
It is important to avoid the soft tissue surrounding joints before injecting. Additionally, injections into tendons should take place in the sheath, not in the tendon itself. For centuries, doctors have administered injections blind, requiring experience, delicacy, and anatomical knowledge. There was no guarantee of success even then. These days, orthopedists mainly use guided technologies like ultrasound to avoid relying on hit-and-miss procedures.
An Overview of Ultrasound-Guided Injections
Ultrasound is a popular technique for image-guided injection. They have rarely been used in orthopedic offices until recently due to their expense or cumbersome nature. In today’s environment, newer portable models are easy, accurate, and offer an excellent resolution for a wide variety of orthopedic procedures.
The procedure for ultrasound-guided injection is similar to that of traditional injections. This gel is placed directly on the skin to ensure clear images.
Gel creates a strong bond between the skin and the ultrasound probe. As a result, the reflections have minimal interference. Using the probe, also known as a transducer, the doctor will place it near or adjacent to the targeted tendon or joint. After identifying the anatomic landmarks on the monitor, the doctor will deliver the injection with a needle and syringe.
Using ultrasound, you can also view fluids to see if the medications are reaching the right location.
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The Ultrasound-Guided Injection Debate
A lot of controversy surrounds the value of ultrasound-guided injections. Insurance companies and private payors often voice concerns over adding $100 or more to a bill as a result of implementing this tool. Some believe that physicians should receive better injection training rather than use technological shortcuts. Even experienced doctors may cringe at the anatomically complex parts of the body, regardless of how valid the arguments are. Consider the use of ultrasound for performing a lumbar puncture (spinal tap) on an older patient with osteoarthritis.
Similarly, patients with joint disorders can suffer from long-term or acute damage that can make an otherwise “simple” injection difficult for both the doctor and patient.
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Alternative Surgical Procedures
There are situations in which ultrasounds are not the ideal imaging modality for injection guidance. Other imaging modalities, such as X-rays and CAT scanners, may provide support for injection guidance. The purpose of imaging guidance in certain types of injections is not always clear. This is also a subject of great debate among physicians. Some will argue that the purpose of imaging guidance is just a way for insurers to bill for a service.
Almost all clinicians agree that imaging guidance is valuable, but it isn’t clear which injections are worth the additional cost of imaging guidance.
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The impact of out-of-pocket medical costs on people with limited insurance coverage or no insurance at all cannot be minimized. If you are facing severe financial difficulties, don’t hesitate to question the cost of medical procedures being offered to you. The next time your doctor schedules you for an ultrasound-guided injection, discuss your concerns with your doctor. Keep an open mind and make an informed choice based on the information shared with you, as it is your right as a patient.
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What are the benefits of ultrasound-guided injections?
As the use of ultrasound increases in sports medicine, rheumatologists, orthopedists, and primary care physicians, ultrasound is being used in an extensive number of ways to help evaluate, treat, and inject different muscles, tendons, ligaments, and joints.
- As ultrasound technology has developed, ultrasound machines have become smaller and more portable. This has allowed treating clinicians to use ultrasound to help them diagnose and treat their patients.
- Besides using ultrasound to diagnose injuries or abnormalities, ultrasound also utilizes as a tool when injecting into the knee, shoulder, or hip.
- Typically, injections use to diagnose or treat various hip, shoulder, and knee problems including osteoarthritis, rheumatoid arthritis, labral tears, muscular tears, ligament repairs, and tendinopathies.
- If rest, ice, anti-inflammatory medications, and injections do not provide adequate relief, injections may be used in the management of inflammatory and degenerative conditions.
- An ultrasound device enhances the precision of injections of corticosteroids, hyaluronic acid, or other therapies like platelet-rich plasma, prolotherapy, or stem cells.
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Joints:
- Joint aspirations can also perform using ultrasound to rule out joint infection or gout. Lastly, guided injections help physicians understand which structures are contributing to pain in the patient.
- With ultrasound-guided injections, the practitioner can visualize the needle in real-time as it travels to the desired location on the body, ensuring that the injection precisely placed in the appropriate area.
- Even in the best of hands, blind injections (injected without imaging) aren’t perfect, and their accuracy can be as low as 30%-40% in some joints.
- Injection accuracy can exceed 90% and approach 100% with ultrasound guidance. Ultrasound-guided injections show to be less painful than blind injections.
- The doctor able to watch treated tissues get delivered to the intended target, as well as visualize surrounding structures both before and after the procedure. Ultrasound injections also have the advantage of providing “real-time” and “dynamic” results that patients and doctors can use immediately.
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The use of ultrasound injections
The use of ultrasound is beneficial for injections despite the fact that many different imaging techniques can be used.
- Ultrasound technology does not emit radiation. Fluoroscopy allows the physician to visualize the joint easier for injection, but fluoroscopy comes with some risks. repeated doses of radiation. Additionally, with fluoroscopy, the providers are unable to visualize surrounding soft tissue structures including tendons, blood vessels, or nerves that may be in the path of the needle. This could lead to increased pain or other complications from the injection.
- Ultrasound is a very useful tool for viewing the bony joints and all adjacent structures. By moving the ultrasound probe the practitioner can see possible obstacles in the path of the needle, helping to avoid any unwanted complications from occurring before they occur.
- In addition to ultrasound, CT-guided injections also frequently use to assist in the delivery of treatments. This enhances the diagnostic ability of conventional radiographs, especially to identify fluid around joints, tendons, muscles, and nerves.
- We can use the CT to get a 3-D view of the joint and pick the correct medication, however, these experiments are increasingly radiation-intensive, expensive, and time-consuming.
- With ultrasound injections, patients receive as accurate a diagnosis as with x-rays and MRIs, with little cost to the patient, improved soft-tissue visualization, and no radiation.
- Injections guided by ultrasound have been thoroughly studied and have been found to have very few complications.
Risks associated with these procedures are similar to those associated with any type of injection: incomplete pain relief, bleeding, damage to surrounding tissues, and infection. Injections are generally low risk, and the use of ultrasound guidance may further minimize some of the risks associated with them.
With ultrasound, injections in the knee, shoulder, hip, and many other structures throughout the body can be performed safely.
Knee:
Several structures within the knee can assess using ultrasound, including quadriceps and patellar tendons, extra-articular (outside the joint) ligaments, and meniscus tears.
In addition, imaging can be used to find out if there is fluid within the knee joint. Although knee injections usually perform without imaging, imaging can be especially valuable for overweight or patients with difficult anatomy.
Hip:
Performing injections into the hip joint is nearly always accompanied by imaging. Because of its deep location and proximity to a blood vessel and nerve. Imaging nearly always uses when performing hip injections. Because of the deep location of the joint and its close proximity to both blood vessels and nerves.
Injections performed blind estimates to be accurate 50% to 80% of the time. Ultrasound imaging allows us to visualize the hip joint, bursa, muscles, tendons, and ligaments surrounding the hip; this enhances the accuracy of the injections by up to 96%.
The trend for ultrasound-guided hip injections has revolutionized the hip injection procedure with lower cost, ease of use. And the ability to perform them in an office setting, instead of fluoroscopy, which usess in the past.
Shoulder:
MRI has demonstrated to be just as sensitive and specific at detecting rotator cuff injuries as ultrasound of the shoulder. It is possible to inject the Acromioclavicular joint (AC), the Glenohumeral joint (the true shoulder joint), the biceps tendon. And the subacromial bursa more accurately using ultrasound.
Using ultrasound guidance for all of these injections is significantly more accurate than using them without guidance. But as noted above, both methods perform equally well without it.
