Ultrasound-Guided Injections: A Guide for Patients
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What is an Ultrasound-Guided Injection?
An ultrasound-guided injection (USGI) uses high-frequency sound waves to create images of your body’s internal structures, allowing doctors to guide a needle to a specific area for treatment or other medical purposes. It utilises an ultrasound probe that emits sound waves into your body, and the echoes returning to the probe are transmitted to a monitor to generate real-time images of soft tissues, tendons, and even joint spaces.
Compared with blind (landmark-guided) injections that rely on surface anatomy, USGIs enable clinicians to position the needle more accurately. A USGI may improve patient safety by ensuring injections reach the intended injection site and reducing the risk of needle trauma to sensitive or delicate structures.
What Happens During an Ultrasound-Guided Injection Procedure?
To prepare for a USGI, you will first undergo a thorough medical examination to determine if you are eligible for the procedure. If you are eligible, your doctor will explain the procedure, possible side effects, and important considerations before your USGI appointment. You can ask the doctor questions about the procedure if you have any concerns regarding your USGI.
You may not be eligible for a USGI if you have any of the following:
- A blood clot or deep vein thrombosis (DVT).
- An infection or a specific underlying condition.
- Recently stopped taking antibiotics.
- Medication allergy.
- Received vaccination within two weeks of the appointment date (before or after).
If you are taking any blood thinners or anticoagulant medications, please notify the doctor, as you may need to stop taking them until further notice.
On the day of the procedure, you will be asked to disrobe and wear a patient gown. Next, you may be asked to sit or lie down on the examination table or couch, and your doctor will briefly summarise the procedure and what you can expect. They will clean the area where the ultrasound scan will be performed with an antiseptic solution before applying a cool, clear gel onto your skin. This gel helps improve the clarity of the ultrasound scan’s imaging and allows the ultrasound probe (which looks like an oversized pen) to move across your skin.
You may experience minimal discomfort when the probe is moved, as some pressure may be applied to obtain a clearer image. The probe will transmit the imaging to a monitor beside you or the doctor, allowing them to examine the scanned area. Once the injection site is identified using the ultrasound imagery, the doctor will prepare the injection itself.
A local anaesthetic may be administered first to ensure your comfort during the actual injection. Once the anaesthesia takes effect, the injection is then administered, typically alongside a long-acting local anaesthetic as part of your aftercare recovery. A sterile dressing is then used to cover the injection site. Your doctor may ask you to wait a while after the injection to monitor your condition and ensure you are feeling all right before you return home.
Medical Considerations for an Ultrasound-Guided Injection
USGIs enable doctors to accurately inject medication to where it is needed. Poor injection accuracy could cause significant safety risks for patients, including repeated visits, follow-up treatments to address complications, and increased medical costs. Precise injections could reduce the risk of unintentional harm or inaccurate treatment that could affect long-term treatment or surgical plans.
Conditions where USGIs may be used include:
- Osteoarthritis
- Rotator cuff injuries
- Tendon/ligament injuries
- Plantar fasciitis
- Frozen shoulder
- Bursitis
- Carpal tunnel syndrome
- Chronic pain conditions
While there are generally few risks from using ultrasound scans, you may experience some discomfort when the probe presses against your skin during a scan. You might also experience some side effects from the local anaesthesia or the injected medication, which may include:
- Pain and discomfort that lasts anywhere from a few hours to several days.
- Some light or moderate bruising at the injection site.
- Redness and swelling (potentially pointing to an infection).
- Facial flushing.
- Heightened blood pressure, especially if you have high blood pressure.
- Short-term blood sugar spike, if you have diabetes.
You may experience some mild side effects, which should subside within a few hours or days. If side effects persist or new symptoms (such as a sudden fever or chills) appear, contact your healthcare provider immediately.
Types of Ultrasound-Guided Injections
Doctors may prescribe certain USGIs to treat certain medical conditions.
Corticosteroid Injections
Also known as steroid or cortisone injections, these are the most common type of USGI. Corticosteroids mimic a naturally occurring hormone called cortisol and are administered to reduce pain and inflammation in a specific area, typically the joints or other soft tissues. They help to calm the immune system’s inflammatory response in that area and may circulate through the bloodstream to reach other areas of your body.
Corticosteroid injections are typically performed alongside other treatment methods to manage symptoms and support your overall treatment plan.
Nerve Block Injections
A nerve block injection involves administering medication near a specific nerve cluster to provide temporary pain relief, which may help manage chronic pain or diagnose the source of pain due to an underlying condition. They may also be used to manage pain after a minor surgical procedure.
Nerve blocks come in different forms for different medical uses, such as:
- Genicular nerve blocks, which target the genicular nerves around your knee joints to address knee pain.
- Intercostal nerve blocks, which are injected close to the intercostal nerves under your ribs to manage pain from rib fractures. They may also be used to diagnose and treat neuralgia, or nerve pain.
- Occipital nerve blocks, which are targeted injections for specific spinal nerves in the back of your head. They may be used to help manage chronic migraines and other headache conditions.
Trigger Point Injections
Trigger points are painful nodules that feel like hardened lumps or knots. They form after acute or repeated trauma to the myofascial muscles, causing them to become “stuck” in a contracted state. This can result in pain, tenderness, and discomfort when pressure is applied to these myofascial muscles or when certain movements are performed. Trigger points can develop in any muscle, but generally affect the ones in your jaw, back, neck, shoulders, and hips.
Trigger point injections soothe pain with a local anaesthetic to provide pain relief while supporting other treatment measures, such as physical therapy. These injections may also involve corticosteroids to address underlying inflammation and provide lasting symptom relief.
Platelet-Rich Plasma (PRP) Injections
A PRP injection uses platelets and plasma to support healing in various musculoskeletal conditions, such as shoulder blade and knee pain. This formulation is achieved by separating blood into its components using a centrifuge, yielding a liquid concentrate with a high platelet count. Platelets are responsible for blood clotting and also contain proteins called growth factors that support your body’s healing, while plasma is the liquid component of blood. PRP injections may be considered for temporary symptom relief when conservative treatments are unable to do so.
If you would like to learn more about ultrasound-guided injections, contact Avant Orthopaedics today or visit us to speak with our team.
Frequently Asked Questions (FAQs)
Are there important aftercare instructions to keep in mind?
After receiving the USGI, refrain from significant physical activity for the first few days. As the anaesthetic wears off, you may experience a steroid flare where symptoms may seem to worsen. If you experience any pain during this time, you may take pain relief medications as recommended by your doctor. See your doctor immediately if symptoms persist or continue to worsen.
What if a USGI does not provide any symptom relief?
In such a circumstance, notify your doctor immediately for a detailed evaluation. There may be cases where the lack of symptom relief indicates that other causal factors need to be considered.
Will I need a follow-up USGI?
A follow-up injection may be considered only under specific circumstances, such as administering corticosteroid injections at fixed intervals to provide continuous symptom relief (but not exceeding a specified annual limit for healthcare reasons).
Consultant Anaesthetist and Pain Physician
Dr. Hope Ang
MBBS (NUS) | MMed (Anaes) | FAMS
Dr Hope Ang is a Consultant Anaesthesiologist with extensive expertise in acute and chronic pain management, dedicated to helping patients regain function, reduce suffering, and improve quality of life through evidence-based, personalised care.
With more than 18 years of clinical experience, Dr Ang specialises in the assessment and treatment of complex chronic pain conditions, including musculoskeletal pain, neuropathic pain, cancer-related pain, and persistent postoperative pain. His approach integrates interventional pain procedures, ultrasound-guided regional techniques, multimodal pharmacological strategies, and close collaboration with multidisciplinary care teams to address both the physical and functional impact of chronic pain.
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