Injection therapy is becoming a more commonly used treatment method for many different types of musculoskeletal conditions such as joint arthritis, bursitis and tendinopathy. There are different types of injections on offer including the most commonly uses corticosteroid injection, as well as PRP, Traumeel and hyaluronic acid injections. Many different health professionals are also trained to be able to give injections such as GPs, nurses and physiotherapist.
Injections can be delivered either landmark guided, also referred to as blind injections, or ultrasound guided. Other injections such as the hip joint are delivered under fluoroscopic or CT guidance. Landmark guided injections are the most used injection whereby the desired target is identified using anatomical knowledge and injection technique. These injections are effective however research shows that the target is not always reached.
Ultrasound guided injections are becoming more commonly used and in a position statement The American Medical Society for Sport Medicine indicate there is strong evidence that ultrasound guided injections are more accurate than landmark guided injections as the injection target area and the needle can be visualised on ultrasound. The injected solution can also be visualise being delivered into the target area. For example, for landmark guided shoulder bursa injections accuracy ranged from 24% to 100% whilst ultrasound guided injections ranged from 65 to 100%.
If we consider different body parts ultrasound guided injections have been shown to be effective. For example, the hip joint was correctly targeted only a total of 52 to 80% of the time using anatomical landmarks, whereas it was 97% accurate with ultrasound guidance, which is comparable to the gold standard of fluoroscopic and CT guided injections.
The American Medical Society for Sport Medicine position statement also indicates there is moderate evidence that ultrasound guided injections are more effective – in that if the desired injectate, be it steroid, PRP or hyaluronic acid – will be more effective if it ends up being delivered into the desired body part. They also state there is preliminary evidence that they are more cost-effective such as US guided injections being cheaper than requiring fluoroscopic and CT guided injections.