Targeted joint and soft-tissue injections, placed accurately under direct ultrasound vision, often within the same appointment as your assessment
An injection can be one of the most effective ways to settle inflammation in a joint, tendon or soft tissue. How well it works often depends on one thing above all: whether the medication reaches exactly the right place. Ultrasound guidance allows that target to be seen directly, so the injection can be placed with precision rather than by landmarks alone.
Written for patients and reviewed by Dr Liubov Borukhson, Consultant Rheumatologist (GMC 7021928).
It is a treatment in which medication, usually a corticosteroid combined with a local anaesthetic, is delivered into or around a joint, tendon sheath, bursa or other structure while the area is viewed live on an ultrasound screen. The ultrasound shows the needle and the target in real time, so the medication can be placed accurately where it is needed.
This contrasts with a landmark-guided injection, where the site is judged by feel and surface anatomy alone, without seeing the target. Being able to watch the needle reach its target means an ultrasound-guided injection is more accurate than a landmark-guided one, whichever joint or structure is being treated. That accuracy is especially valuable for deeper or smaller targets, or where a previous injection has not helped, but the benefit of seeing exactly where the medication goes applies in every case.
Seeing the needle and the target together means the medication can be delivered to the right place and, just as importantly, away from structures that should be avoided. Where a joint or tendon sheath is difficult to enter, guidance helps confirm the needle is correctly positioned before anything is injected.
Ultrasound also adds information before the injection is even given. It can confirm whether the problem is genuinely inflammatory, show fluid that can be drained, and sometimes change the plan entirely, so the treatment matches what is actually found rather than what was assumed.
The skin over the area is cleaned, and ultrasound is used to guide the injection to the right place. Because Dr Borukhson uses a combined steroid and local anaesthetic, this is given as a single injection, which usually takes only a short time. Most people feel pressure rather than sharp pain, and the procedure is generally well tolerated.
Afterwards you can usually go straight home. It is sensible to rest the area for a day or two. Any specific aftercare, and how soon a benefit might be felt, will be explained to you at the time, as this varies with the structure treated and the reason for the injection.
Because Dr Borukhson uses point-of-care ultrasound during the consultation, assessment, diagnosis and, where appropriate, an ultrasound-guided injection can often take place within the same visit. This can save a separate trip and reduce the wait between recognising a problem and beginning to treat it. You can read more about this on the ultrasound clinic page.
Whether an injection is the right step, and which medication is suitable, is always discussed with you first. It is one option among several, and the assessment comes before any decision to treat.
An assessment with ultrasound can confirm whether a guided injection is the right option and, where suitable, often carry it out in the same visit
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