Ultrasound-guided injections

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. Studies generally find ultrasound-guided injections more accurate than landmark-guided ones, though the size of the advantage varies from site to site. Seeing exactly where the medication goes counts most for deeper or smaller targets, or where a previous injection has not helped.

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, though if the local anaesthetic has left the area numb it is better to arrange a lift than to drive yourself. It is sensible to rest the treated area for a day or two, then build activity back up gradually rather than returning at once to heavy or repeated loading, which matters most where a tendon has been treated. 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.

A few people notice a temporary flare of pain for a day or two once the anaesthetic wears off; this settles on its own. Infection after an injection is rare, but it matters: if the area becomes increasingly hot, swollen and very painful in the days afterwards, or you develop a fever or feel unwell, seek medical advice urgently rather than waiting for it to pass.

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.

How is an ultrasound-guided injection different from an ordinary injection?

With an ordinary, landmark-guided injection the site is judged by feel and surface anatomy alone, without seeing the target. An ultrasound-guided injection shows the needle and the structure together on screen, so the medication is placed accurately and away from areas that should be avoided. Studies generally find this more accurate than going by feel alone, and it is particularly valuable for deeper or smaller targets, or where a previous injection has not helped.

What does the injection involve, and will it hurt?

The skin is cleaned and ultrasound is used to guide the needle to the right place. Because Dr Borukhson uses a combined steroid and local anaesthetic, it is given as a single injection that usually takes only a short time. Most people feel pressure rather than sharp pain, and the procedure is generally well tolerated. You can usually go straight home afterwards, although it is better to arrange a lift than to drive if the local anaesthetic has left the area numb, and it is sensible to rest the area for a day or two.

How soon will I feel the benefit, and how long does it last?

This varies with the structure treated and the reason for the injection, so the likely timing will be explained to you at the time. The local anaesthetic can ease symptoms briefly at first, while the steroid component generally takes a little longer to settle the inflammation. An injection is intended to calm a flare and create a window for recovery rather than to act as a permanent cure, and it usually sits alongside other measures.

Do I always need an injection, or are there other options?

Not at all. An injection is one option among several, and the assessment always comes first. Ultrasound can confirm whether the problem is genuinely inflammatory, show fluid that might be drained, and sometimes change the plan entirely. Whether an injection is the right step, and which medication suits you, is discussed fully before any decision to treat. The aim is to match the treatment to what is actually found.

Can the assessment and injection happen in the same visit?

Often, yes. Because Dr Borukhson uses point-of-care ultrasound during the consultation, assessment, diagnosis and, where appropriate, a guided injection can frequently take place within the same appointment. This one-stop approach can save a separate trip and shorten the wait between recognising a problem and beginning treatment. It is never automatic, though: the assessment comes first, and an injection only follows if it is genuinely the right step for you.