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Ultrasound (US) Guided Injections

Traditionally, cortisone injections have historically been given based on landmarks, which means that by looking and feeling a doctor can know where the needle needs to be placed to inject the medicine into the proper location. Just as it is critical to know exactly where the inflammation is by getting the proper diagnosis, it is also critical to inject the cortisone into the right place, since a more accurate injection will result in a greater improvement in your symptoms. Here we will discuss how US guidance improves this accuracy of medicine delivery.

Improvement of Accuracy With Ultrasound Guidance

There are four common locations to get a cortisone injection in the shoulder: 

1) The glenohumeral joint - the space between where the ball of the humerus meets the glenoid socket is where the cortisone must be injected for SLAP tears, frozen shoulder, and glenohumeral joint arthritis. This space is only a few millimeters wide, so the accuracy with US guidance is 93%, which is significantly better than the 73% accuracy without US guidance.

2) The biceps tendon sheath - for people with biceps tendonitis who cannot take or do not improve with a short course of NSAIDs, a cortisone injection can be a great relief for the severe constant pain in the front of the shoulder. The reduction in pain and the improvement in function for these injections is significantly better with US guidance, since the accuracy of these injections is 87% with US guidance and only 27% without US guidance. 

3) The AC joint - for people with AC joint arthritis or significant inflammation in the AC joint the accuracy of the placement of their cortisone injection goes from 68% without US guidance to 94% with US guidance.  

4) The subacromial space - these injections may be given for people with isolated subacromial bursitis or rotator cuff tears that cannot be repaired with surgery. While some studies suggest that US guidance has a greater improvement in pain for these types of injections, this has not been connected to an improvement in accuracy for the delivery of the injection. Since the US is a tool to make the injections more accurate, it is not necessary for these types of injections. The way to get the best possible relief for any type of cortisone injection is to only get an injection when you really need it, following it up with physical therapy, if appropriate.

1. Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1042‐1049.

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