When you come into Spine West for an injection in a location other than your spine, we will greet you with an ultrasound machine. Office-based diagnostic ultrasonography and ultrasound-guided injections are becoming increasingly common. It is an efficient and safe way to visualize what is going on in the joints and soft tissue. Why do we prefer to use ultrasound to guide our injections at Spine West? Because the most recent medical literature shows that ultrasound-guided injections are, for the most part, more accurate than “blind” or “landmark guided” injections. Visualizing the needle in real-time going into the target increases accuracy and reduces the risk of the needle damaging nearby structures. Additionally, using ultrasound allows us to quickly “take a look around” the area of interest, confirming the diagnosis or perhaps finding another injured structure that may be contributing to your pain.
Let us take a quick look at the current research, using the shoulder as an example. Most studies comparing ultrasound-guided injections versus blind injections are cadaveric studies, meaning they perform them on cadavers. In the glenohumeral, or shoulder joint, steroid injections are often used for osteoarthritis or adhesive capsulitis (also known as frozen shoulder). One sizeable cadaveric study compared ultrasound-guided injections with blind injections; The ultrasound-guided injections were accurate 92% of the time, and the blind injections were accurate 72.5%. Another study compared ultrasound-guided injections with blind injections in living patients with Frozen Shoulder. There were more significant improvements in pain, range of motion, and shoulder function in the group that had received ultrasound-guided injections. A similar study looking at another joint in the shoulder called the acromioclavicular (AC) joint found that 100% of the ultrasound-guided injections were placed successfully in the AC joint. By comparison, only 40% of the blind injections were accurate. Another common injection we do for pain in the front of the shoulder is a biceps tendon sheath injection. One study showed that when using ultrasound, the injection goes directly into the tendon sheath 86.7% of the time, whereas, without ultrasound, the injections were accurate only 26.7% of the time.
At Spine West, we inject everything from the shoulders to ankles and everything in between. For the most part, we will use ultrasound guidance. However, the research shows that using ultrasound is less critical for certain injections, such as subacromial injections in the shoulder, knee injections, and elbow injections. So, do not be alarmed if you get an injection without an ultrasound from time to time. However, we may also use ultrasound regardless because it is either how we were trained or we want to “take a look around.”
Written by Cassy Cooper, M.D.