In Office Joint Injections

In-Office Injections of Joints Under Ultrasound Guidance

Peripheral intra-articular injections (also called joint injections) have been used successfully for decades for the treatment of chronic joint pain. Injections may be performed into joints for diagnostic reasons, to identify pain-generating structures. Most often, joint injections are done for therapeutic purposes into the knee, hip, shoulder, ankle and other joints, with months of relief usually resulting.


Why is ultrasound guidance important?

Peripheral joint injections have been performed primarily in the office setting, with the doctor using bony landmarks identification for needle placement. With new technology, doctors now utilize the ultrasound guidance method to facilitate proper needle placement. This is done to avoid the possibility of incorrect needle placement, and to ensure that the medication goes into the joint space.


What are the advantages of ultrasound guidance over fluoroscopy?

Fluoroscopy has been used in the past for peripheral joint injections. This involves a special x-ray device and contrast dye to directly visualize and confirm needle placement. Ultrasonography does not involve exposure to ionizing radiation (as with x-ray). The advantages of ultrasound over fluoroscopy also include the ability to directly see the surrounding soft tissue, vessels, and nerve structures.

What peripheral joints can be injected under ultrasound guidance?

The three most commonly injected joints are:

Knee joints

These are the largest joints of the body, and they are subject to arthritic conditions, such as osteoarthritis and bursitis. The knee joint is easily accessible, as it is not a deep joint.

Shoulder joints

Another commonly injected joint is the glenohumeral joint (shoulder), which is the most mobile joint of the body. The shoulder joint is a complex structure, and it is surrounded by many muscles, tendons, and ligaments.

Hip joints

These are frequently prone to chronic pain related to arthritic changes and injury. The hip is a ball-and-socket joint located deep in the body. The hip joint capsule extends down the top of the thigh bone (femur neck). Certain nerves and vessels should be avoided when injected these joints (neurovascular femoral nerve-vein-artery bundle).

What other joints can be injected using ultrasound guidance?

A sacroiliac (SI) joint injection places a long-acting anesthetic medication into the joints on both sides of the very lower back region. The SI joints are located where the pelvis joins the posterior spine. With arthritis, these joints become inflamed, causing low back pain and radiating pain to the buttocks, legs, and groin.


Who should not have a joint injection?

Certain people cannot have peripheral joint injections. This includes persons who:

  • Are pregnant
  • Have a systemic infection
  • Have a skin infection
  • Are allergic to contrast dye
  • Have blood clotting problems

When will I notice pain relief?

Because an anesthetic is injected into the joint, most patients report immediate pain relief. However, the local agent wears off in 4-16 hours, and pain could return. It takes the corticosteroid 20-48 hours to begin working. The injection site will be slightly tender for a few hours, but patients may apply an ice pack to relieve pain. Most people enjoy 2-6 months of pain relief following a peripheral intra-articular injection.

If the patient undergoes Bone Marrow Aspirate Concentrate Therapy or PRP therapy procedure, relief typically starts within a few days and continues to improve for months!


Are joint injections effective?

In recent clinical studies, researchers found that joint injections were successful for relieving chronic joint pain. In one study involving 148 painful joints, ultrasound guidance was used for the injections. The study found that the procedure was significantly less painful than without ultrasound guidance. Two weeks after injection, 75% of patients reported good pain relief. In another study, researchers noticed 50% less procedural pain when ultrasound guidance was used for injecting joints in arthritis patients.


Sibbitt WL, Peisajovich A, Michael AA, et al. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J. Rheumatol. 2009 Sep;36(9):1892-902.

Sibbitt WL, Kettwich LG, Band PA, et al. Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee? Scand J Rheumatol. 2012 Feb;41(1):66-72.

All content has been reviewed and approved by orthopedic specialist Dr. Zvezdomir “Zed” Zamfirov. Dr. Zed’s practice — All Star Pain Management and Regenerative Medicine — proudly serves the Annapolis, Greater Baltimore and Washington D.C. areas.

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