Why Ultrasound?

Shoulder joint/capsule: 72% to 92.5% accuracy w U/S (Lee et al). The improvements in pain intensity, range of motion, and shoulder function score were significantly greater in the ultrasound-guided injection group than in the landmark-guided injection group by the second week after injection (P < .05).

Bicep tendon: Hashiuchi et al20 studied 30 patients with reported anterior shoulder pain with a primary diagnosis of tenosynovitis, tendinitis of the biceps tendon, or both. Shoulders were randomly allocated into ultrasound-guided and landmark-guided injection groups. Computed tomography (CT) imaging was performed immediately after a contrast agent was injected into the biceps tendon sheath. Ultrasound guidance resulted in 86.7% of injections into the tendon sheath, whereas landmark guidance resulted in 26.7% into the tendon sheath, which was a significant difference (P < .05).

Wrist and hand: Goncalves et al18 conducted a case series demonstrating that ultrasound-guided injections of the metacarpophalangeal joint were efficacious and visual analog scale scores were improved. Raza et al34 assessed the accuracy of proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint injections: Palpation-guided injections were intra-articular 59% of the time (6/12 PIP and 4/5 MCP joints) compared with 96% (24/26 PIP and 27/27 MCP joints) for ultrasound guidance.

Hip Yoong et al53 evaluated the utility of ultrasound-guided hip joint injection in predicting surgical outcomes. In that study, 138 patients underwent ultrasound-guided injection with local anesthetic to aid in diagnosis of hip disease prior to surgical hip arthroscopy. Yoong et al53 found that 93% of patients who had pain relief after injection had successful surgical outcomes, compared with 63% of patients with partial relief; 44 of 49 patients who had no relief from the injection ultimately did not have hip surgery.

Knee  Curtiss et al,10 in a cadaveric ultrasound-guided versus landmark-guided study published in 2011, showed a range of accuracy of 55% to 100% in the landmark-guided group. The results for landmark-guided injections were dependent upon the injector, while the ultrasound-guided injections were 100% accurate regardless of injector.

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