Joint injection

Efficacy in osteoarthritis

In osteoarthritis, joint injection of glucocorticoids (such as hydrocortisone) leads to short term pain relief that may last between a few weeks and a few months. Injections of hyaluronic acid have not produced improvement compared to placebo for knee arthritis, but did increase risk of further pain. The effectiveness of injections of platelet-rich plasma is unclear; there are suggestions that such injections improve function but not pain, and are associated with increased risk.

A 2015 Cochrane review found that intra-articular corticosteroid injections of the knee did not benefit quality of life and had no effect on knee joint space; clinical effects one to six weeks after injection could not be determined clearly due to poor study quality. Another 2015 study reported negative effects of intra-articular corticosteroid injections at higher doses, and a 2017 trial showed reduction in cartilage thickness with intra-articular triamcinolone every 12 weeks for 2 years compared to placebo. A 2018 study found that intra-articular triamcinolone is associated with an increase in intraocular pressure.

Ultrasound-guided

Usual standards for musculoskeletal interventional procedures apply, including review of prior imaging, informed consent, and appropriate local anesthesia. A high-frequency (10 MHz) linear array transducer is recommended, though lower-frequency curvilinear probes may be needed to visualize deep structures in larger patients. A preliminary diagnostic ultrasound, including color Doppler of the target area, is necessary to assess adjacent neurovascular structures.

Injections should be performed with adherence to aseptic technique although this varies between institutions and radiologists attributable to resources, training, perceived risk and experience. In a survey of 250 health professionals in the United Kingdom, 43.5% believed infection rates were

After planning a safe route of access, a line parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced. Once the patient's skin is sterilized and initial needle entry is made adjacent to the mark, the probe can be returned quickly to the same location and orientation by aligning to the skin mark. The needle is directed toward the intended target by a freehand technique. The needle size, length and type should be selected based on the site, depth and patient's body habitus. 22–24G needles are sufficed for most injections.

As an example, ultrasound-guided hip joint injection can be considered when symptoms persist despite initial treatment options such as activity modification, analgesia and physical therapy.

References

References

1. (25 July 2013). "Carpal Tunnel Review". JohnDRhoads.
2. (2010). "intraarticular injection - definition". Farlex.
3. Wen, Dennis Y. (1 August 2000). "Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis". American Academy of Family Physicians.
4. (April 2004). "Corticosteroid injections for osteoarthritis of the knee: meta-analysis". BMJ.
5. (August 2012). "Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis". Annals of Internal Medicine.
6. (December 2015). "Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence". The Journal of Bone and Joint Surgery. American Volume.
7. (October 2015). "Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle". The Cochrane Database of Systematic Reviews.
8. (December 2013). "The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis". Arthroscopy.
9. (September 2013). "Intraarticular Injections of Platelet-rich Plasma (PRP) in the Management of Knee Osteoarthritis". The Archives of Bone and Joint Surgery.
10. (October 2015). "Intra-articular corticosteroid for knee osteoarthritis". The Cochrane Database of Systematic Reviews.
11. (May 2015). "The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review". Orthopaedic Journal of Sports Medicine.
12. (May 2017). "Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial". JAMA.
13. (9 March 2018). "Intraocular Pressure Increases After Intraarticular Knee Injection With Triamcinolone but Not Hyaluronic Acid". [[Clinical Orthopaedics and Related Research]].
14. (2017). "Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin". Journal of the Belgian Society of Radiology.
15. Tortora, Silvia. (2021). "Ultrasound-guided musculoskeletal interventional procedures around the elbow, hand and wrist excluding carpal tunnel procedures". Journal of Ultrasonography.
16. (2008). "Musculoskeletal injections: a review of the evidence". American Family Physician.
17. "MSK Ultrasound Guided Injection".