Existing Evidence on Ultrasound-Guided Injections in Sports Medicine

Abstract

Office-based ultrasonography has become increasingly available in many settings, and its use to guide joint and soft tissue injections has increased. Numerous studies have been conducted to evaluate the use of ultrasound-guided injections over traditional landmark-guided injections, with a rapid growth in the literature over the past few years. A comprehensive review of the literature was conducted to demonstrate increased accuracy of ultrasound-guided injections regardless of anatomic location. In the upper extremity, ultrasound-guided injections have been shown to provide superior benefit to landmark-guided injections at the glenohumeral joint, the subacromial space, the biceps tendon sheath, and the joints of the hand and wrist. Ultrasound-guided injections of the acromioclavicular and the elbow joints have not been shown to be more efficacious. In the lower extremity, ultrasound-guided injections at the knee, ankle, and foot have superior efficacy to landmark-guided injections. Conclusive evidence is not available regarding improved efficacy of ultrasound-guided injections of the hip, although landmark-guided injection is performed less commonly at the hip joint. Ultrasound-guided injections are overall more accurate than landmark-guided injections. While current studies indicate that ultrasound guidance improves efficacy and cost-effectiveness of many injections, these studies are limited and more research is needed.

Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive Review

“…The results of this study were put into practice by Dankarini et al, showing significant clinical improvement of foot pain following US-guided injections for up to 3 months in the majority of those treated [70]. As the use of ultrasound in clinical practice continues to rise, US-guided injections could prove to be a safe way to manage foot and ankle OA pain non-surgically, however more data is needed to assess its efficacy and cost-effectiveness [71].…”

Comparison of ultrasound-guided versus blind interventions for supraspinatus tendinopathy: a cadaveric study.

“…Our hypothesis that ultrasound-guided interventions demonstrate greater precision than blind infiltrations has been validated. Enough evidence can be found in the literature to support the need to use ultrasound in shoulder infiltrations (4,17- 19). In contrast, a recent Cochrane review concluded that the cost of ultrasound does not justify its use (20).…”

“…To date, it must be kept in mind that the clinical results of an invasive technique that is not performed in an ultrasound-guided manner cannot be analyzed. Multiple studies show that, without ultrasound control, a very significant number of infiltrations end up outside the "target" site (8,17,19). Therefore, the clinical results do not correlate with said procedure20.…”

Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

“…3,16 Accuracy rates of US-guided procedures in the hip were reported between 97% and 100% with a few cases of incorrect needle positioning. 17 As in other joints, there is no standard approach to USguided intra-articular injections in the hip. The purpose is to place the needle tip in the joint space avoiding sensitive structures.…”