The Benefits of Ultrasound-Guidance in Pain Management Injections
If you have ever spoken to your doctor about persistent pain, sports injuries or degenerative joint concerns, there is a good chance you have discussed numerous forms of treatment, including injection therapies.
Injections to reduce pain or hasten healing are becoming increasingly common. For decades these injections have been performed using a technique known as palpation or landmark-guided, where the health care provider uses anatomical landmarks on a person’s skin and bones to estimate the location of intended targets below the surface (like ligaments, tendons, and joints). However, we now have a safer, more accurate and effective way of performing these injections.
Enter ultrasound-guided injections. An ultrasound is like a flashlight that allows us to see below the surface of the skin. They emit sound waves at various frequencies able to penetrate the tissues of the body, which bounce back to the probe at varying speeds depending on the type of tissue encountered. They work like a sonar system on a boat, except ultrasound produces a live image. Utilizing this incredible technology provides the doctor with many advantages, the top three advantages are discussed below:
1) Improved diagnostic accuracy
Being able to see below the surface of the skin makes identifying injured tissues possible. Not only are we able to confirm injured tissues by visualizing pathological changes in ligaments, tendons, muscles and bursae; but we can also note the exact location of the injury within the tissue. Another unique diagnostic advantage over other imaging techniques like MRI and CT scans is the fact that ultrasound provides a real-time image, which allows for an “active assessment” - where the tissues of interest can be observed while being tested during a physical examination. The combination of confirming, locating and actively testing injured tissues is an invaluable diagnostic tool.
2) Increased safety
The ultrasound can not only be used to visualize tissues of interest, but it also allows you to track the needle and medicine during the injection. When you can follow the path of your needle and see both the targets you want to hit and avoid – this creates a much safer procedure with fewer chances of error.
3) Improved efficacy and reduced side effects
Knowing the exact location of the injury and being able to observe the path of your needle and the location of medicine, allows the practitioner to be much more precise. Being able to observe the injection translates to improved outcomes and reduced side effects. This becomes even more important with deeper, smaller, and more difficult-to-access targets; as well as when using more concentrated medicines.
Studies that compared ultrasound-guided to landmark-guided injections consistently conclude that ultrasound-guided injections are more accurate and more effective with fewer side effects. One such analysis comparing the accuracy of various shoulder injections reported a rate of 93.6% vs 68.2% for acromial clavicular joint injections, 86.7% vs 26.7% for biceps tendon sheath injections and 92.5% vs 72.5% for glenohumeral injections with decreased pain and improved function at each location in favour of ultrasound-guidance.
Here at the IHC, we are proud to provide all our pain medicine injections under ultrasound-guidance.
Dr. Luke Mountjoy, ND
Aly, Abdel-Rahman, Sathish Rajasekaran, and Nigel Ashworth. "Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis." British journal of sports medicine 49.16 (2015): 1042-1049.