Every day in the realm of orthopedics, patients receive diagnostic and therapeutic cortisone injections under the guidance of ultrasound. The use of ultrasound has become a frequent practice especially in orthopedic medicine and studies have shown that the use of ultrasound guidance can increase the accuracy of the injection compared to landmark guided injections (LMG) to close to 100% accuracy. Whether it be for the shoulder, hip, knee or frankly any other body part, studies overwhelmingly point to use ultrasound guidance as a link to more favorable outcomes with cortisone injections.
The use of ultrasound began during and shortly after World War II. During the years following, ultrasound became more commercially available and took on a wider use in the medical community. In the 1980s, use of sonography to assist in biopsy and aspiration of joints took on a bigger role as well as beginning to inject joints with different substances to promote pain relief. Today, high-tech ultrasound machines are used to accurately deliver medication to a specific area in the body as well as used to assist in diagnosing certain conditions.
Cortisone, which is a broad term for a synthetic alternative to natural cortisol - which is a steroid made by your body - is a common injection done in orthopedics. Normally the injection consists of a mixture of a local anesthetic, such as lidocaine or bupivacaine, as well as a synthetic steroid. Common steroids used are methylprednisolone, dexamethasone, and triamcinolone acetate.
Now, you have been scheduled for an ultrasound-guided cortisone injection and you are wondering what to expect. Most injections are done as quick outpatient procedures and do not require any restrictions for the rest of the day. Normally on the day of the injection you will come into the office. The physician or physician's assistant that is performing the injection will sit down and discuss with you what the injection will consist of as well as expectations afterwards. You will be positioned appropriately for the injection you are receiving. Occasionally a local anesthetic is used prior to the procedure to help with pain relief from the injection itself. The ultrasound will be used to visualize the anatomy pertinent to the injection, and then the injection will be administered while visualizing the needle under ultrasound guidance. Occasionally, you may even be able to see exactly what the physician or physician's assistant is looking at on the ultrasound screen. Normally, a cortisone injection will take a few days for you to start to get pain relief. Again, there are usually no restrictions on the day of or the following days after the injection. Depending on the body part you can get a repeat injection in the future if the injection does work well for you.
Ultrasound guided injections are a very commonly used practice, especially when it comes to orthopedics. They are used to administer medication, pull fluid out of a joint for analysis and symptomatic relief, and occasionally for diagnostic purposes. Overall, injections themselves can be very scary, however providers who commonly operate the ultrasound to administer injections are always open to giving as much information and walking you through the process so that you have a pleasant experience and get some much-needed pain relief!