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Ultrasound Guidance for Steroid Injections

Boyd W. Haynes III, MD

In my last article, I outlined the many uses of Ultrasound (Sonography) as a diagnostic resource for physicians.  In this installment, I will describe how Orthopaedic physicians use ultrasound to guide the steroid injections that we perform on a daily basis in our practice.
Steroids get a lot of bad press.  Our body produces steroids naturally, as they are hormones important for normal body functioning. It is only when a person abuses prescription steroids and takes them in mass quantities that they become undesirable.  You may envision some muscle-bound dude walking around like

The Hulk, breaking things and being in a bad mood all the time.

Synthetic pharmacological steroids or corticosteroids are one of the most valuable medications I use to help patients feel better.  Steroid medications have incredible anti-inflammatory properties that help to reduce swelling by reducing the immune response.  Although no one likes to get an injection, steroids can be directly placed into the inflamed tissue, whether that be a joint, tendon, bursa, ligament or muscle, or near an inflamed nerve.  If you take steroids orally, they are distributed throughout your body and a much smaller dose goes to the inflamed area.  The injection provides pinpoint (no pun intended) accuracy and gets a much higher concentration of medication where it needs to be.  The result – your pain decreases, your function returns and you feel better – FASTER.

Any experienced orthopaedic physician can give a steroid injection without ultrasound guidance and should be able to get the medication very close to where it needs to go.  However, with ultrasound guidance, I can visualize the tissue that is injured or diseased and put the medication exactly where I think it will result in the most healing and quickest pain relief.  Using ultrasound also allows me to visualize natural pathways within the body, reducing resistance to the hypodermic needle, so that the injection may not cause as much bruising or soreness.   It also may result in a more comfortable injection for the patient.

Sonography guided injections provide better accuracy and also a better patient experience, with improved outcomes and recovery.  Now you know why we use Ultrasound to guide us when you receive an injection.

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