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Ultrasound-guided injections - when are they indicated?

In general terms corticosteroids can help where the main problem is inflammation which can take many forms and at many sites. Steroid injections, therefore, work well for specific conditions where reduction of inflammation or the local tissue water produced can help relieve symptoms. Steroid injections can help to reduce pain due to inflamed joints, tendon sheaths and bursae.

Although injecting them will not usually take away the cause of the problem itself, they will reduce pain at least in the short-term giving physiotherapy and other treatments time to correct the underlying problem. In some cases, it may be a matter of doing so until a permanent surgical solution can be found. In others, it will be seeing if pain is taken away at all, as even if only short-term it helps confirm the anatomical site of the problem.

A good example where “cure” can be achieved is DeQuervain’s tenosynovitis where the lubricating lining (sheath) around the tendons at the outside on the wrist passing to the thumb become irritated as they pass through a fibrous tunnel. Often mothers nursing a new baby get this condition to a combination of hormone effect and repeatedly holding a growing baby. Ultrasound-guided injection of steroids will often produce good initial symptomatic relief and, as the hormonal effect and need to nurse the baby reduces with time, that temporary relief can become effectively permanent.

It is possible to inject around some tendons to produce pain relief even when a tendon sheath does not exist. One such example is the tendons that run from the outside of your elbow to the back of your hand and wrist. Tendon wear at this site due to excessive use can result in pain commonly referred to as a “tennis elbow”. If inflammation is severe then it may be worth injecting steroids. At this site like in many cases, the decision as to whether to inject steroids may not be straightforward. In severe tennis elbow, small areas of internal tearing may occur. The inflammation in these circumstances is the body’s attempt at repair. Reducing the inflammation, therefore, can also reduce that repair process and for the small tears to become larger ones. Steroids can have a value where the overuse is temporary or where other treatments will resolve the problem if given time to work. However, in some patients, it may be preferable to inject platelet rich plasma obtained by spinning down your own blood in an attempt to generate repair.

There are other areas where steroid injections can help. Swelling of nerves where they are trapped in tunnels with the swelling making the entrapment even worse can sometimes be reversed by injection of steroids around those nerves. This obviously takes very accurate needle position under ultrasound-guidance to avoid nerve damage. The most common condition where such injections are used is carpal tunnel syndrome at the wrist. In this latter case, the nerve can be compressed due to inflammation of adjacent tendons sheaths or wrist joint and these can also be injected to make more room for the nerve in the tunnel. It can also be the case where a nerve is compressed by gel-filled cyst (ganglion) and symptomatic ganglia at different sites are another common indication for steroid injection.

Care should be taken over injecting steroids into joints for arthritis when a joint replacement is being considered as there is a recorded subsequent increased in infection rate. Steroids can also potentially accelerate the deterioration of joints that take a great deal of weight such as your hip, knee and ankle? In these circumstances’ platelet rich plasma or other injectable drugs such as hyaluronic acid that attempt to protect joint surfaces may be preferable.

The list of other medical conditions that may benefit is quite extensive and range from trigger finger, Morton’s neuroma (between toes), plantar fasciitis (and other causes of heel pain), hip (trochanteric) bursitis, shoulder bursitis and nerve entrapment syndromes giving headaches (occipital nerve) or even sciatica (if due to pelvic hamstring tendon problems).

Importantly, injecting steroids under imaging-guidance means that you can minimise the harmful effects by ensuring correct needle positing.

You can see from the above that ultrasound-guided steroid (and other) injections can often help with painful limbs so if you have a problem ask your doctor for their advice. They can then refer you to a specialist medical imaging clinic such as ClinRad for injection if they feel it appropriate.