Musculoskeletal Ultrasound/ Ultrasound Guided Injections

Musculoskeletal ultrasound imaging is a technique that uses high-frequency sound waves to produce immediate images of the body without radiation. Ultrasound can evaluate “soft tissue” structures that are not seen well on x-ray, including muscles, tendons, ligaments, and nerves. Ultrasound can additionally provide information regarding joints, including whether there is fluid in the joint that can be drained. 

Although MRI is still the imaging technique of choice for certain deeper structures, ultrasound can provide greater detail of superficial structures compared to MRI. Ultrasound can help diagnose and determine the severity of numerous conditions, including:

• Tendonitis/ tendinosis/ tendon tears (including the rotator cuff, tennis elbow, etc.)
• Bursitis
• Ligament sprains (including degree of ankle sprains)
• Peripheral nerve entrapments (carpal and cubital tunnel syndrome)
• Fascial disruption/ damage (plantar fasciitis)
• Muscle strains
• Tendon subluxations
• Cysts

Ultrasound for injections

Musculoskeletal ultrasound may also be used for injections, to ensure accuracy of the injection. The needle can be visualized inside a target joint, or in the precise location where a tendon demonstrates the maximum amount of damage. When compared head-to-head, ultrasound guided injections have demonstrated superior accuracy compared to unguided injections. For example, studies have demonstrated knee injections are 64-87% percent accurate without image guidance, compared to 100% for experienced injectors (but lower for inexperienced injectors). If you want to confirm your provider has significant ultrasound experience look for the RMSK certification.

The use of ultrasound allows precision for:

• Nerve hydrodissection/ nerve blocks
• Scar tissue hydrodissection (loosening up tight, painful scar tissue)
• Joint injection/ aspiration (may confirm completeness of excess joint fluid removal)
• Tendon sheath injection (safely inject into tendon sheath for biceps tendinitis, or trigger finger)
• Tendon mid-substance injection (especially for regenerative injections)
• Bursal injection for bursitis
• Cyst drainage