Ultrasonographic guidance boosts joint injection accuracy

Corticosteroid injection in the joints of patients with inflammatory arthritis results in significant alleviation of symptoms and improvement in functional status. Ultrasonography (US)-guided injections are significantly more accurate than clinical examination (CE)-guided injections.

Cunnington and colleagues compared the effects of corticosteroid injections delivered via US or CE guidance in 184 patients with inflammatory arthritis. Treatment outcomes were measured with serological markers of inflammation and patient assessment questionnaires.

US-guided injections were accurate in 83% of patients, compared with 66% of patients who had CE-guided injections. There was a trend toward increased accuracy with US-guided injections for all joints, particularly the shoulder, elbow, and ankle. The greater accuracy of US-guided injections held true regardless of the physician’s level of experience-junior trainees were more precise with US than senior physicians were with CE. Joint function at 6 weeks was better in the US group than in the CE group, although overall clinical outcomes were similar.

The authors noted that injection with US guidance may be considered for joints that frequently are injected inaccurately, when less soluble preparations are used, if the anatomy is distorted by the disease process or by obesity, and to reduce the systemic adverse effects of corticosteroids.