Ultrasound guided injections

Physiotherapists increasingly use ultrasound imaging as an adjunct to diagnosis and also to perform ultrasound guided injection (USGI) procedures. 

Research consistently demonstrates a mild to moderate benefit in treatment outcomes from USGI versus landmark guided corticosteroid injection. The clinical significance and cost effectiveness of this benefit has been rightly questioned. 

USGI have been shown to significantly improve accuracy of needle placement. This may suggest that a greater improvement in clinical effectiveness can be gained for more complex and intricate procedures such as barbotage, hydro-distension or high volume stripping injections. USGI also provides an important medico-legal record of technique accuracy.

Above all, USGIs can be utilised to improve patient safety, for example confirming diagnosis and reducing the risk of needle trauma to tendons and neurovascular structures. 

Accurate assessment and diagnosis may improve clinical reasoning and patient selection for injection.

Much of the benefit of USGI comes from being able to accurately scan and interpret the ultrasound images. Best practice would be to first achieve a level of training and competency in ultrasound imaging before progressing to USGI. 

A thorough understanding of ultrasound imaging, physics, systems optimisation, quality assurance checks, probe skills and diagnostics are all key to the safe and effective delivery of USGI. I would recommend an M level, HEI-accredited training program ideally accredited by the Consortium for the Accreditation of Sonographic Education. 

Performing USGIs is a technically challenging skill with a significant learning curve. The use of additional equipment and training adds cost. But it is an opportunity to further refine our assessment and expand the range of injection procedures offered. 

For the physiotherapy profession to progress it is important that we embrace and utilise available technology.

• Dave Baker is clinical director of Complete Physio Ltd and Complete Injections. He is also an honorary lecturer at Brunel University  and chairman of the professional network ACPOMIT