About Ultrasound-Guided Joint and Tendon Injections
Many injections are traditionally done by feeling landmarks on the skin. That works in some places, but deeper or smaller targets, such as the hip joint, a tendon sheath, or a small bursa, are easy to miss. With ultrasound, your physician sees the target and the needle tip in real time throughout the injection.
We use guided injections for joints, tendon sheaths, bursae, and other soft tissues. The medicine may be a corticosteroid for inflammation, a numbing medicine to confirm the source of pain, hyaluronic acid for some arthritic joints, or an orthobiologic such as PRP. The choice depends on the diagnosis and your goals.
Dr. Gruner and Dr. Chen perform every injection themselves. Injections are one part of a plan, not the whole plan: we pair them with rehab so the calmer window afterward is used to build strength.
Where we use Guided Injections
Shoulder
- Shoulder Arthritis · glenohumeral joint
- Subacromial Bursitis · subacromial bursa
- Rotator Cuff Tendinopathy and Partial Tears · subacromial bursa
- Biceps Tendinopathy (Front of Shoulder) · biceps tendon sheath
- AC Joint Arthritis · AC joint
- Calcific Tendinitis
- Frozen Shoulder (Adhesive Capsulitis)
- Shoulder Labral Tear
- Subacromial and Subcoracoid Impingement
- Shoulder Instability and Dislocation
Hand and Wrist
- De Quervain's Tenosynovitis · De Quervain's tendon sheath
- Wrist and Hand Arthritis
- TFCC Tear (Pinky-Side Wrist Pain)
- Ganglion Cyst
Hip and Pelvis
- Hip Arthritis · hip joint
- Gluteal Tendinopathy and Partial Gluteal Tendon Tears · greater trochanteric region
- Hamstring Tendinopathy · hamstring origin
- Hip Flexor Strain and Iliopsoas Tendinopathy · iliopsoas bursa
- Hip Labral Tears and FAI
- Ischiofemoral Impingement
- Morel-Lavallée Lesion
What happens during treatment
- 1.
Your physician examines you and scans the area with ultrasound to confirm the diagnosis and target.
- 2.
The skin is cleaned, and a numbing medicine may be used.
- 3.
Under live ultrasound, the needle is guided to the target and the medicine is injected while your physician watches it spread.
- 4.
You rest briefly, and your physician reviews activity guidance and follow-up before you leave.
Who may be a good candidate
- People with joint, tendon, or bursa pain who have not improved with rehab and activity changes.
- People who need an injection in a deep or small area, such as the hip, a tendon sheath, or a small joint in the hand or foot.
- Patients who had little benefit from an earlier injection done without imaging.
- People who need a diagnostic numbing injection to confirm where pain is coming from.
Recovery
Most people return to normal daily activities the same day. After a steroid injection, we often suggest a few days of lighter use before resuming exercise. The numbing medicine wears off within hours, and some soreness can follow for a day or two.
Risks and limits
Risks include post-injection soreness, bruising, bleeding, infection, and irritation of a nearby nerve, all uncommon with ultrasound guidance. Steroid injections can briefly raise blood sugar in people with diabetes, cause a temporary flare of pain, lighten the skin, or thin nearby tissue, so we limit how often they are repeated. Injections are not given through infected skin, and blood thinners should be reviewed ahead of time.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Clinical evidence
Published studies our physicians draw on. Results in studies do not predict any one person's outcome.
Questions about Guided Injections
- Are ultrasound-guided injections more effective than blind injections?
- Yes. With ultrasound, your physician watches the needle reach the exact tendon, bursa, or joint space instead of aiming by feel. The American Medical Society for Sports Medicine (AMSSM) reviewed the published studies in its position statement on interventional musculoskeletal ultrasound and concluded that ultrasound-guided injections are more accurate than landmark-guided (blind) injections, work better, and are more cost-effective.Source: AMSSM position statement on interventional musculoskeletal ultrasound (Finnoff et al., 2015)
- Is an ultrasound-guided injection more painful?
- Usually not. Because the physician can see the target, the needle takes a more direct path. Many people find guided injections more comfortable than injections done by feel.
- How many steroid injections can I have?
- We limit how often steroid injections are repeated in the same spot, because frequent use can weaken nearby tissue. Your physician will discuss the right spacing and alternatives, such as PRP, if you need repeated treatment.
- Can I exercise after an injection?
- Light activity is usually fine the same day. We typically suggest a short break from hard or heavy exercise, then a gradual return guided by your rehab plan.