Journal Club: The accuracy and efficacy of palpation versus image-guided peripheral joint injections

Reviewing a recent paper by Mederic Hall, MD, looking at the benefit of using imaging to help make sure that injections go to the right place

http://europepmc.org/abstract/MED/24030302/reload=0;jsessionid=JsAJg5bV6NLhcIHLaP3w.38

The benefits can be seen pretty easily by the summary table below

Joint	Landmark Guidance	Ultrasound Guidance
Shoulder (Glenohumeral)	10-100%	93-100%
Shoulder (Acromio-clavicular)	39-72%	90-100%
Elbow	38-100%	91-100%
Wrist	25-97%	79-94%
Knee	51-80%	97-100%
Ankle (Subtalar)	68-100%	90-100%

In all cases, the use of ultrasound-guidance improves the accuracy of making sure the injection goes where it should

At Lake Washington Sports & Spine, we strongly believe in the benefit of using ultrasound-guidance for our injections.  In addition to being more accurate, we have found the following additional benefits:

1. Hurts less.  By using ultrasound-guidance, we can find our target and still be tangential to the painful tissue. When performing landmark-based injections (or "blind" injections), the needle is targeted directly at the sensitive tissues.  This is particularly true for small sensitive structures like hands, feet, and nerves.

2. Can use less medication.  Because we are targeting medication right "where the action is", we can use smaller doses of medication.

3. More effective.  Studies are coming out now showing that the accuracy of using image guidance leads to more effective and cost-effective injections (e.g., http://www.jrheum.org/content/38/2/252.short)

4. Helpful even when they don't work.  Back when we used to perform landmark-based injections, if the patient did not benefit, we didn't know if it was because we missed the target.  Now, we know, so if the injection doesn't work, we can move on to considering an alternative diagnosis.