Some joint symptoms should not wait

Ultrasound shows where the needle goes

Ultrasound uses sound waves to make moving pictures of the joint on a screen. A doctor can watch the needle enter a deep hip or small joint.

During a knee shot, ultrasound also lets the doctor check the needle's position. The screen confirms placement, but it can't tell you how long relief will continue.

Ask whether ultrasound is being used to examine the soreness, place the needle, or both. The doctor can explain what the screen shows and what remains unknown.

Your medicines can change the risk

Cortisone can cause a brief rise in blood sugar when you have diabetes. Blood thinners and a past bad reaction need review before a shot.

Immune medicines are drugs that lower your body's defense against illness. Keep taking prescribed medicine until its prescribing doctor tells you otherwise.

Tell the clinic if you are ill or the skin over the sore joint is cut. Before planned joint replacement, your surgeon needs the shot date, the joint, and what the shot contained.

A good visit answers direct questions

The doctor will ask what hurts, which motions bring soreness, and which daily tasks are harder now. The exam checks swelling and tender areas, then tests strength and movement.

What belongs in the shot? Ask for the name of the medicine, why it may fit, and when you will check the result.

Ask which side effects require a call. Increasing redness, drainage, fever, breathing trouble, or fast-growing swelling shouldn't be ignored.

Sources

1. A systematic review of ultrasound versus anatomic (landmark) guidance found needle-placement accuracy was greater with ultrasound guidance at every anatomic site, and short-term (<6 weeks) symptom onset improved, but long-term outcomes were NOT shown to differ between the two techniques; the accuracy advantage was largest in small joints.

   Gilliland CA, et al. — Ultrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review.. Phys Sportsmed, 2011. DOI: 10.3810/psm.2011.09.1928.

2. A study using fluoroscopy as the reference standard confirmed that injectate placed into the suprapatellar recess under ultrasound guidance disperses into the tibiofemoral joint after a brief bout of walking, and that blinded radiologist review corroborated the interventionalist's reading of correct needle placement.

   Varlotta C, et al. — Accuracy of ultrasound-guided knee injections confirmed by fluoroscopy.. Interv Pain Med, 2023. DOI: 10.1016/j.inpm.2022.100174.

3. A meta-analysis estimated the incidence of rapidly progressive osteoarthritis after hip corticosteroid injection at 6% (95% CI 3-9%) among the 10 studies designed to detect it, while noting definitions varied widely, many cases were not severe, selection bias is likely, and 17 of 27 studies - including every study cited in the AAOS recommendation - could not have detected the outcome at all.

   Sabatini FM, et al. — Incidence of Rapidly Progressive Osteoarthritis Following Intra-articular Hip Corticosteroid Injection: A Systematic Review and Meta-Analysis.. Arthroplast Today, 2023. DOI: 10.1016/j.artd.2023.101242.

4. In a controlled cohort of 1,471 patients injected in the hip, 106 (7.2%) developed rapidly progressive idiopathic arthritis; compared with controls they were older, had narrower joint spaces and higher Croft scores before injection - so pre-injection joint severity, not the injectate or the anaesthetic, marked the at-risk group.

   Boutin RD, et al. — Rapidly progressive idiopathic arthritis of the hip: incidence and risk factors in a controlled cohort study of 1471 patients after intra-articular corticosteroid injection.. Skeletal Radiol, 2021. DOI: 10.1007/s00256-021-03815-7.

5. The HIT randomized trial (198 participants) found that adding a single ultrasound-guided triamcinolone-plus-lidocaine hip injection to best current treatment improved hip pain over six months (mean difference -1.43, 95% CI -2.15 to -0.72), but that the triamcinolone arm was NOT better than ultrasound-guided lidocaine alone; benefit was concentrated in patients with ultrasound-confirmed synovitis or effusion.

   Paskins Z, et al. — Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): single blind, parallel group, three arm, randomised controlled trial.. BMJ, 2022. DOI: 10.1136/bmj-2021-068446.