Ultrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review

To investigate the clinical efficacy of ultrasound when compared with anatomic standard injection using palpation/anatomic landmarks.

PubMed, Ovid Medline/Cochrane Reviews, BIOSIS Previews, and SPORTDiscus™ databases were searched to January 2011. To narrow the search, the following key search terms were used: ultrasound, guided, injection, joint, shoulder, elbow, wrist, hip, knee, and ankle. Fifteen articles were determined to be relevant, and an additional 2 articles were added after bibliography sections of the 15 articles were reviewed, resulting in a total of 17 articles meeting inclusion and exclusion criteria.

Accuracy was greater in the ultrasound-guided group, independent of anatomic site. An improvement in time to symptom onset in the short term (< 6 weeks) was greatest with the use of ultrasound-guided intra-articular injection. Long-term outcomes are not proven to be different between intra-articular injection with ultrasound or anatomic guidance. The greatest trends were observed in the knee and shoulder joints, demonstrating improvements in function, pain, intensity, and range of motion, independent of injection technique. In foot/ankle and wrist/hand, small joint space injections showed a greater accuracy with ultrasound-guided injections contrasted to larger joint spaces, in which these joint injections demonstrated equal accuracy independent of injection technique.

This systematic review can confirm that accuracy is improved with the use of ultrasound-guided intra-articular injection. We can also confirm that short-term outcome improvements are present using ultrasound-guided injection techniques but can confirm no difference in long-term outcome measures using either technique.