Ultrasound-guided joint and soft-tissue injection

What an ultrasound-guided injection is

An injection is the delivery of medication through a fine needle into a joint or next to a painful structure (a bursa, a tendon sheath). Depending on the case, what's injected may be a corticosteroid, hyaluronic acid or a local anesthetic, alone or in combination. The medication is chosen at your consultation, based on your diagnosis.

The difference from a "blind" (landmark-guided) injection is that here I use an ultrasound machine. Ultrasound shows me the needle tip, the joint, and the nearby vessels and nerves in real time. I can see where I am and where I'm heading as I place it. It uses no radiation.

Why ultrasound guidance matters

• Precision. The medication reaches the structure I want to treat, not the surrounding tissue.
• I see the nearby vessels and nerves in real time, so I can avoid them and place the medication where it needs to go.
• And I can usually get it done with a single, well-directed needle pass, instead of feeling around for the joint.

What kinds of pain it's used for

A guided injection is a tool for treating pain arising from specific structures, once we have a clear diagnosis (physical examination plus imaging studies when needed). Some common situations:

• Shoulder: rotator cuff pain, subacromial bursitis, biceps tendinitis, frozen shoulder, acromioclavicular osteoarthritis.
• Knee: osteoarthritis, joint effusion, overuse pain.
• Hip: trochanteric bursitis, hip joint pain.
• Other areas: De Quervain tenosynovitis at the wrist, elbow, ankle, bursae and tendon sheaths.

Not every ache needs an injection, and it isn't always the first step. In many cases we start with physical therapy, oral medication and activity modification; the injection comes in when the pain persists or when it needs to be brought down so you can rehabilitate.

What the day of the procedure looks like

It's an outpatient procedure. You come in, have it done and go home the same day, walking.

• I position you according to the area being treated and use the ultrasound probe to locate the target.
• I clean the skin and apply local anesthesia. Most joint and soft-tissue injections require no sedation.
• With the image on screen, I guide the needle and deliver the medication. The procedure itself takes only a few minutes.
• Afterwards you can go home. You generally don't need anyone to accompany you unless we've planned sedation.

Any discomfort over the first few days is managed with ice and the medication I prescribe. I give you written instructions on what you can do and what to avoid for the first 48 hours.

What to expect from the results

I want to be clear about this. An injection treats pain and inflammation; it doesn't repair or reverse the underlying structure. If there's osteoarthritis, the osteoarthritis is still there: the goal is to lower the pain and restore function so you can move and rehabilitate better.

How long the relief lasts varies. It depends on what's injected, on the area and on the individual: it can range from a few weeks to several months. Sometimes a single application is enough; other times it's worth repeating it or combining it with physical therapy and activity modification. We adjust that based on how you respond.

Let me tell you what I tell my patients in the office: ultrasound gets the needle to the exact spot, and along the way I see the nearby vessels and nerves so I can steer around them while placing the dose without wasting it. But guidance doesn't turn an injection into a cure. The evidence shows better accuracy with ultrasound in nearly every joint, and in some areas that also translates into better outcomes; in others, such as the subacromial space of the shoulder, the benefit on pain is much the same with either technique. That's why I decide case by case whether guidance adds value, and I don't promise what an injection cannot deliver.

An injection is one piece of the treatment, not the whole treatment. It works best alongside rehabilitation and a well-established diagnosis. When surgery is indicated, an injection can be part of the plan to manage pain; it neither replaces nor postpones surgery on its own — that's something to discuss with your surgeon and with me.

Where is it done? Locations in Buenos Aires

I see patients at two locations: Hepta, in San Isidro (Av. Fondo de la Legua 577, Zona Norte) and CIAREC, in Villa Urquiza (Av. Monroe 4770, CABA). At the consultation we evaluate your case and arrange where and when to do the procedure. I welcome patients from across the northern suburbs of Greater Buenos Aires and the City of Buenos Aires. Phone: (011) 5895-3260.

Insurance coverage

Injections are generally covered by private health insurance plans and obras sociales (Argentine health funds), depending on your plan and the indication. At the consultation we review your case, and I explain which procedure applies and how coverage works. I also see self-pay patients. Consultations can be in person in San Isidro (Hepta) or Villa Urquiza (CIAREC), or virtual for an initial evaluation.

When to seek help and how to proceed

It makes sense to consider an injection when joint or tendon pain doesn't ease with initial measures, limits your movement, or disrupts your sleep and daily activities. The first step is always a consultation: examining the area, reviewing your imaging and deciding whether an injection is the best option for you — and which one.

Dr. Mauricio Casarsa

Anesthesiologist. Postgraduate training in Pain Medicine and Interventional Pain Management (UBA — Fundación Dolor; UNLP — CAIDBA). Staff physician at Hospital Alemán de Buenos Aires.

MN 137.756 (Argentine medical license) · San Isidro · Villa Urquiza