At Orthopedic Specialists, we pride ourselves in offering the latest technology available to ensure our patients receive the best possible outcome when receiving injections. Despite good intentions, even by the most experienced physicians, studies have shown injections performed without imaging are not 100% accurate and in some joints accuracy is as low as 75%. With guidance, the accuracy of nearly every injection exceeds 90% and approaches 100% in many.
Fluoroscopy is a form of imaging very similar to x-ray. Fluoroscopy is most commonly used for spine and joint injections.
Ultrasound does not require the use of radiation and is most commonly used for soft tissue such as tendon and ligament injections.
An arthrogram is a type of injection that uses a minimal amount of a contrast agent or dye prior to the administration of medication into a joint or vertebral space. The needle is placed in the joint space or vertebral space guided by the fluoroscopy machine; a small amount of dye is then injected to confirm the dye infiltrates the correct space where the physician intends to place the medication. Once ensuring there is proper needle placement, the physician then injects the mixture of numbing medication and/or steroid.
Arthrograms are also used prior to performing some MRI studies. Occasionally, a plain MRI, one done without contrast, does not provide a full picture of certain structures in the body. Joints, specifically shoulders, hips, occasionally knees, wrists and ankles can have tears in tendons, cartilage, and ligaments that are so small and covered by tissue that a non-contrasted MRI will often miss the injury site. Commonly these tears are overlooked in a standard MRI, patients are experiencing considerable pain and struggle for a proper diagnosis but have been unable to achieve it without the imaging of an Arthrogram.
An ultrasound guided injection is similar to the fluoroscopic guided injection however it produces real-time and dynamic images for injections of different muscles, tendons, ligaments as well as joints. The use of ultrasound improves the accuracy of the injection of corticosteroids, hyaluronic acid or other therapies such as Platelet Rich Plasma or Stem Cells. Ultrasound can also be used for joint or bursa aspirations when needed. Lastly, guided injections can be used diagnostically to help determine which structures are generating the patient’s pain.
Like any skill, it takes many years to learn fluoroscopic and ultrasound-guided injections. Skill levels amongst practitioners can vary considerably potentially affecting the success of an injection. It is important that you have an injection performed by a physician who has the proper experience and skill to perform these injections.
Orthopedic surgeons often use injections to treat a variety of conditions. Commonly injected medications include cortisone, local anesthetics, and joint lubricants such as hyaluronic acid. In some injections, you need to hit the targeted area just right in order for the benefits of the injection to be effective.
Joint injections, for example, need to be administered within the joint space and not the surrounding soft tissue. Similarly, tendon injections should be administered in the tendon sheath, the structure covering the tendon, and not the tendon itself.
Without guidance, there is no guarantee of a successfully placed injection. However, with this technology in our office, we have a greater than average success of providing you the most optimum results when administering the medication to the right area.