Ultrasound guided injections placed under real-time imaging
Rob Mast watches the needle on screen as it reaches the joint, tendon or bursa, so the medicine goes exactly where the scan says the pain is.
Ask about your painOr call 07999 923844 and speak to Rob.
What is an ultrasound guided injection?
An ultrasound guided injection is an injection placed while the clinician watches the needle on an ultrasound screen. At Sonoscope in Ware, Hertfordshire, Rob Mast scans the painful area first, then guides the needle into the exact structure the scan shows, whether that is a joint, a tendon sheath, a bursa or the space beside a nerve.
Most people assume the skill is in the drug. It is not. The same corticosteroid does little if it lands a centimetre from the target. The skill is in finding the structure that causes the pain and putting the needle into that one.
Also called
An image guided injection, which is the wider term for any injection placed with the help of a scan.
The needle shows on the screen as a bright line, so Rob can follow it all the way to the target.
Guided injections reach the target 83% of the time, unguided 66%
-
Shoulder, elbow, wrist, knee and ankle
With ultrasound guidance
83%
Placed by feel
66%
In a trial of 184 patients injected at the shoulder, elbow, wrist, knee or ankle, guided injections reached the intended structure 83% of the time. Injections placed by feel reached it 66% of the time.
-
The shoulder joint on its own
With ultrasound guidance
92.5%
Placed by hand
72.5%
At the shoulder joint the gap is wider. One study found 92.5% of guided injections reached the joint, against 72.5% placed by hand.
Hips, hands and feet
The gap is widest where the target is deep or small. A hip joint sits under muscle and cannot be felt from the surface. That is why a review of hip injections (opens in a new tab) found guidance clearly more accurate. The small joints of the hand and foot leave little room for error.
Steering round nerves
Seeing the needle also lets Rob steer around nerves and blood vessels. He can watch the medicine spread into the right place before the needle comes out. Ultrasound uses sound waves, so there is no radiation.
Confirming the diagnosis
Even at shallow targets where an experienced hand can reach the tendon reliably, the scan earns its place, because it confirms the diagnosis and shows Rob the nerve to steer clear of.
Patient comfort during the injection
Ultrasound also makes the injection itself more comfortable. In a review of knee arthritis trials, Oo et al. (2024) (opens in a new tab) found that guided injections hurt much less than injections placed by feel.
Unsure whether an injection is right for you?
Your appointment starts with an assessment and ultrasound scan before treatment is discussed.
During your appointment
What happens in the room during the injection
The ultrasound guided injection procedure happens in one appointment, after Rob has examined you and scanned the area. Here is what he does once the decision to inject is made.
Step 1: Marking the target
Step 1 of 5
Marking the target
Rob places the probe over the area and finds the structure on screen. He picks a route that avoids nerves and vessels, then cleans the skin.
1 of 5
Step 2: Numbing the skin
Step 2 of 5
Numbing the skin
A small amount of local anaesthetic is often used, so most patients describe the injection as well tolerated, and many as virtually painless.
2 of 5
Step 3: Watching the needle in
Step 3 of 5
Watching the needle in
The needle appears on screen as a bright line. Rob follows it all the way to the target, adjusting the angle as he goes. Precise placement into the target structure is the point of guidance.
3 of 5
Step 4: Seeing the medicine land
Step 4 of 5
Seeing the medicine land
As he injects, the fluid can be seen spreading inside the joint, bursa or tendon sheath. He watches it land where the scan said it should.
4 of 5
Step 5: A test you can feel
Step 5 of 5
A test you can feel
Where local anaesthetic is mixed in, your pain often eases within minutes. That short relief tells Rob the structure he injected was the one causing the pain.
5 of 5
Five injection treatments, chosen after the scan
Rob uses five kinds of ultrasound guided injection. The scan decides which suits you. The right treatment depends on what is inflamed, worn or stuck. Open a card to read about it.
Steroid (cortisone) injections
For a swollen joint, bursa or tendon lining
Read more
Close
Steroid injections suit a swollen joint, bursa or tendon lining. A corticosteroid calms the swelling, which often creates a window for rehabilitation.
Hydrodistension injections
For a frozen shoulder
Read more
Close
Hydrodistension injections suit a frozen shoulder. Fluid stretches the tight capsule, with steroid and local anaesthetic added.
Hyaluronic acid injections
For a worn joint where the cartilage has thinned
Read more
Close
Hyaluronic acid injections suit a worn joint where the cartilage has thinned. Ostenil Plus or Durolane adds lubrication where it is missing.
Arthrosamid injections
For knee osteoarthritis, when a longer lasting option is wanted
Read more
Close
Arthrosamid injections suit knee osteoarthritis where a longer lasting option is wanted. The gel stays in the knee instead of being absorbed.
Barbotage
For a calcium deposit in a shoulder tendon
Read more
Close
Barbotage suits a calcium deposit in a shoulder tendon. The deposit is broken up and drawn out through the needle while the scan shows the tendon live.
A diagnostic scan on its own
For an answer before deciding on any treatment
Read more
Close
A diagnostic ultrasound scan on its own is available when you want an answer before deciding on any treatment.
Next step
Speak to the clinic
Still deciding what treatment you need?
Book an assessment to discuss your symptoms and whether ultrasound-guided treatment may be suitable.
Which joints and tendons Rob injects under ultrasound
Rob injects the shoulder, elbow, hand and wrist, hip, knee, foot and ankle under ultrasound guidance.
The list below covers the common problems in each area. If yours is not named, ask. The scan decides whether an injection can help.
Select an area on the body
Shoulder
- Frozen shoulder
- Rotator cuff impingement
- Rotator cuff tears
- Shoulder bursitis (subacromial)
- Shoulder osteoarthritis
- Glenohumeral and AC joint pain (the shoulder joint and the joint at the top of the collarbone)
- Shoulder instability
Elbow
- Tennis elbow
- Golfer's elbow
- Elbow osteoarthritis
- Biceps and triceps tendon pain
- Olecranon bursitis
Hand and wrist
- Carpal tunnel syndrome
- Trigger finger
- De Quervain's tenosynovitis
- Thumb base osteoarthritis (first CMC joint)
- Finger joint osteoarthritis
- Wrist osteoarthritis
Hip
- Hip osteoarthritis and hip joint pain
- Trochanteric bursitis
- Gluteal tendinopathy (gluteal tendon pain)
- Iliopsoas tendinopathy and bursitis
- Proximal hamstring tendinopathy (hamstring tendon pain at the sitting bone)
Knee
- Knee osteoarthritis
- Patellofemoral pain
- Patellar tendinopathy
- Iliotibial band (ITB) friction syndrome
- Baker's cyst
- Pre-patellar and infra-patellar bursitis (the bursae in front of and below the kneecap)
Foot and ankle
- Achilles tendinopathy
- Plantar fasciitis
- Morton's neuroma
- Ankle osteoarthritis
- Retrocalcaneal bursitis (the bursa behind the heel)
The linked conditions have their own pages. Rob injects for the other conditions listed here too. See every condition we treat on the conditions page.
Spinal injections, nerve blocks and treatment for sciatica are done in hospital under X-ray guidance, so they are not offered here. Injections are not given to anyone aged 16 or under.
How you will feel in the first two weeks
Recovery time after an ultrasound guided injection is short for most people. Here is the usual order of things.
-
Straight away
If local anaesthetic was used, the area may feel easier straight away.
-
An hour or two
That relief wears off after an hour or two.
-
A day or two
Some soreness for a day or two is normal.
-
Several days
A corticosteroid then takes several days to work.
-
Weeks
Hyaluronic acid and Arthrosamid take longer, often weeks.
The part that decides the outcome
What you do in those weeks matters more than most people expect. An injection is often used to create a window for rehabilitation. That is a spell where the pain is low enough to strengthen and stretch the area properly. Patients who use that window tend to keep the benefit long after the injection itself has worn off.
Two things to plan for
-
Driving home
Whether you can drive home depends on the joint and the anaesthetic used, and we have written separately about driving after a steroid injection.
-
How often you can have one
Steroid injections into the same area are spaced at least six weeks apart, with no more than three in a year.
One published fee and one clinician for every injection
Rob Mast
Advanced Practice Physiotherapist and musculoskeletal sonographer
He performs every injection at Sonoscope personally.
- Registration
- Health and Care Professions Council, PH47036
- Experience
- More than 20 years in musculoskeletal care
- NHS work
- Interventional musculoskeletal sonographer in an NHS radiology department
- Teaching
- The ultrasound guided injection programme at Brunel University
- Prescribing
- Independent prescriber, which only around 4% of physiotherapists are qualified to do
- Reviews
- More than 130 patients have rated the clinic 5 stars on Google
Being an independent prescriber means Rob prescribes the injectable medicine himself, so no separate doctor's appointment is needed before you come in.
Ultrasound guided injections
Questions patients ask before booking an injection
Clear answers about what guidance means, whether it hurts, driving afterwards, and what happens if the scan says an injection will not help.
What is a guided injection?
A guided injection is any injection placed using imaging to see the needle, instead of by feel. At Sonoscope the imaging is ultrasound. It shows soft tissue clearly and uses no radiation.
Does an ultrasound guided injection hurt?
Most patients find it well tolerated, and many describe it as virtually painless. Local anaesthetic is often used. Because Rob can see the target, the needle takes the shortest safe route and avoids the structures that hurt most. Some soreness for a day or two afterwards is normal. A few people feel worse for a day or two before the steroid starts to work, and that passes on its own.
Can I drive after an ultrasound guided injection?
It depends on the joint and whether local anaesthetic was used, so ask Rob on the day. Our separate page on driving after a steroid injection covers the common situations.
Do I need a scan before the injection?
Yes, and it is built into the fee. The scan confirms which structure is causing the pain and shows Rob the safest route in. You do not need to bring a scan, X-ray or MRI from elsewhere, and no GP referral is needed.
What if the scan shows an injection will not help?
Then Rob will not inject. You pay for the examination, the scan and the report, and you leave with a clear diagnosis and advice on what to do instead. An injection is given only when clinically appropriate, after examination and scan.
Ask about your injection before you book
The injection itself is over in a few minutes. What decides the outcome is the scan before it and the weeks after it.
Ask about your pain first, at no cost and with no commitment to book.
What is included
- Examination, scan and report
- No GP referral needed
- One fee, nothing added after
- A diagnosis either way
Physiotherapists and GPs can send patients too.
Referring clinicians can use the referral page. Patients can also book online through the client portal.