Imaging: Is it worth using ultrasonography to guide injections?

FOR IMMEDIATE RELEASE
(Free-Press-Release.com) November 30, 2009 --

Abstract: Objective. This randomized controlled study addressed wherher sonographic needle guidance affected clinical outcomes of intraarticular (IA) joint injections. Methods. In total, 148 painful joints were randomized to IA triamcinolone acetonide injection by conventional palpation-guided anatomic injection or sonographic image-guided injection enhanced with a one-handed control syringe (reciprocating procedure device). A one-needle, 2-syringe technique was used, where the first syringe was used to introduce the needle, aspirate any effusion, and anesthetize and dilate the IA space with lidocaine. After IA placement and synovial space dilation were confirmed, a syringe exchange was performed, and corticosterioid was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks), and changes in pain scores were measured with a 0-10cm visual analog pain scale (VAS). Results. Relative to conventional palpation-guided methods, sonographic guidance resulted in 43% reduction in procedural pain (p /- 5 cm; p < 0.001), 25.6% increase in the responder rate (reduction in VAS score < 50% from baseline; p <0.01), and 62.0% reduction in the nonresponder rate (reduction in VAS score < 50% from baseline; p <0.01). Sonography also increased detection of effusion by 200% and volume of aspirated fluid by 337%. Conclusions. Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner.

CORTICOSTEROID     injection     INTRAARTICULAR     Outcome     sonography     ultrasound