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Ultrasound-Guided Injections: More Effective, Less Painful

​​​​​​​Marshfield Clinic now offers a new use for a familiar form of imaging technology. 

woman walking 

Patients suffering from the pain of osteoarthritis and inflammatory diseases such as rheumatoid arthritis and gout may be candidates for ultrasound-guided injections of medications to relieve their pain.

The Rheumatology Department at Marshfield Clinic Wausau Center is using ultrasound to guide injections of anti-inflammatory medication into the knee and other joints. Ultrasound uses high-frequency sound waves, without exposure to potentially harmful radiation, to look at organs and structures inside the body.

This service is being provided by Rheumatologists Vera Bocoun, M.D.​, and Arti Khurana, M.D.​, and Rheumatology Certified Nurse Practitioner Lyn Forbes-Kearns.

Ultrasound is also used to treat osteoarthritis symptoms, including pain, stiffness and limited range of motion, by injecting hyaluronic acid directly into the knee joint. This naturally occurring fluid of the connective tissues helps lubricate and cushion the joint.

“We are very excited to be able to offer this to our patients,” said Forbes-Kearns. She noted that injections of corticosteroids often provide relief of arthritis pain.

“With the ultrasound probe, we can see the placement of the needle in the tissue and make sure we are going into the right spot,” Forbes-Kearns said. 

While rheumatology professionals have a good understanding of normal joint anatomy, arthritis can dramatically change that anatomy. “We are able to see the alteration of the normal anatomy with the ultrasound. It’s similar to how the military uses night vision goggles.”

Studies have shown the ultrasound-guided approach provides up to a 107 percent increase in the number of people who respond to the treatment. Researchers also noted a 47 percent reduction in pain during the procedure and a 41.7 percent reduction in pain within two weeks of receiving the injection. The researchers also showed a significant increase in the length of time patients experienced pain relief.

Because of its preciseness, ultrasound-guided injection is typically less painful than injections placed by feel, known as palpation. The compact ultrasound machine is also highly portable and can be wheeled into any exam room, Forbes-Kearns said. Ultrasound guidance also offers advantages when aspirating fluid from a joint. This fluid draining is frequently performed before an injection, to:

  • Relieve pressure from the fluid inside the joint

  • Provide a sample for laboratory analysis, and

  • Confirm the diagnosis

Osteoarthritis is the most common joint disease for middle-aged and older people, affecting an estimated 27 million Americans. It is characterized by progressive damage to the joint cartilage – the slippery material that cushions the ends of long bones – and causes changes in the structures around the joint. 

These changes can include fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons. All these changes may limit movement and cause pain and swelling. People experiencing joint discomfort should talk to their physician and ask about a referral to a rheumatologist.