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Ultrasound-Guided Injections: what are they and what are the benefits?

At MiniHospital “Sandro Pertini,” it is possible to undergo ultrasound-guided infiltrations, innovative procedures that treat inflammatory and traumatic orthopedic pathologies.

Ultrasound-guided infiltrations allow for the administration of medication under ultrasound guidance directly into the target area (joint, sheath, tissue), ensuring that it can act precisely where needed. This approach offers three fundamental advantages:

  • Administering low doses of medications
  • Injecting medications where they are most effective (some therapeutic agents are ineffective unless injected with extreme precision)
  • Maintaining real-time control over the needle’s path, thus avoiding collateral damage to important structures (veins, arteries, nerves, tendons)

Therefore, ultrasound-guided infiltrations offer greater effectiveness, fewer side effects, and reduced damage to local structures.

The procedure for an ultrasound-guided infiltration involves using an ultrasound machine to guide and monitor the infiltration (or drainage) procedure, assisting the specialist in inserting the needle with extreme precision and performing the treatment correctly. The infiltration itself takes only a few seconds, and the entire procedure is performed using sterile field and single-use materials for a total duration of about 15-20 minutes. No preparation is required from the patient, and no hospitalization or post-exam rehabilitation process is involved. After a few hours, the patient can return to their normal daily activities; however, it is recommended to avoid intense or strenuous activities or sports for the following 24-48 hours.

Ultrasound-guided infiltrations can utilize various therapeutic agents:

  • Anti-inflammatories: Steroids are commonly used to reduce swelling and inflammation, thereby reducing pain and functional impairment.
  • Hyaluronic acid: Through viscosupplementation and viscoinduction, hyaluronic acid aims to restore the mechanical properties of the joints. Hyaluronic acid is a natural lubricant found in the joints. Administering it into a diseased joint helps compensate for the loss of natural hyaluronic acid (e.g., in osteoarthritis), thereby facilitating joint improvement.
  • Blood-derived products (platelet gel, stem cells

 

Ultrasound-Guided Infiltrations: Dr. Riccardo Giuliani and the Success of the Versilia Group

MiniHospital “Sandro Pertini” relies on expert specialists in the medical-surgical field. Dr. Riccardo Giuliani, a specialist in radiology, has been involved in interventional radiology and musculoskeletal radiology for 20 years, with publications and participation as a speaker at national and international congresses and conferences.

In the early 2000s, Dr. Giuliani founded, along with two other colleagues (Dr. Burrelli and Dr. Tarabelli), the musculoskeletal interventional group at the “Versilia” hospital, which now boasts over 12,000 active procedures (such as lithotripsy, treatment of De Quervain’s syndrome, trigger finger, and ultrasound-guided infiltrations of the shoulder, hip, ankle, and wrist).

In 2014, the Versilia Group undoubtedly had one of the largest case volumes nationally and internationally. For years, it has been and continues to be one of the most important reference centers for osteoarticular interventions at both regional and national levels.

Ultrasound-Guided Infiltrations: List of Services

Interventional radiology with ultrasound guidance comprises a set of techniques for guided infiltration, providing real-time visualization of the joint to be pharmacologically treated. In this field of medicine, there are several techniques and procedures aimed at resolving various orthopedic pathologies of traumatic or inflammatory origin.

Percutaneous ultrasound-guided lithotripsy is a minimally invasive alternative to surgery for the treatment of painful calcifications in the shoulder (and other areas). It involves a removal procedure under local anesthesia, followed by the washing of the calcification (total or partial removal) and ultrasound-guided infiltration. The procedure takes about 20 minutes, with a complete recovery time of 24/48 hours.

Ultrasound-guided intra-articular infiltrations are outpatient therapies that treat pain and functional impairment in the joints of the shoulder, hip, knee, ankle, hand, foot, wrist, and elbow. With this infiltrative technique, medications are injected into the affected joint, while the ultrasound allows real-time monitoring of the needle’s path, directing it optimally toward the affected area. Main indications: osteoarthritis, hip, shoulder, knee, wrist, hand, ankle.

Extrarticular ultrasound-guided infiltrations, on the other hand, are specific procedures for the treatment of pathologies affecting tendons, bursae, and joint sheaths. Main indications: trigger finger, De Quervain’s syndrome, pubalgia, plantar fasciitis, peritrochanteric bursitis, Civinini-Morton neuroma, peritendinitis (Achilles tendon), carpal tunnel syndrome, Baker’s cyst.

What are the advantages of ultrasound-guided infiltrations?

Some areas of our body are not easily accessible: deep regions require specific investigations capable of locating the problem of interest and addressing it in a targeted manner. Many therapeutic agents, such as hyaluronic acid, and blood derivatives are not water-soluble, so if they are not injected with extreme precision into the joint or bursa of interest, they are ineffective.

Ultrasound-guided infiltrations address this issue: they provide clear visualization of the joint, allowing the specialist to inject the drug precisely where needed using a needle.

Ultrasound-guided infiltration offers several advantages:

  1. Greater effectiveness in performing the procedure. The results obtained are more accurate and reliable.
  2. Reduced drug side effects, as it acts exclusively on the joint pathology.
  3. Safe needle path during the injection process. Ultrasound guidance prevents damage to nerves, vessels, or tendons during needle insertion.
  4. No exposure to radiation.
  5. Absence of iodinated contrast agents.

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