Knee injections are a common procedure performed in sports, pain, primary care and orthopedic clinics. From the occasional cortisone to viscosupplement (e.g. synvisc, hyalgan) and on to advanced platelet and stem cell procedures, as a physician I always consider the best approach to treating my patients. Consider a simple fact: if an injection is not placed in the correct location, you have a minimal chance of helping a patient. A debate is brewing nationally on when physicians should use guidance when placing an injection. With knees being the most commonly injected joint, consider some of the recent publications:
Jackson et al (J Bone Joint Surg Am. 2002 Sep;84-A(9):1522-7) found that 7-27% of knee injections missed the joint. In the case of using synvisc, you just wasted the patients time and money to the tune of 300+ dollars for no benefit.
Sibbitt WL, et al. (J Rheum. 2009;36(9):1892-1902) found that ultrasound guidance resulted in 43.0% reduction in procedural pain, 58.5% reduction in absolute pain scores at the 2 week outcome, 75% reduction in significant pain, 25.6% increase in the responder rate, 62% reduction in non-responder rate and increased detection of fluid in the joint by 200% and volume of aspirated fluid by 337%.
Many other examples exist in the literature with simple pubmed.com searching.
Future posts will show patient responses using ultrasound and fluoroscopic guidance.