Intra-articular injections performed with sonographic image guidance are significantly superior to palpation-guided methods in all outcome measures. They significantly reduce procedural pain, reduce pain scores at outcome, increase responder rates, and reduce nonresponder rates.
Sibbitt and colleagues randomized 148 patients with painful joints (100 with rheumatoid arthritis and 48 with osteoarthritis) to corticosteroid injection via palpation or sonographic guidance. Pain was measured with the standardized and validated Visual Analog Scale (VAS) pain score.
The patients injected with ultrasonic guidance had significantly less pain during the injection and better outcomes than those managed conventionally. Injection pain was reduced by 43%, and absolute pain scores at 2 weeks were reduced by 58.5% (as assessed by the VAS pain score). Significant pain was cut by 75%. The difference in response rate weighed favorably toward sonographic guidance; there was a 25.6% increase in responders and a 62% decrease in nonresponders. The amount of fluid withdrawn was greater in the ultrasonography group.
The authors suggested that their findings strongly support the use of sonography for intra-articular injections in outpatient musculoskeletal practices and that research is needed to address the effects of such procedures on long-term outcomes.