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Musculoskeletal ultrasonography: Guided injection and aspiration of joints and related structures

George AW Bruyn, MD, PhD
Section Editor
Robert H Shmerling, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Ultrasonography (US), sometimes referred to as ultrasound imaging or sonography, is an imaging modality that utilizes reflected pulses of high-frequency (ultrasonic) sound waves. Musculoskeletal US can be used to assess soft tissues, cartilage, bone surfaces, and fluid-containing structures and is becoming more widely available for diagnostic and therapeutic use in outpatient settings, including rheumatology practices [1].

Among the major uses of US in the management of joint disorders and related conditions are image guidance of glucocorticoid injections and aspiration of joint effusions and other fluid collections [2-5]. Among the possible advantages of US are the avoidance of the radiation exposure and inconvenience associated with use of fluoroscopy for procedures involving otherwise difficult-to-enter joints and other spaces, including the sacroiliac and hip joints, and small targets, including tendon sheaths, gouty tophi, and small effusions; procedures in patients with obscured surface landmarks such as morbidly obese patients; avoidance of critical structures like nerves or arteries; appropriate needle placement in particular conditions like hemophilia [6]; and direct aspiration of Baker's cysts [7].

The use of US imaging for joint, tendon, and bursal injections and for aspiration of fluid is discussed here. A review of the clinical applications of musculoskeletal US and the technical aspects of musculoskeletal US, including the validity and reliability of image acquisition and interpretation in rheumatic disorders, are addressed in detail separately:

(See "Musculoskeletal ultrasonography: Clinical applications".)

(See "Musculoskeletal ultrasonography: Nomenclature, technical considerations, validation, and standardization".)

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Literature review current through: Nov 2017. | This topic last updated: Aug 07, 2017.
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