An ultrasound-guided injection uses real-time ultrasound imaging to direct a needle accurately to the target structure — a joint, bursa, tendon sheath, or soft tissue lesion — under direct visual control. The sonographer visualises the needle tip throughout the procedure, confirming correct placement before the injection is administered.
This is in contrast to landmark-guided injections, where the clinician uses anatomical surface landmarks to estimate the position of the target structure and inserts the needle without imaging guidance. Landmark-guided injections are faster and do not require specialist equipment, but they are significantly less accurate.
| Injection type | Indication |
|---|---|
| Corticosteroid (cortisone) | Inflammation — bursitis, tendinopathy, synovitis, inflammatory arthritis flare |
| Hyaluronic acid (viscosupplementation) | Osteoarthritis — particularly knee and hip; lubricates the joint and may reduce pain |
| Aspiration | Removal of fluid from a joint effusion, bursa, or ganglion cyst |
| Barbotage (needling) | Treatment of calcific tendinopathy — the calcium deposit is broken up and aspirated under ultrasound guidance |
The clinical case for ultrasound guidance is well established. A systematic review published in the British Journal of Sports Medicine (2011) analysed 27 studies and found that ultrasound-guided injections were significantly more accurate than landmark-guided injections across all joint sites, with the greatest benefit seen in the shoulder (subacromial space) and hip.
More importantly, accuracy translates to clinical outcome. A 2009 randomised controlled trial found that ultrasound-guided shoulder injections produced significantly greater pain relief at 6 weeks compared with landmark-guided injections, despite using the same corticosteroid dose.
At Sonoworld, all injections are performed under ultrasound guidance as standard. We do not offer landmark-guided injections.
Calcific tendinopathy of the shoulder is one of the conditions where ultrasound-guided barbotage (needling and aspiration of the calcium deposit) produces the most dramatic results. Patients who have had months of severe shoulder pain — often worse than a rotator cuff tear — can experience near-complete resolution of symptoms within 2–4 weeks of a single ultrasound-guided barbotage procedure. The key is accurate needle placement within the calcium deposit, which is only reliably achievable under ultrasound guidance.
The skin is numbed with local anaesthetic before the injection, so the procedure is well tolerated. You may feel a brief sting from the local anaesthetic and mild pressure during the injection itself. Most patients find the procedure significantly less uncomfortable than they expected.
The duration of benefit varies by condition and individual. For bursitis and tendinopathy, most patients experience 3–6 months of pain relief from a single injection. Some patients require repeat injections; most clinicians recommend no more than 3 injections per year in any single site to minimise the risk of tendon weakening.
At Sonoworld, a diagnostic scan is performed at the start of every injection appointment to confirm the diagnosis and identify the target structure before the injection is administered. This ensures the injection is placed in the correct structure for the correct indication.
Ultrasound-guided cortisone injections at Sonoworld are priced from £250. See our injection page for full pricing.
Sonoworld is registered with the Care Quality Commission (CQC). Our sonographers are registered with HCPC and are members of BMUS. All scans are performed at our Marylebone clinic: 29 Weymouth Street, London W1G 7DB.
Same-day and next-day appointments available at our Marylebone clinic. Instant verbal results. Written report within 24 hours. No GP referral required.
Price: from £250
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