Does sonographic needle guidance affect the clinical outcome of intraarticular injections?
OBJECTIVE
This randomized controlled study addressed whether sonographic needle guidance affected clinical outcomes of intraarticular (IA) joint injections.


METHODS
In total, 148 painful joints were randomized to IA triamcinolone acetonide injection by conventional palpation-guided anatomic injection or sonographic image-guided injection enhanced with a one-handed control syringe (the reciprocating device). A one-needle, 2-syringe technique was used, where the first syringe was used to introduce the needle, aspirate any effusion, and anesthetize and dilate the IA space with lidocaine. After IA placement and synovial space dilation were confirmed, a syringe exchange was performed, and corticosteroid was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks), and changes in pain scores were measured with a 0-10 cm visual analog pain scale (VAS).


RESULTS
Relative to conventional palpation-guided methods, sonographic guidance resulted in 43.0% reduction in procedural pain (p < 0.001), 58.5% reduction in absolute pain scores at the 2 week outcome (p < 0.001), 75% reduction in significant pain (VAS pain score > or = 5 cm; p < 0.001), 25.6% increase in the responder rate (reduction in VAS score > or = 50% from baseline; p < 0.01), and 62.0% reduction in the nonresponder rate (reduction in VAS score < 50% from baseline; p < 0.01). Sonography also increased detection of effusion by 200% and volume of aspirated fluid by 337%.


CONCLUSIONS
Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner.
Sibbitt
Wilmer L
WL
Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA. wsibbitt@salud.unm.edu
Peisajovich
Andres
A
Michael
Adrian A
AA
Park
Kye S
KS
Sibbitt
Randy R
RR
Band
Philip A
PA
Bankhurst
Arthur D
AD
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D007596:Joints / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000627:therapeutic use; D014463:Ultrasonography
D000305:Adrenal Cortex Hormones; D014222:Triamcinolone Acetonide