Ultrasound-guided injections in primary care: evidence, costs, and suggestions for change.

Abstract

Musculoskeletal (MSK) ultrasound has been used increasingly over the past decade, by non-radiologist hospital doctors, extended scope physiotherapists (ESPs), and to a lesser extent by GPs in primary care, both for diagnostic purposes and to guide therapeutic interventions. The reduction in equipment costs, together with improved image resolution and an increase in educational opportunities, seem to have facilitated these changes. MSK ultrasound is a highly effective diagnostic modality and is regularly used in secondary care to guide MSK interventions including joint and soft-tissue injections. Recent evidence, based on large randomised controlled trials (RCTs) and meta-analyses, demonstrates improved accuracy, efficacy, and cost-effectiveness of ultrasound-guided joint and MSK soft-tissue injections when compared with landmark-guided injections (LMGIs). In 2015 the American Medical Society for Sports Medicine (AMSSM) published a position statement reviewing the current evidence for ultrasound-guided injections (USGIs), focusing on the accuracy, efficacy, and cost-effectiveness of these interventions.1 It demonstrated high-quality evidence that USGIs are more accurate than ‘blind’ or LMGIs and ‘good’ evidence that USGIs are more effective than LMGIs specifically for large joints, inflamed joints, subacromial bursitis, carpal tunnel syndrome, and de Quervain’s tenosynovitis (Figure 1). There was also limited evidence …