Ultrasound guided injection (USGI) of soft tissue or joints

For the treatment of

Musculoskeletal pathology

Commissioning position

USGI of a corticosteroid to soft tissue or a joint is commissioned if there is:

  • History of severe trauma which would derange the normal architecture of the joint OR
  • Failure to identify landmarks due to obesity or another disease process OR
  • No symptomatic relief after two landmark guided injections OR
  • Significant adverse effects associated with a landmark guided injection, such as severe procedural pain

AND

No response to conservative treatment over at least three months.

USGI for aspiration of a joint is commissioned if there is:

  • History of severe trauma which would derange the normal architecture of the joint OR
  • Failure to identify landmarks due to obesity or another disease process OR
  • Failure to successfully aspirate after a landmark guided attempt OR

Abandonment of a landmark guided attempt, due to significant adverse effects, such as severe procedural pain.

Summary of rationale

Corticosteroid injections are commonly used for patients with ongoing joint pain. It is a recognised step according to NICE guidance on the pain management pathway for several conditions.

Aspiration of joints is commonly undertaken for symptomatic or diagnostic reasons.

There is high quality evidence that USGI are more accurate than landmark guided injections but inconclusive evidence that USGI are more clinically effective than landmark guided injections. USGI are more expensive than landmark guided injections and therefore should be reserved for cases where there is a technical challenge to performing landmark guided injection, or those which do not initially respond well to landmark guided injection.

Date created: 08/07/2025, 11:35
Last modified: 20/08/2025, 16:03
Date of review: 2028/12/31