Skip to main content

Abstract

Synovial fluid aspiration and intra- and periarticular injection treatment are part of the standard diagnostic and therapeutic armamentarium in rheumatological clinical practice.

The obtainment of synovial fluid sample allows its analysis which provides several diagnostic information including the definition of its inflammatory nature, the detection of crystals, and the identification of bacteria. Moreover, in case of acutely and significantly swollen joint due to a variable, but usually important, amount of synovial fluid, its aspiration can highly contribute to joint pain relief.

Steroid or hyaluronic acid injection represents an alternative or adjunctive therapeutic option to the systemic treatment in many rheumatic disorders.

These procedures are normally carried out using anatomical landmarks with a variable successful rate mainly depending on both the degree of anatomical complexity and the size of the target area.

In particular, the traditional non-imaging-guided approach may result to be inadequate when the target area is far from the skin and/or small in size or when a dry joint has to be injected. In fact, both efficacy and side effects of an injection largely depend on the correct placement of the tip of the needle at the target area avoiding direct contact with nerves, tendons, articular cartilage, and blood vessels.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Further Readings

  • Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49:1042–9.

    Article  Google Scholar 

  • Ammitzbøll-Danielsen M, Østergaard M, Fana V, Glinatsi D, Døhn UM, Ørnbjerg LM, et al. Intramuscular versus ultrasound-guided intratenosynovial glucocorticoid injection for tenosynovitis in patients with rheumatoid arthritis: a randomised, double-blind, controlled study. Ann Rheum Dis. 2017;76:666–72.

    Article  Google Scholar 

  • Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27:1578–89.

    Article  CAS  Google Scholar 

  • Chevalier X. Acide hyaluronique dans la gonarthrose : mécanismes d’action. In: Chevalier X, editor. Injection d’acide hyaluronique et arthrose. Paris: Masson; 2005. p. 9–39.

    Google Scholar 

  • Cipolletta E, Filippucci E, Incorvaia A, Schettino M, Smerilli G, Di Battista J, Tesei G, Cosatti MA, Di Donato E, Tardella M, Di Matteo A, Di Carlo M, Grassi W. Ultrasound-guided procedures in rheumatology daily practice: feasibility, accuracy and safety issues. J Clin Rheumatol. 27(6):226–31.

    Google Scholar 

  • Conrozier T. Is the addition of a polyol to hyaluronic acid a significant advance in the treatment of osteoarthritis? Curr Rheumatol Rev. 2018;14(3):226–30.

    Article  CAS  Google Scholar 

  • Cunnington J, Marshall N, Hide G, Bracewell C, Isaacs J, Platt P, Kane D. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum. 2010;62(7):1862–9.

    PubMed  Google Scholar 

  • D’Agostino MA, Schmidt WA. Ultrasound-guided injections in rheumatology: actual knowledge on efficacy and procedures. Best Pract Res Clin Rheumatol. 2013;27:283–94.

    Article  Google Scholar 

  • De Luigi AJ, Saini V, Mathur R, Saini A, Yokel N. Assessing the accuracy of ultrasound-guided needle placement in sacroiliac joint injections. Am J Phys Med Rehabil. 2019;98:666–70.

    Article  Google Scholar 

  • Di Geso L, Filippucci E, Meenagh G, Gutierrez M, Ciapetti A, Salaffi F, Grassi W. CS injection of tenosynovitis in patients with chronic inflammatory arthritis: the role of US. Rheumatology (Oxford). 2012;51:1299–303.

    Article  Google Scholar 

  • Eustace JA, Brophy DP, Gibney RP, Bresnihan B, FitzGerald O. Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis. 1997;56:59–63.

    Article  CAS  Google Scholar 

  • Glattes RC, Spindler KP, Blanchard GM, Rohmiller MT, McCarty EC, Block J. A simple, accurate method to confirm placement of intra-articular knee injection. Am J Sports Med. 2004;32:1029–31.

    Article  Google Scholar 

  • Gutierrez M, Di Matteo A, Rosemffet M, Cazenave T, Rodriguez-Gil G, Diaz CH, Rios LV, Zamora N, Guzman Mdel C, Carrillo I, Okano T, Salaffi F, Pineda C, Pan-American League against Rheumatisms (PANLAR) Ultrasound Study Group. Short-term efficacy to conventional blind injection versus ultrasound-guided injection of local corticosteroids in tenosynovitis in patients with inflammatory chronic arthritis: a randomized comparative study. Joint Bone Spine. 2016;83:161–6.

    Article  CAS  Google Scholar 

  • Hoeber S, Aly AR, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2016;50:392–6.

    Article  Google Scholar 

  • Johal H, Devji T, Schemitsch EH, Bhandari M. Viscosupplementation in knee osteoarthritis: evidence revisited. JBJS Rev. 2016;4(4):e11–111.

    Article  Google Scholar 

  • Jones A, Regan M, Ledingham J, Pattrick M, Manhire A, Doherty M. Importance of placement of intra-articular steroid injections. Br Med J. 1993;307:1329–30.

    Article  CAS  Google Scholar 

  • Kane D, Koski J. Musculoskeletal interventional procedures: with or without imaging guidance? Best Pract Res Clin Rheumatol. 2016;30:736–50.

    Article  Google Scholar 

  • Koski JM, Saarakkala SJ, Heikkinen JO, Hermunen HS. Use of air-steroid-saline mixture as contrast medium in greyscale ultrasound imaging: experimental study and practical applications in rheumatology. Clin Exp Rheumatol. 2005;23:373–8.

    CAS  PubMed  Google Scholar 

  • Kumar N, Newmon RJ. Complications of intra and peri-articular steroid injections. Br J Gen Pract. 1999;49:465–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Kuusalo LA, Puolakka KT, Kautiainen H, Alasaarela EM, Hannonen PJ, Julkunen HA, Kaipiainen-Seppänen OA, Korpela MM, Möttönen TT, Paimela LH, Peltomaa RL, Yli-Kerttula TK, Leirisalo-Repo M, Rantalaiho VM, NEO-RACo Study Group. Intra-articular glucocorticoid injections should not be neglected in the remission targeted treatment of early rheumatoid arthritis: a post hoc analysis from the NEO-RACo trial. Clin Exp Rheumatol. 2016;34:1038–44.

    PubMed  Google Scholar 

  • Legre V, Boyer T, Fichez O. Gestes locaux en pathologie sportive: anesthésiques, glucocorticoïdes. Rev Rhum. 2017;74:602–7.

    Article  Google Scholar 

  • Luc M, Pham T, Chagnaud C, Lafforgue P, Legré V. Placement of intraarticular injection verified by the backflow technique. Osteoarthr Cartil. 2006;14:714–6.

    Article  CAS  Google Scholar 

  • Lussier A, Civino AA, McFarlane CA, Olzinski WP, Potasner WJ, De Medicic R. Viscosupplementation with hylan for the treatment of osteoarthritis: findings from clinical practice in Canada. J Rheumatol. 1996;23:1579–85.

    CAS  PubMed  Google Scholar 

  • Luz KR, Furtado RN, Nunes CC, Rosenfeld A, Fernandes AR, Natour J. Ultrasound-guided intra-articular injections in the wrist in patients with rheumatoid arthritis: a double-blind, randomised controlled study. Ann Rheum Dis. 2008;67:1198–200.

    Article  CAS  Google Scholar 

  • Makhlouf T, Emil NS, Sibbitt WL Jr, Fields RA, Bankhurst AD. Outcomes and cost-effectiveness of carpal tunnel injections using sonographic needle guidance. Clin Rheumatol. 2014;33:849–58.

    Article  Google Scholar 

  • Mandl P, Naredo E, Conaghan PG, D’Agostino MA, Wakefield RJ, Bachta A, et al. Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies. Rheumatology. 2012;51:184–90.

    Article  Google Scholar 

  • Naredo E, Cabero F, Beneyto P, Cruz A, Mondéjar B, Uson J, Palop MJ, Crespo M. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004;31:308–14.

    PubMed  Google Scholar 

  • Naredo E, Rull M. Aspiration and injection of joints and periarticular tissue and intralesional therapy. Hochberg Rheumat. 6th ed. Section 4, Chapter 69. 2015.

    Google Scholar 

  • Nordberg LB, Lillegraven S, Aga AB, Sexton J, Lie E, Hammer HB, Olsen IC, Uhlig T, van der Heijde D, Kvien TK, Haavardsholm EA. The impact of ultrasound on the use and efficacy of intraarticular glucocorticoid injections in early rheumatoid arthritis: secondary analyses from a randomized trial examining the benefit of ultrasound in a clinical tight control regimen. Arthritis Rheumatol. 2018;70:1192–9.

    Article  CAS  Google Scholar 

  • Sconfienza LM, Orlandi D, Silvestri E. Ultrasound-guided musculoskeletal procedures: the lower limb. New York: Springer; 2015.

    Book  Google Scholar 

  • Legré-Boyer V. Viscosupplementation: technique, indications, results. Orthop Traumatol Surg Res. 2015;101:S101–8.

    Article  Google Scholar 

  • Wang S, Wang X, Liu Y, Sun X, Tang Y. Ultrasound-guided intra-articular triamcinolone acetonide injection for treating refractory small joints arthritis of rheumatoid arthritis patients. Medicine (Baltimore). 2019;98:e16714.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Carotti, M., Filippucci, E., Salaffi, F., Martino, F., Silvestri, E., Orlandi, D. (2022). Joint and Bursal Infiltration. In: Martino, F., Silvestri, E., Orlandi, D. (eds) Musculoskeletal Ultrasound in Orthopedic and Rheumatic disease in Adults. Springer, Cham. https://doi.org/10.1007/978-3-030-91202-4_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-91202-4_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-91201-7

  • Online ISBN: 978-3-030-91202-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics