Image guided injections

What is an image-guided injection?

An image guided injection is a minimally invasive medical technique used to administer medication to a very localised and specific area inside the body. To help the medical practitioner do this accurately, they use imaging tools such as X-ray, ultrasound or CT scan to guide them. It’s usually recommended for treating pain and inflammation caused by musculoskeletal issues, but does have other applications as well.

What are the different methods used for image-guided injections?

Image-guided injections is a broad term used to describe several different types that are available. Which is right for you will depend on your personal circumstances, and your consultant and Nuffield medical team will be able to advise you.

Ultrasound-guided injection

As its name suggests, this technique uses ultrasound imaging to guide the needle used to perform your injection. Ultrasound technology works by sending high-frequency sound waves through your body. These bounce back from your internal tissues to create a visual image.

Ultrasound-guided injections are performed using a small, handheld probe. Conducting gel is placed onto the target area and the probe is passed over your skin. It may be necessary to press down onto the skin quite firmly to get the clearest and most accurate picture.

Fluoroscopic-guided injection

This is another name for X-ray guided injections. However, unlike most diagnostic X-rays, they use a very low dose of radiation to produce the images used to guide the injection. In many cases, a special contrast dye is injected first to confirm the needle is in the correct spot before administering the medication. And as with an ultrasound-guided injection, live images will be shown on screens while the procedure takes place.

CT guided injection

Unsurprisingly, this technique uses Computer Tomography (CT) imaging to guide the injection. CT scanners provide much more detail than standard X-rays, illustrating the area in 3D, which gives an enhanced overview for optimal guidance for injections.

What conditions may require an image-guided injection?

Many health conditions could benefit from treatment that involves an image-guided injection. Most of these are musculoskeletal injuries or disorders, and include but aren’t limited to:

• Sciatica: a condition characterised by pain, tingling, numbness or weakness that extends from your lower back into your buttocks and potentially leg.
• Osteoarthritis: a painful degenerative condition of the joints that may be associated with injury, inflammation, genetics or family history, hormonal changes, or more general wear and tear.
• Meniscal tears: injury to the shock-absorbing cartilage cushions in the knee, which frequently causes local inflammation and pain.
• Sacroiliac joint dysfunction: pain from the small joint that connects the sacrum at the base of the spine to the pelvis. There are a range of causes, from pregnancy and arthritis to injury or repetitive stress.
• Spinal arthritis: arthritis that occurs in the joints of the spine. It’s most often caused by wear and tear but can also be a result of autoimmune conditions.
• Herniated disc: a herniated disc occurs when one of the soft discs between the bones of the spine develops a tear or bulges out of place, enabling the soft inner material to push out past the tougher, outer layer. When this happens, it presses on nearby nerves and causes pain, numbness and other symptoms. Herniated discs usually happen due to injury, strain or as part of the natural aging process.

Your consultant will be able to advise you if you have a condition which could benefit from an image-guided injection.

How can image-guided injections treat joints?

Joint conditions are extremely common, and it's estimated that more than 20 million people in the UK live with a musculoskeletal disorder like arthritis². These disorders can cause very debilitating symptoms, ranging from mild to severe pain, to limited movement, and both of these can very quickly affect your quality of life.

Image-guided injections can help to treat joints as they are typically used to administer medication directly into the affected area. These medications are designed to reduce pain and inflammation, which in turn can improve mobility in the affected joint.

How can image-guided injections treat bursas?

A bursa is a thin, fluid-filled sac found in joints. Its role is to reduce friction between the bones, tendons, muscles and other soft tissue in the joint, enabling it to move comfortably without adding any unnecessary wear and tear.

Image-guided injections can ensure that medication is delivered directly into the bursa to ensure that it gets to work in the right area and limiting the risk of local complications.

How can image-guided injections treat cysts?

Cysts are very common, fluid-filled sacs that can be found anywhere in the body. Most are non-cancerous and develop when a duct or gland gets blocked, or as a result of injury or infection.

Treatment of cysts is a little different, with image-guidance technology being used both to draw fluid out of the cyst (a process called aspiration), and to administer medicine directly into the area to treat it – for example, corticosteroid. Draining a cyst is important because all although most are benign, removing the fluid can help to relieve pressure, pain and manage infection.

How can image-guided injections treat tendons?

Image-guided injections are used to treat tendons in much the same way as they treat bursas and osteoarthritis, to help improve accuracy and reduce risk during the procedure.

When might I need an image-guided injection?

You may need an image-guided injection if you routinely suffer from pain, inflammation and stiffness due to a musculoskeletal injury or disorder that isn’t getting better with more conservative treatments, such as rest, icing and over-the-counter pain relief. Your orthopaedic consultant will be able to advise you if image-guided injections are right for you.

Who is a good candidate for an image guided injection?

Typically, good candidates for image-guided injections:

• Haven’t responded to treatments such as ice, physical therapy, etc.
• Experience persistent pain or mobility issues that are affecting their quality of life.
• Want to avoid or delay more invasive treatment options like surgery.
• Require fluid aspiration from a cyst or area of a joint, which may or may not be sent off for biopsy.
• Injection is required to a deeper joint or tissue, or where there is complex local anatomy, which means extra visualisation of the area would be beneficial to ensure accuracy.

Who is not suitable for an image guided injection?

Image-guided injections are generally considered to be very safe. However, as with all treatments, there are some people who may not be good or suitable candidates. Image guided injections are not recommended for people with:

• Active infections: either systemic (whole body) or a localised infection at the injection site.
• Bleeding disorders, or if you are taking certain blood-thinning medication.
• Allergies to local anaesthetic or the medication that would be administered via injection/
• Poorly controlled diabetes, as corticosteroid injections can cause a temporary increase in blood sugar levels⁴.

You will also need careful evaluation for your suitability if you are pregnant or breastfeeding.

If you regularly take prescription medication, please let your consultant or healthcare team know as they can interact with the medication administered via injection.

How the image guided injection is performed

How can I prepare for an image-guided injection procedure?

As a minimally invasive treatment, preparing for an image-guided injection is usually very straightforward. Your consultant will carry out a comprehensive review of your medical history and any current medications you are taking as part of checking your suitability for treatment.

Will I need to stop any medication before having an image-guided injection?

You’ll be advised if there are any drugs that you should temporarily stop or ask your doctor for a substitute for ahead of your treatment, as well as the timeline for doing this. It’s important that you follow your consultant’s instructions for this, as it will help reduce any risks of having your image-guided injection procedure.

Can I eat and drink before an image-guided injection?

For the majority of image-guided injections, you’ll be able to eat and drink as normal. However, if you’re having any sort of sedation, you may be advised to avoid food and drink for several hours before your procedure. This is to help reduce the risk of side effects like nausea and vomiting during or after the treatment. Again, always follow the instructions provided by your medical team.

What happens during image-guided injections?

Exactly what will happen during your image-guided injection will depend on the joint that is being treated, and whether you’re having a simple injection or if you’re also having a cyst or bursa aspirated as part of the treatment. However, you can typically expect a very similar approach to the procedure, regardless of the reason for treatment.

You’ll be made comfortable with the joint exposed. Your consultant will then set up the relevant imaging and ensure this is working correctly before using it to guide the injection into the precise area being treated. There are no open wounds, and no need for sutures or dressings.

Is an image-guided injection painful?

We know that the thought of having an injection into a joint can seem worrying. There may be a feeling of a slight scratch, pinch or pressure when the needle goes in, but there shouldn’t be any significant lasting discomfort. If you’re concerned, speak to your Nuffield Health team ahead of your appointment. You may be able to have a local numbing agent applied to the area before your injection.

How long does an image-guided injection take?

Again, the answer to this question depends on the joint being treated and whether or not you are also having fluid aspirated. However, the process itself usually takes anywhere from 15 to 30 minutes. If you take into account time to prepare and a brief, post-treatment recovery period in our care, you can expect your appointment to last around an hour.

What type of medication is used in an image-guided injection?

• Corticosteroids
• Local anaesthetics
• Arthrosamid®
• Hyaluronic Acid
• Platelet-rich plasma (PRP)

How long does it take to recover after an image-guided injection?

You can expect to go home the same day as your treatment and should be able to return to your usual activities the next day, provided that they aren’t too heavy or strenuous. It’s always important to follow the guidance provided by your medical team.

Can I drive after an image-guided injection?

It is usually recommended that you don’t drive for at least 24 hours after having a steroid injection. This is because you may be given a local anaesthetic or sedation, and this could have an impact on your ability to drive. Whilst everyone’s response to an injection is different, it is a good idea to arrange for someone to bring you to your appointment, and to stay with you so that they can take you home after.

What activities should I avoid after an image-guided injection?

Mild activity, such as walking, can be resumed within 24 hours of an image-guided injection unless your medical team advises you otherwise. However, for strenuous activity, heavy lifting and high-impact exercise, you may be recommended to wait at least 48 hours, if not longer. This is to ensure your treatment has time to start working and provide relief. Always follow the recommendations given to you by your healthcare team.

How long before I start to feel the results of an image-guided injection?

Again, exactly how long it will take for you to feel the effects of your image-guided injection may vary depending on the type of injection given. Following a steroid injection, most people start to notice an improvement within a few days, and this can be sustained for several months or more.

What are the risks and complications of an image-guided injection?

Image-guided injections are generally considered to be extremely safe, with a low risk of complications. However, it’s still advisable to make yourself aware of the side effects that can occur, so that you can seek medical advice if it’s needed.

Common side effects of image-guided injections:

• Bruising, bleeding and temporary pain at the injection site.
• Minor, temporary redness at the injection site.
• A temporary increase in pain in the affected joint before the medication starts working.

Less common/rare side effects of image-guided injections:

• Temporary increase in blood sugar levels in diabetic patients.
• Skin or tissue changes at the injection site.
• Nerve damage to nerves surrounding the injection site.
• Tendon weakness.
• Infection, which is rare but can be serious. If the area becomes painful, red and swollen or if you feel unwell, you must seek urgent medical attention.

In rare cases, it’s possible to have an allergic reaction to the injected medications. Symptoms of this include a skin rash, breathing difficulties, swelling of your mouth, tongue, lips or throat, and feeling very dizzy and unwell. Allergic reactions usually happen very quickly after the medication has been administered, and this is one of the reasons you may be asked to wait for 15 minutes or so after your treatment so that you can be monitored. However, if you experience any of the signs of an allergic reaction after you’ve returned home, you should always immediately contact your healthcare provider or Nuffield medical team for advice⁶.

How much does an image injection cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.

Sources:
1. https://healthcare-bulletin.co.uk/article/the-role-of-ultrasound-in-guiding-knee-injections-2306/
2. https://www.england.nhs.uk/elective-care/best-practice-solutions/musculoskeletal/#:~:text=Over%2020%....
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC11171832/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC3971392/
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC4545130/
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC9463191/