Editing Joint injection (section)

==Ultrasound-guided==
Usual standards for musculoskeletal interventional procedures apply include review of previous imaging, informed consent and appropriate local anesthetic.
The use of a high-frequency (> 10 MHz) linear array transducer is recommended, but lower-frequency curvilinear probes may be occasionally required to visualize deep structures in larger patients. A preliminary diagnostic sonographic examination, including color Doppler of the area to be punctured is necessary to define the relationship of adjacent neurovascular structures.<ref name="YeapRobinson2017">Initially largely copied from: {{cite journal|last1=Yeap|first1=Phey Ming|last2=Robinson|first2=Philip|title=Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin|journal=Journal of the Belgian Society of Radiology|volume=101|issue=S2|pages=6|year=2017|issn=2514-8281|doi=10.5334/jbr-btr.1371|pmid=30498802|pmc=6251072 |doi-access=free }}<br>[https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License (CC-BY 4.0)]</ref>

Injections should be performed with adherence to aseptic technique although this varies between institutions and radiologists attributable to resources, training, perceived risk and experience.<ref>{{Cite journal|last1=Stephens|first1=Mark B.|last2=Beutler|first2=Anthony I.|last3=O'Connor|first3=Francis G.|date=2008|title=Musculoskeletal injections: a review of the evidence|url=https://www.ncbi.nlm.nih.gov/pubmed/18953975|journal=American Family Physician|volume=78|issue=8|pages=971–976|issn=0002-838X|pmid=18953975}}</ref> In a survey of 250 health professionals in the United Kingdom, 43.5% believed infection rates were < 1/1000 following intra-articular injections, 33.0% perceived rates were < 1/100, and 2.6% perceived the risk as negligible.<ref name="YeapRobinson2017"/> Sterile preparation of the entire injection field, including adjacent skin where the gel and probe are applied, is recommended. Areas of superficial infection such as cellulitis or abscess should be avoided to prevent deeper spread.<ref name="YeapRobinson2017"/>

After planning a safe route of access, a line parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced. Once the patient's skin is sterilized and initial needle entry is made adjacent to the mark, the probe can be returned quickly to the same location and orientation by aligning to the skin mark. The needle is directed toward the intended target by a freehand technique. The needle size, length and type should be selected based on the site, depth and patient's body habitus. 22–24G needles are sufficed for most injections.<ref name="YeapRobinson2017"/>

As an example, [[ultrasound-guided hip joint injection]]<ref>{{Cite web|title=MSK Ultrasound Guided Injection|url=https://r3medicaltraining.com/events/msk-ultrasound-guided-injection-course/|access-date=2021-05-21|website=R3 Medical Training|language=en-US}}</ref> can be considered when symptoms persist despite initial treatment options such as activity modification, analgesia and physical therapy.<ref name="YeapRobinson2017"/>