Ultrasound-guided infiltrations have replaced those that have always been performed “blindly”. In other words, it refers to an infiltration technique guided by an image, the ultrasound, to precisely locate the anatomical structure to be infiltrated, be it a bursa, a tendon sheath or a peritendon, which generally cannot be visualized with X-rays.
Therefore, the difference between traditional and ultrasound-guided infiltrations is the use of ultrasound. This brings with it certain advantages, such as minimization of risks and greater patient comfort. Specifically, the positive aspects of this procedure are:
- Safety that the infiltrated substance reaches its target: it drastically reduces the risk of vascular and/or nerve puncture and the possibility of harmful infiltrations in already injured tendons.
- It does not entail radiation risks.
- It reduces the risk of contracting any allergy, since there is no injection of iodinated contrast products.
In what cases are ultrasound-guided infiltrations recommended?
This type of procedure is recommended in several situations:
– To locate a lesion: it can help the drainage of collections, hematomas, cysts, foreign bodies, abscesses or joints that have effusion inside.
– Treat pain by infiltration of anti-inflammatory substances in acute tendinopathies, hyaluronic acid in cases of osteoarthritis, growth factors to accelerate the process of regeneration and healing in cases of tendinopathies, chronic chondropathies and muscle or ligament injuries.
Are there any limitations?
The limit depends on the product that is infiltrated. Corticoids are usually indicated in specific cases, to reduce inflammation and pain early on.
For their part, hyaluronic acid infiltrations in joints or tendons have a therapeutic effect but with a limited duration in time. They are useful for restoring the viscoelastic properties of the joint fluid in patients with osteoarthritis or of the peritendinous fluid in chronic tendinopathies.
On the other hand, infiltrations with growth factors are usually repeated several times, at least 2 or 3 per cycle. This is because their effect is not immediately noticeable, as is the case with corticosteroids. Tendon repair tends to occur more in the long term, between 2 and 3 months, although there is no time limit for not infiltrating on different occasions.
How often are infiltrations performed?
In the case of corticosteroids, a joint should not be infiltrated repeatedly, as there is a risk of chondrolysis, or a tendon, to avoid tendon rupture, subcutaneous atrophy or depigmentation.
As for hyaluronic acid, it is an alternative that has a longer effect over time, between 6 and 12 months, although it takes longer to show its effect initially. After this result, the infiltrations can be repeated as a background treatment.
Finally, infiltrations of platelet-rich plasma (PRP) provide growth factors that seek to heal and regenerate the injured tissue. They can be repeated periodically, depending on the joint or anatomical structure to be treated, the size of the lesion and the patient’s response to the treatment.
Are there any side effects?
First of all, corticosteroids can increase blood glucose in diabetic patients or produce increases in blood pressure in hypertensive people.
In addition, there are complications in the area to be treated. These range from local infection, if aseptic conditions are not adequate, to extravasation of a hematoma following injection. This usually occurs when the infiltration has not been performed in the correct site, which is normal in those procedures that are not performed under ultrasound, resulting in intravascular injection pictures or pictures of nerve compression.
Finally, since the plasma that is infiltrated is an ultra centrifuged plasma in which there is a concentrate of the patient’s own blood platelets, there is no risk of adverse reactions and it is considered a safe therapeutic procedure. However, there may be a peak of pain 24-72 hours after infiltration, which passes with paracetamol.