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Effectiveness of Ultrasound Guidance on Intraarticular and Periarticular Joint Injections

Systematic Review and Meta-analysis of Randomized Trials

Huang, Zhongming, PhD, MD; Du, Shaohua, PhD, MD; Qi, Yiying, PhD, MD; Chen, Guangnan, MD; Yan, Weiqi, PhD, MD

American Journal of Physical Medicine & Rehabilitation: October 2015 - Volume 94 - Issue 10 - p 775–783
doi: 10.1097/PHM.0000000000000260
Original Research Articles
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Objective The aim of this study was to evaluate the effectiveness and accuracy of ultrasound-guided intraarticular and periarticular joint injections as compared with landmark-guided injections technique.

Methods A systematic literature search was performed in Medline, Web of Science, Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and other sources. Only randomized controlled trials were included. Two reviewers independently selected and assessed each study for quality and extracted data.

Results Twelve randomized controlled trials were included in the meta-analysis. The results indicated that ultrasound-guided intraarticular and periarticular joint injections were more accurate than the landmark-guided injections (odds ratio, 0.36; 95% confidence interval, 0.22–0.60). Ultrasound-guided joint injections significantly decreased the visual analog scale scores at both 2 wks (mean difference, −9.57; 95% confidence interval, −13.14 to −5.99) (P < 0.00001) and 6 wks (mean difference, −14.21; 95% confidence interval, −18.20 to −10.21) (P < 0.00001) after injection. There was no statistically significant difference in visual analog scale score at 12 wks between ultrasound-guided and landmark-guided intraarticular and periarticular joint injections (mean difference, −4.42; 95% confidence interval, −11.71 to 2.87) (P = 0.23).

Conclusions Intraarticular and periarticular injections using ultrasound guidance significantly improves the accuracy of joint injections, and there is a significant decrease in visual analog scale scores for up to 6 wks after injection. The effect of ultrasound guidance on the long-term outcome of joint injections is inconclusive. The improved accuracy of injections was associated with pain relief. The authors recommend routine ultrasound guidance for intraarticular and periarticular injections.

From the Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

All correspondence and requests for reprints should be addressed to: Weiqi Yan, PhD, MD, Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, 310009.

All authors contributed to and finally approved the current manuscript.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.