Ultrasound-guided injection in Vienna
An injection brings a medication to the place where the complaints arise. Whether it arrives there is decided at the tip of the needle. That is why I guide the needle under ultrasound vision — and not by feel.
In short
With an injection I use a fine needle to place a medication at an irritated structure: into a joint, into a tendon sheath, at a bursa or around a nerve. I follow the path of the needle on the ultrasound image and see where its tip lies. The aim is to damp down pain and inflammation and to make movement possible again; in unclear cases it secures the diagnosis. It does not remove a cause — it buys time for the measures that address the cause.
What an injection is
Injection here means that the medication is brought directly to the place where it is meant to act, instead of passing through the whole body via the stomach and the bloodstream. As a result, more of it arrives at the irritated structure and less in the rest of the body.
Which group of active substances I choose depends on the findings: a local anaesthetic, an anti-inflammatory agent from the group of the corticosteroids and, for joint complaints, also hyaluronic acid as a lubricant. I deliberately do not name any products here; what suits the individual case I discuss with you at the appointment.
Why I work under ultrasound guidance
Without an image, an injection is an estimate based on what can be felt: I know roughly where the structure lies, but I do not see the tip of the needle. At the shoulder, elbow and hand, tendons, vessels and nerves lie close together; a bursa is a narrow gap.
On ultrasound I follow the needle from the point of entry to the target and see how the medication spreads. The medication reaches the structure it is meant to reach; what lies beside it is spared — above all the tendon itself, into which nothing should go. What else the ultrasound in the practice shows is described on its own page.
Where I inject
- Into a joint (intra-articular) — for states of irritation and for osteoarthritis, for instance at the shoulder joint or at the thumb base joint (thumb base osteoarthritis).
- Into a tendon sheath — for tenosynovitis and for trigger finger, where the tendon catches at the pulley.
- At a bursa — above all under the roof of the shoulder in subacromial bursitis, when every movement above the head fails because of it.
- Around a nerve — at the carpal tunnel, for instance. The medication belongs beside the nerve, not into it; that is exactly why vision is needed. More on carpal tunnel syndrome.
How an appointment proceeds
Before the puncture
At the beginning there is the examination. I ask how the complaints have developed, test mobility and strength and look at the structure on ultrasound. Only then do I decide whether an injection is the right step and where it belongs. Please tell me whether you take blood-thinning medication and whether you are known to have an allergy or diabetes.
The puncture
The skin is disinfected and the transducer is covered sterilely. I insert the needle flat to the transducer so that it remains visible along its whole length in the image. The puncture can be felt, much as when blood is taken; in addition there is a sensation of pressure while the medication spreads. No anaesthetic is needed beforehand.
Afterwards
A plaster is enough; a dressing is not needed. On the day of the injection, please avoid heavy strain on the arm. At the follow-up appointment we see what has changed and decide on the next step.
What an injection can achieve — and what it cannot
I pursue three aims with it:
- Relieving the complaints — so that sleep and everyday life become possible again.
- Damping down inflammation — so that a state of irritation that would otherwise keep itself going can settle.
- Securing the diagnosis — if the pain disappears for as long as the local anaesthetic acts, the injected structure is probably the source. If it remains, I keep looking.
It does not remove a cause. A calcium deposit remains a calcium deposit, a narrowing remains a narrowing, and a tear does not grow back together because of it. What the injection can do is buy time: it reduces the state of irritation far enough for physiotherapy and progressive training to take effect again — and those carry the improvement. That is why it rarely stands alone, but alongside shockwave therapy and PRP therapy; all conservative procedures at a glance.
Nor can it be repeated at will: corticosteroids can weaken tendon tissue if they are given too often.
When I do not inject
No injection is given if there is an infection in the area of the puncture site or a known intolerance to the intended medication. With blood-thinning medication, poorly controlled blood sugar or weakened immune defences, I weigh things up carefully. If the findings call for an operation anyway — a complete tendon tear, an instability, a nerve with increasing loss of strength — an injection achieves nothing.
My practice is a private practice, in Austria a Wahlarztordination. I do not bill any public health insurer directly; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. Whether an injection is an option for you, which structure it should reach and what follows afterwards, I decide together with you after the examination and the findings.
Frequently asked
Frequently asked questions about injections
A medication is placed precisely at an irritated structure through a fine needle — into a joint, into a tendon sheath, at a bursa or beside a nerve. Ultrasound-guided means that I follow the needle on the image and see where its tip lies.
Because it lets me see where the medication goes. A bursa is a narrow gap, a tendon sheath hardly wider, and nerves and vessels lie close beside them. Under vision the medication reaches the structure it is meant to reach, and the tendon itself is spared.
The puncture can be felt, much as when blood is taken. While the medication spreads, a sensation of pressure develops that can be briefly unpleasant. If the mixture contains a local anaesthetic, the pain usually eases while you are still in the treatment room.
That depends on the findings. Local anaesthetics take the pain away immediately, but only briefly. Anti-inflammatory agents from the group of the corticosteroids take effect later and damp down the irritation for longer. For joint complaints, hyaluronic acid comes into question as a lubricant.
That cannot be predicted. The local anaesthetic acts only briefly; the anti-inflammatory effect sets in later and lasts longer. Some patients have few complaints for a long time, while in others the pain returns. That is why I use the window gained for physiotherapy and progressive training.
No, it does not. A calcium deposit, a narrowing or a tendon tear remains in place. The injection reduces the state of irritation far enough for movement and training to become possible again; it is movement and training that then carry the improvement.
Certainly not as often as one likes. Corticosteroids can weaken tendon tissue if they are given too often; that is why I use them sparingly and leave intervals between injections. If a second injection does not help, I review the diagnosis rather than doing the same thing a third time.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. How much of it is refunded depends on your insurer and on any supplementary insurance.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.