AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Ultrasound-Josef K. Eichinger, M.D., Sanjeev Bhatia, M.D., Kyle Pilz, MMS, PA-C, Paige Maher, PA-C

Ultrasound-Josef K. Eichinger, M.D., Sanjeev Bhatia, M.D., Kyle Pilz, MMS, PA-C, Paige Maher, PA-C

Pdf Summary

Dr. Josef K. Eichinger, Professor at the Medical University of South Carolina's Shoulder & Elbow Service, addresses common reservations orthopedic practitioners have about adopting ultrasound (US) guidance for joint injections and aspirations. Frequently cited concerns include confidence in traditional landmark-based techniques, lack of prior US training, workflow disruption, reliance on radiology specialists, and perceived high costs.<br /><br />Dr. Eichinger highlights that many clinicians have no formal US training from residency or fellowship. To overcome barriers such as long wait times in radiology and the need to expedite procedures, his institution initiated an ultrasound injection clinic and sent a senior physician assistant to a weekend US course, emphasizing hands-on experience.<br /><br />Comparative studies on injection accuracy reveal that ultrasound-guided injections (USGI) generally achieve higher or equivalent accuracy to landmark-guided injections (LMGI), particularly for shoulder and glenohumeral (GH) joints. For example, studies showed USGI accuracy up to 100% verified by MRI or arthroscopy, while LMGI accuracy varied widely (27%-64%). However, some studies found no significant difference in clinical outcomes such as pain relief. Factors such as patient variability, clinician experience, and study design influence results.<br /><br />Recent healthcare reimbursement changes by CMS have decreased payment by about 30% and now require documentation or permanent recording of US procedures, likely responding to increased US utilization.<br /><br />Looking forward, US guidance is anticipated to become standard for most joint injections, with limited use for diagnostics, specific clinical scenarios, and research. Effective implementation requires involvement of nursing staff, clear protocols, proper documentation, and ensuring clinician confidence and patient convenience.<br /><br />Technical considerations include needle visualization—recognizing challenges such as out-of-plane needle tracking needing an assistant. Overall, US-guided injections improve procedural accuracy, patient satisfaction, and clinician confidence, warranting broader adoption despite initial training hurdles.

Keywords

ultrasound guidance

joint injections

orthopedic practitioners

landmark-based techniques

ultrasound training

injection accuracy

shoulder injections

glenohumeral joint

CMS reimbursement changes

needle visualization