Ultrasound-Guided Injections
When an injection is worth doing, it is worth doing precisely
An injection is only as good as its placement. A few millimeters can be the difference between medication delivered into an inflamed tendon sheath - and medication delivered next to it, achieving little.
Ultrasound guidance means the physician sees the target, the needle and the spread of the medication in real time, on a screen, throughout the procedure. Nothing is done blind.
At Team Clinic 360° in Herzliya, ultrasound guidance is not an upgrade - it is the standard for every injection we perform.
What are ultrasound-guided injections?
Musculoskeletal ultrasound produces a live image of joints, tendons, ligaments, bursae, muscles and nerves. When an injection is performed under ultrasound, the physician:
- Identifies the exact structure generating the pain
- Plans a safe needle path that avoids vessels and nerves
- Watches the needle advance in real time
- Confirms that the medication spreads exactly where intended
Studies across multiple joints and tendons consistently show that ultrasound guidance improves injection accuracy compared with landmark-based ("blind") injections. Accuracy matters because it drives both effectiveness and safety.
What can be treated this way?
- Shoulder - frozen shoulder, rotator cuff-related pain, bursitis
- Elbow - tennis elbow, golfer's elbow
- Hip - trochanteric pain, gluteal tendinopathy, joint injections
- Knee - osteoarthritis, tendon and bursa problems
- Wrist and hand - carpal tunnel, De Quervain's tenosynovitis, small joints
- Ankle and foot - plantar fascia, tendon sheaths, joints
- Muscles - trigger points and myofascial pain
- Nerves - nerve blocks and hydrodissection
What is actually injected?
The medication is chosen for the diagnosis, not the other way around:
- Local anesthetics - for diagnosis and immediate relief
- Corticosteroids - for clearly inflammatory problems, used judiciously; helpful short-term relief, but not a treatment we repeat routinely, particularly in tendons
- Dextrose (prolotherapy solutions) - aimed at stimulating repair in chronic tendon and ligament problems - see prolotherapy
- Botulinum toxin - in selected pain indications - see medical Botox for pain
- Fluid alone - in nerve hydrodissection, where the mechanical separation is the treatment
What happens at the appointment?
- Review of your story, imaging and previous treatments
- Clinical examination and a diagnostic ultrasound scan of the region
- A clear explanation of the finding and the recommended injection - or, sometimes, the recommendation not to inject
- Skin cleansing and local anesthesia
- The guided injection itself - typically a few minutes
- Simple aftercare instructions; most patients resume light activity the same day
Why it matters who holds the probe
Ultrasound-guided injection is an operator-dependent skill: reading the anatomy, recognizing pathology, and steering a needle in three dimensions while watching a two-dimensional screen.
At Team Clinic 360°, all guided procedures are performed by Dr. Lior Shem Tov, specialist in anesthesiology and pain medicine, who performs these procedures daily as the core of his practice - with the overall plan coordinated by Dr. Natalie Siegel.
Precision is not a luxury - it is the treatment
If an injection has been recommended to you, or previous injections brought little relief, it is worth asking one question first: was the medication actually delivered to the right place? Under ultrasound, that question has a visible answer.
To schedule an evaluation for an ultrasound-guided injection - contact us by phone or WhatsApp.
Frequently asked questions
Are ultrasound-guided injections more effective than regular injections?
The evidence consistently shows better placement accuracy with ultrasound guidance, and for many targets - tendon sheaths, small joints, deep bursae, nerves - accurate placement is what the outcome depends on. It also reduces the risk of injecting into the wrong structure.
Does the injection hurt?
The skin is numbed first, and guidance means one planned pass rather than repeated probing. Most patients are surprised by how quick and tolerable it is.
Is there radiation involved?
No. Ultrasound uses sound waves - no radiation at all. It is safe to repeat as needed.
How soon will I feel relief?
It depends on the medication. Anesthetic effect is immediate but brief; corticosteroid effect typically builds over days; prolotherapy works gradually over weeks as the tissue responds.
How many cortisone injections can I have?
Corticosteroids are a tool, not a routine. We use them sparingly, in clearly inflammatory situations, and generally avoid repeated steroid injections into tendons - where evidence shows they can do more harm than good over time.
Can the injection be diagnostic too?
Yes. If numbing a specific structure relieves your pain, that structure is very likely the source - information that shapes the entire treatment plan.
Medical sources for further reading
The information on this page is intended as general background and does not replace personal medical advice.
The information on this page is general in nature and does not replace a personal medical diagnosis, consultation or treatment. Any treatment is tailored only after a medical evaluation, at the physician's discretion.