Stem Cell

The need for Ultrasound Guided Injections when using STEM CELLS



Interventional injections of target structures by pain physicians are expensive. The failure of getting to the target structure such as nerve, tendon sheath, bursa, joint space, muscle can lead to the following:

  1. Failure of treatment.
  2. An additional expense.
  3. Possible surgery because of failure in conservative treatment.

Because of these potential situations, ULTRASOUND has become the mainstream treatment for musculoskeletal medicine. The delivery of STEM CELLS / PLATELETS into the appropriate designated structure is priceless.

Ultrasound Guided Therapy


The following terms compare CAT scan/fluoroscopic guided injections/ultrasound guided injections and the utility for using ULTRASOUND for many procedures, which is the mainstream for pain injections today:

  • Ultrasound imaging has several attributes that make it an attractive soft tissue injection guidance modality:
    • Fluoroscopic guided contrast injections that cannot image soft tissues is older medicine.
    • Ultrasound provides excellent soft tissue images of structures such as muscles, nerves, tendons, bursa, bones which enhance the accuracy of needle placement and assist in the prevention of complications.
    • The surface of bony structures can also be imaged with ultrasound, which allows their use as landmarks for the localization of soft tissue structures.
    • The ability of ultrasound to provide real time imaging assist in anatomic structure identification and proper needle placement.
    • Ultrasound does not expose the patient or clinician to ionizing radiation like CAT scan.
    • Ultrasound is portable and can be done at the bedside and is quick and easy.
    • Ultrasound has no radiation and so can be used for pregnant patients and children.
    • Ultrasound does not require injection of a contrast agent, thus reducing costs and preventing potential contrast agent related complications.
    • Ultrasound is fast and often technically easy to perform.
    • Ultrasound guided injections can be used in a large variety of musculoskeletal interventional problems: Injections we do
    • Ultrasound has the direct advantage of imaging in real time, enabling one to:
      1. See the needle tip at the target of interest
      2. Observe medication delivery.
      3. Confirm localization of medication at the end of the procedure. (STEM CELLS, PLATELETS, and steroids)
    • Ultrasound has a Doppler setting and can appreciate venous and arterial vessels.
    • Real time injections under ultrasound allows for selective injection into tendon sheaths as opposed to direct injections into tendons (where steroids have been noted to cause tendon degeneration and rupture).
    • One of the strongest advantages of ultrasound is the ability to show needle placement and subsequent therapeutic injection or diagnostic aspiration in real time
    • Ultrasound allows physicians to perform injections with little or no patient discomfort because of the real time injection and the high resolution capability of seeing the nerve and/or tendon sheath or joint.
    • Ultrasound’s real time capabilities allow one to visualize the needle tip continuously and ensures that the needle is placed precisely in the desired location, avoiding the risk for inadvertent nerve and surrounding structure damage.
    • If one is able to see the desired structure, one can indisputably reach it without damaging neighboring tissue.
    • Ultrasound guided injections require experience and thus education.
    • Basic knowledge of ultrasound and detailed knowledge of the anatomy of the target tissue are required for ultrasound guided interventions.
    • Ultrasound guidance is superior to CT-scan for injections into joints, muscles and nerves.

RESEARCH on Ultrasound Injections

  • Ultrasound imaging is almost equally effective in detecting partial tears of the rotator cuff compared to MRI.
  • MRI may be reserved for doubtful or complex cases.
  • Ultrasound and MRI could equally be used in detecting full thickness tears.
  • MRI and ultrasound have poor sensitivity for detecting partial thickness tears.



The study of 148 painful joints compared the use of ultrasound to a blind injection.  Ultrasound demonstrated:


  • 43% decrease in injection pain.
  • 62% decrease in the non-responder rate.
  • 200% increase in the rate of effusion detection.

Sibbitt, WL – – Journal of Rheumatology 2009



Berkoff, D. J. et al and Sibbitt, W.L. et al showed that ultrasound guidance had an improved accuracy of 95.8% versus a blind stick (of 77.8%)