Ultrasound Guided ProlotherapyApril 10, 2014 April 10, 2014
Recently we saw an article how MRI images can mislead a physician into a misguided or inappropriate surgical intervention. The reason? Over reliance on what the doctor saw on the MRI scans as opposed to what he should have explored with physical examination and manipulation. Failed Back Surgery
In this same seduction of technology, many Prolotherapy doctors are moving towards the use of ultrasound guided injections. Here again – a doctor is not even looking at the patient or the area being treated, they are looking at a monitor during the injection process. In essence, they are treating the monitor image, not the patient.
Prolotherapy works best when delivered by a skilled physician who is expert in physical examination and clinical judgement. In the same way many top doctors do not rely on MRI images when treating their patients, we do not rely on ultrasound to know where the Prolotherapy or PRP treatments need to be delivered.
Research is showing that in the hands of an experienced physician, ultrasound guidance is not needed to deliver a healing solution to the right spot.
In this recent study, researchers compared the accuracy of blind vs. ultrasonography-guided corticosteroid injections in subacromial impingement syndrome and determine the correlation between accuracy of the injection location and clinical outcome.
What they found was no statistically significant difference in the injection location accuracy between ultrasound guided and “blind,” injections.
They concluded “Blind injections performed in the subacromial region by experienced individuals were reliably accurate and could therefore be given in daily routines.” (1)
Recent research also suggested a higher rate of injection therapy efficiency if performed under ultrasound guidance. But there is a paradox.
Researchers suggest that a disadvantage of ultrasound-guided injection technique is the long learning curve that is required for the medical professional to be well acquainted with the simultaneous manipulation of ultrasound equipment, placement of needles, and the correct interpretation of musculoskeletal sonographic images. (2)
So you need an experienced clinician to interpret the images, manipulate the needle, manipulate the equipment, etc. However, many clinicians who can do Prolotherapy and PRP under ultrasound guidance choose not to. Why, when some suggest its absolute superiority?
People who have chronic joint pain, typically have many spots of that joint causing pain. It is usually not a localized singular event. So a clinician may isolate a single point in the knee per se that is causing pain, inject that point and consider the job done. The clinician may not see other areas causing pain because they are not obvious on the image.
When physically examining the knee, palpitating the knee can reveal other painful areas that need treatment. So it is possible for an ultrasound reliant knee pain specialist to miss these other pain causing areas. Then we see patients who insist Prolotherapy does not work as they had it done under ultrasound guidance with no benefit. They did not get Prolotherapy, then got a single injection, to a single spot under ultrasound. We practice Prolotherapy differently here.
In the hands of an experienced clinician, prolotherapy can be delivered without ultrasound guidance with the same degree of accuracy BUT without the extra time and expense.
1. Dogu B, Yucel SD, Sag SY, Blind or Ultrasound-Guided Corticosteroid Injections and Short-Term Response in Subacromial Impingement Syndrome: A Randomized, Double-Blind, Prospective Study. Am J Phys Med Rehabil. 2012 May 2. [Epub ahead of print]
2. Chen CP, Lew HL, Tsai WC, et al. Ultrasound-guided injection techniques for the low back and hip joint. Am J Phys Med Rehabil. 2011 Oct;90(10):860-7.