Written and clinically reviewed by Jeremy Swisher, MD
About Dr. Swisher Official UCLA Health profile (opens in a new tab)
Diagnostic ultrasound
A focused look at structures in motion.
Musculoskeletal ultrasound uses sound waves to produce real-time images. The probe can be moved over the exact area of concern while a tendon, muscle, joint, or nerve is assessed dynamically.
Tendons & muscles
Selected tears, tendinopathy, tendon motion, muscle injury, and calcific deposits.
Joints & bursae
Fluid, synovial change, bursitis, and selected superficial joint findings.
Superficial ligaments & nerves
Focused assessment where anatomy and depth make ultrasound suitable.
Results are interpreted with the history and physical examination. Imaging findings can also appear in people without pain, so the scan should answer a clinical question rather than stand alone as a diagnosis.
Ultrasound has important limits.
Most ultrasound is reflected by cortical bone, so structures deep to bone and the full extent of most fractures are not well assessed. Deep structures such as the knee ACL and menisci are generally better assessed with MRI. Depending on the question, an X-ray, MRI, or CT scan may still be the better test.
Image guidance
Seeing the target, needle, and nearby anatomy.
During a guided procedure, ultrasound can help identify the intended target and visualize the needle as it advances. It may be used for selected joint or bursal aspirations, injections, and tendon procedures.
Guidance can help improve placement accuracy, but it does not guarantee pain relief or eliminate procedure risk. The diagnosis, evidence, alternatives, and role of rehabilitation still matter more than the technology itself.
Selected options
Procedures considered after a full evaluation.
Not every condition benefits from a procedure, and not every listed option is appropriate or available at every visit or location. A consultation should clarify whether a procedure adds value to a larger treatment plan.
Platelet-rich plasma (PRP)
A product made from your own blood that may be considered for selected tendon and joint conditions. Evidence is diagnosis-specific, preparations vary, and insurance coverage is uncommon.
Hyaluronic acid
A viscosupplement option discussed selectively for knee osteoarthritis. Evidence, society recommendations, cost, and coverage vary, and the evidence does not generalize to every joint.
Corticosteroid
May offer short-term relief for selected joint or bursal pain, with benefit varying by diagnosis. Corticosteroid can temporarily raise blood glucose, especially in people with diabetes, and may also affect skin, fat, or tendon. These risks and other health conditions require individualized counseling.
Percutaneous needle tenotomy
A minimally invasive option sometimes considered for selected chronic tendinopathy after diagnosis-specific rehabilitation. Evidence is mainly from small or noncomparative studies, and benefit over continued rehabilitation or sham remains uncertain.
Needle barbotage
Ultrasound-guided lavage of a calcium deposit considered for selected cases of symptomatic calcific tendinopathy, most often at the shoulder. Evidence is mixed, including a large sham-controlled trial that found no added benefit.
These procedures do not regenerate cartilage, remove all “scar tissue,” or guarantee healing. The intended goal and uncertainty should be clear before consent.
The appointment
What to expect before and during a procedure.
- 01
Confirm the diagnosis and goal
Review symptoms, examination, prior care, alternatives, and whether the procedure is likely to change pain or function.
- 02
Review safety factors
Discuss medication and anticoagulant use, bleeding history, diabetes and the glucose-monitoring plan, allergies, infection, and prior reactions. Do not stop a medication unless your treating clinician instructs you to do so.
- 03
Consent and correct-site confirmation
The target, expected benefit, limitations, alternatives, and risks should be reviewed before sterile preparation.
- 04
Individualized aftercare
Activity and follow-up instructions depend on the procedure, medication or biologic used, and your diagnosis.
- Bring prior images and reports.
- Bring a complete medication and anticoagulant list.
- Bring dates, targets, and responses from prior procedures.
- Allow for the possibility that authorization or a separate procedure visit is needed.
Informed decisions
Benefits, limits, and risks belong in the same conversation.
Risks vary by the body part treated and the material injected. They may include a temporary pain flare, bleeding or bruising, infection, allergic reaction, skin or tissue effects, and injury to nearby structures. A corticosteroid injection can temporarily raise blood glucose, particularly in people with diabetes, and some injected medicines may affect other medical conditions.
After a procedure
Rapidly worsening pain or swelling, spreading warmth or redness, drainage, or inability to bear weight requires same-day medical assessment even without fever. Fever or chills, new weakness or numbness, trouble breathing, or allergic symptoms also require prompt care. Call 911 for trouble breathing, fainting, confusion, severe illness, or another emergency.
For PTs & referring clinicians
A procedural consultation should support the rehabilitation plan.
Referrals are welcome for diagnostic clarification, a focused ultrasound question, procedure candidacy, or coordinated care when symptoms have stopped improving. Please include the working diagnosis, prior rehabilitation, relevant imaging, and the clinical question you hope the consultation will answer.
UCLA referral information (opens in a new tab)Common questions
Ultrasound & procedure FAQs
Is musculoskeletal ultrasound the same as MRI?
No. Ultrasound is real-time and excels at many superficial soft tissues and dynamic questions. MRI offers a wider field of view and can assess many deep or intra-articular structures that ultrasound cannot. The best test depends on the question.
Will I have an ultrasound at my first visit?
Not necessarily. The history and examination come first. Ultrasound is used when it can answer a focused question or support a procedure decision.
Can I have an injection at the consultation?
Possibly, but it should not be assumed. Diagnosis, medical safety, available records, medication choice, insurance authorization, scheduling, and location can all affect timing.
Does ultrasound guidance guarantee that an injection works?
No. Guidance helps visualize placement, but outcome also depends on the diagnosis, the selected treatment, the biology of the condition, rehabilitation, and individual response.
Evidence
Sources and further reading
- American Institute of Ultrasound in Medicine: Musculoskeletal Ultrasound Practice Parameter (opens in a new tab)
- AIUM: Ultrasound-Guided Procedures Practice Parameter (opens in a new tab)
- American Medical Society for Sports Medicine Position Statement on Interventional Musculoskeletal Ultrasound (opens in a new tab)
- Koonen et al.: Percutaneous Needle Tenotomy Pilot Randomized Trial, 2023 (opens in a new tab)
- Moosmayer et al.: Ultrasound-Guided Lavage Versus Sham for Calcific Shoulder Tendinopathy, 2023 (opens in a new tab)
- American Academy of Orthopaedic Surgeons: Cortisone Shot (Steroid Injection) (opens in a new tab)
- AMSSM: Sports Ultrasound (opens in a new tab)
- Jeremy Swisher, MD: Official UCLA Health Profile (opens in a new tab)