Steroid Injection in Knee with Ultrasound Guidance

 Knee pain can be a persistent and troubling issue, often impacting movement, daily tasks, and overall quality of life. In certain cases, where conservative management has not brought sufficient comfort, steroid injections are considered as a treatment option. At Joint Injections, we focus on precision-led care through the use of ultrasound guidance, ensuring that every injection is accurately placed and tailored to individual needs.

This blog offers a detailed insight into steroid injection in the knee with ultrasound guidance, exploring anatomy, common conditions treated, the procedure itself, benefits of image guidance, and what to expect.

Understanding the Knee Joint

The knee joint is a complex hinge joint formed by the articulation of the femur (thigh bone), tibia (shin bone), and patella (kneecap). It is supported by various structures including cartilage, ligaments, menisci, tendons, and bursae. The joint capsule surrounds the knee and is filled with synovial fluid, which aids in smooth movement and reduces friction.

Due to its function and location, the knee is prone to wear-and-tear, injury, and inflammatory conditions, making it a common site for discomfort and mobility concerns.

Common Conditions That May Lead to Knee Injections

Conditions for which a steroid injection in the knee may be considered include:

• Osteoarthritis — Degenerative wear of the joint surfaces, often leading to stiffness and discomfort.
• Rheumatoid arthritis — An autoimmune inflammatory condition affecting the joint lining.
• Gout or pseudogout — Crystalline arthropathies that can cause joint inflammation.
• Bursitis — Inflammation of the small fluid-filled sacs (bursae) around the joint.
• Meniscal tears (degenerative) — Especially in older individuals.
• Persistent knee effusion (fluid on the knee).

Each case is assessed individually by a clinician to determine whether a steroid injection is an appropriate part of the management plan.

Why Ultrasound Guidance?

Ultrasound guidance plays a vital role in enhancing the precision of steroid injections. The knee joint and surrounding structures are visualised in real time, allowing the clinician to:

• Identify the exact injection site.
• Avoid nearby blood vessels and nerves.
• Confirm the presence and location of joint fluid or inflamed tissue.
• Ensure accurate delivery of the medication into the targeted area.

Without image guidance, the needle may not always reach the intended space. Ultrasound use supports a more focused approach, especially in anatomically complex or swollen knees.

The Steroid Injection Procedure: Step-by-Step

At Joint Injections, all injections are performed by trained clinicians with expertise in musculoskeletal ultrasound. Here’s a general outline of what the procedure involves:

1. Initial Assessment

A detailed clinical assessment is carried out to understand the nature of the knee concern. This includes:

• Clinical history
• Physical examination
• Review of previous imaging, if available
• Diagnostic ultrasound to assess the joint structures in real-time

2. Consent and Explanation

The procedure, including potential benefits, limitations, and possible risks, is explained thoroughly. As with any intervention, informed consent is obtained before proceeding.

3. Preparation

• The skin around the knee is cleaned using antiseptic solution.
• A sterile environment is maintained throughout.
• Ultrasound gel is applied, and the ultrasound probe is covered with a sterile sheath.

4. Ultrasound-Guided Injection

• The clinician identifies the joint space or targeted area under ultrasound.
• A fine needle is introduced under real-time imaging.
• Once correct placement is confirmed, a small volume of corticosteroid (often combined with local anaesthetic) is injected.

5. Aftercare Advice

Post-procedure guidance is provided, which may include:

• Resting the knee for 24–48 hours.
• Gradual return to activity.
• Avoiding strenuous exercise for a short period.
• Watching for any unusual symptoms.

Follow-up may be arranged depending on the condition being managed.

Steroid Medication Used

The steroid used in knee injections is typically a long-acting corticosteroid. These steroids have anti-inflammatory properties and may be used to reduce inflammation within the joint.

Local anaesthetic is often included to provide temporary numbness and assist with identifying the correct joint space during the procedure.

Benefits of Ultrasound-Guided Knee Steroid Injections

While every individual responds differently, and no guaranteed outcome can be promised, ultrasound-guided injections are known for several practical advantages:

• Accurate needle placement into joint or inflamed area.
• Real-time visualisation of joint structures and surrounding anatomy.
• Customised approach based on patient’s anatomy and underlying condition.
• Minimally invasive procedure, often performed in an outpatient setting.

The use of ultrasound may also assist in the diagnosis itself by highlighting issues such as joint effusion, synovitis, or degenerative changes.

Limitations and Considerations

Steroid injections are not always a standalone solution. Their role is often part of a wider management plan which may include:

• Activity modification
• Weight optimisation (where relevant)
• Joint strengthening exercises
• Further imaging or surgical referral (if required)

It’s also important to understand that responses to steroid injections can vary. Some individuals may experience a period of reduced inflammation, while others may not find significant benefit. Repeated injections are typically spaced out and only considered after a careful clinical review.

Risks and Precautions

As with any injection procedure, certain risks may exist. These can include:

• Temporary increase in discomfort after the injection (a flare reaction)
• Skin changes at the injection site
• Risk of infection (very rare)
• Tendon weakening if injected too frequently
• Local bleeding or bruising
• Elevation of blood glucose levels in individuals with diabetes

Each individual’s circumstances are carefully reviewed before proceeding, and any concerns are discussed beforehand with the clinician.

Ultrasound vs Landmark-Guided Injections

Traditionally, knee injections have been performed using anatomical landmarks alone. However, studies and clinical experience have shown that this technique may be less accurate — particularly in individuals with altered anatomy, severe swelling, or complex conditions.

Ultrasound guidance allows the clinician to tailor the approach in real time, avoiding guesswork and enabling observation of the medication entering the desired location.

Patient Experience at Joint Injections

At Joint Injections, we offer a clinician-led service focused exclusively on image-guided musculoskeletal injections. Our approach is structured, with attention to detail and patient comfort.

Key features of our care model include

• Consultant-led assessments
• Real-time diagnostic ultrasound scanning
• Image-guided precision injections
• Multiple clinic locations
• Prompt appointment availability

We understand that each case is unique. That’s why every injection is planned based on your clinical presentation, joint examination, and ultrasound findings.

Preparing for Your Appointment

Before attending your injection appointment, consider the following tips:

• Bring along any relevant medical records or imaging reports (e.g., X-ray or MRI).
• Wear loose-fitting clothing or shorts for easy access to the knee.
• Inform the clinician if you are taking blood-thinning medication or have any allergies.
• Let the team know if you are pregnant or breastfeeding, as this may affect the choice of medication.

You are welcome to ask questions at any point during your visit — our clinicians are here to support you.

Post-Injection Advice

While the procedure itself is brief, the effects of the injection can vary in timing. Some individuals notice a difference within a day or two, while others may experience a delayed response.

After your injection, we recommend:

• Resting the knee for a day or two.
• Applying ice packs if needed for temporary relief.
• Monitoring for any unusual symptoms and reporting them to the clinic.

It’s advisable to avoid high-impact activities for at least 48 hours. Gradual return to usual routines is encouraged under guidance.

When to Revisit the Clinic

Follow-up may be necessary depending on the response to the injection. Clinicians may recommend additional assessment or alternative options if:

• Symptoms return or worsen
• Additional joints become affected
• Further diagnostic clarity is required

At Joint Injections, we are committed to supporting ongoing care, with transparent guidance and access to specialist opinion when required.

Final Thoughts

Steroid injection in the knee with ultrasound guidance is a procedure designed to support targeted management of joint-related inflammation. While it is not suitable for every situation, it may play a useful role in reducing joint irritation and enhancing mobility in selected cases.

At Joint Injections, our focus is on providing image-guided musculoskeletal injections through an experienced and personalised approach. With ultrasound as a core tool, we strive to ensure accuracy, comfort, and quality of care throughout your journey.

If you would like to discuss your knee concern or explore whether a guided injection is appropriate, feel free to contact our team to arrange an appointment.