Steroid Injection in Knee with Ultrasound Guidance

 Knee discomfort can be persistent and often impacts movement, daily tasks, and overall wellbeing. When conservative approaches such as rest, physiotherapy, or medication have not brought sufficient ease, steroid injections may be considered. At Alton Pain Clinic, we provide ultrasound-guided steroid injections to support precision and personalised care in the management of musculoskeletal conditions.

This blog offers a detailed overview of steroid injection in the knee using ultrasound guidance — exploring joint anatomy, common indications, the injection process, benefits of imaging, and what to expect before and after the procedure.

The Knee Joint: A Complex Structure

The knee is one of the largest and most active joints in the body. It connects the femur (thigh bone), tibia (shin bone), and patella (kneecap), forming a hinge joint that allows movement such as walking, bending, and climbing.

Several structures contribute to the knee’s function:

  • Cartilage, which cushions the joint surfaces
  • Menisci, which act as shock absorbers
  • Ligaments and tendons, providing stability
  • Bursae, small fluid-filled sacs that reduce friction
  • Synovial fluid, enabling smooth movement within the joint capsule

Due to its constant use, the knee is prone to wear, injury, and inflammation — making it a frequent source of pain.

Common Reasons for Knee Steroid Injections

Steroid injections in the knee are typically considered when other non-invasive measures have not provided enough improvement. Some common conditions include:

  • Osteoarthritis — Degeneration of the joint cartilage and underlying bone
  • Rheumatoid arthritis — Autoimmune inflammation of the synovial lining
  • Bursitis — Inflammation of bursae around the joint
  • Gout and pseudogout — Crystal deposition causing joint irritation
  • Meniscal degeneration — Especially in middle-aged or older individuals
  • Persistent effusion — Accumulation of excess fluid in the knee joint

The decision to proceed with an injection is made following a thorough clinical assessment.

Why Use Ultrasound Guidance?

Ultrasound guidance enhances the accuracy of knee injections. The real-time imaging allows the clinician to:

  • Visualise the joint structures and soft tissues
  • Identify the precise location for injection
  • Avoid critical structures like nerves and vessels
  • Confirm the presence of joint effusion or inflammation
  • Monitor the needle path throughout the procedure

This approach supports a more focused and informed technique, particularly useful in anatomically challenging or swollen knees.

What to Expect During the Procedure

At Alton Pain Clinic, all procedures are carried out by trained clinicians with experience in musculoskeletal ultrasound. Here is an outline of what typically happens during a guided injection:

1. Clinical Review

A full review is carried out, including:

  • Medical history
  • Joint examination
  • Review of any past imaging
  • Ultrasound scan of the affected knee

This step ensures the injection is appropriate and accurately planned.

2. Consent and Explanation

You will receive a clear explanation of the procedure, including its purpose, limitations, and potential risks. Your clinician will answer any questions before obtaining informed consent.

3. Preparation

  • The skin is cleansed using antiseptic solution.
  • A sterile technique is used throughout.
  • Ultrasound gel is applied to the area, and the probe is covered with a sterile sheath.

4. Injection Technique

  • Under ultrasound guidance, the clinician locates the target site.
  • A fine needle is inserted and visualised in real time.
  • A corticosteroid (often mixed with local anaesthetic) is slowly injected into the joint or surrounding inflamed area.

5. Aftercare Advice

Once the procedure is complete, you will receive guidance such as:

  • Resting the knee for the rest of the day
  • Avoiding vigorous activity for 48 hours
  • Using ice packs if needed
  • Monitoring for any unexpected symptoms

Practical Benefits of Ultrasound Guidance

Although outcomes may vary between individuals, ultrasound-guided injections offer practical advantages:

  • Improved accuracy of needle placement
  • Real-time visualisation of the joint and surrounding anatomy
  • A tailored approach based on patient-specific findings
  • Potential avoidance of surrounding sensitive structures
  • Assistance in diagnosis when evaluating joint fluid, synovitis, or bursitis

At Alton Pain Clinic, ultrasound is a core part of our assessment and injection strategy.

Limitations and Broader Management

It’s important to understand that steroid injections are not a cure for knee conditions. They are often part of a broader treatment plan that may include:

  • Strength and stability exercises
  • Lifestyle or activity adjustments
  • Weight management (where appropriate)
  • Supportive braces or footwear
  • Referral to orthopaedic or rheumatology services (if necessary)

Not all individuals respond the same way, and the duration of any relief may vary. Repeat injections are spaced apart and considered based on individual clinical need.

Safety and Potential Side Effects

Steroid injections are generally well tolerated but may carry some risks, which are discussed in full during your consultation. These may include:

  • Temporary flare of discomfort following the injection
  • Skin thinning or discolouration at the injection site
  • Rare risk of infection
  • Local bleeding or bruising
  • Tendon weakening with frequent or improper use
  • Temporary elevation in blood sugar in individuals with diabetes

Our clinicians work within strict safety protocols to minimise any potential risk.

Comparing Ultrasound-Guided and Landmark-Guided Injections

Traditional (landmark-guided) knee injections rely on anatomical feel rather than visual imaging. While this may be sufficient in some cases, it can lead to variability in needle placement — especially in complex or swollen knees.

Ultrasound provides a real-time view of where the needle is going, ensuring the steroid is delivered exactly where intended. This added precision is particularly useful in cases involving:

  • Small joint effusions
  • Post-surgical knees
  • Obesity or altered anatomy
  • Localised bursitis or tendon issues

Your Experience at Alton Pain Clinic

At Alton Pain Clinic, our approach is clinician-led and focused entirely on musculoskeletal pain management. We provide:

  • Thorough clinical assessments
  • Real-time diagnostic ultrasound scanning
  • Precision-guided steroid injections
  • Professional advice and aftercare
  • Convenient access to appointments

Every patient is assessed and managed on an individual basis. We work collaboratively with you to develop an appropriate care plan that supports your comfort and mobility.

Preparing for Your Appointment

Before your appointment at Alton Pain Clinic, it may help to:

  • Wear loose trousers or bring shorts for easier access to the knee
  • Bring any previous imaging or clinic letters
  • Inform the team if you are on blood thinners or have any allergies
  • Let us know if you are pregnant or breastfeeding

Please feel free to ask any questions — you will be guided through the process from start to finish.

After Your Injection

Following the injection, you may be advised to:

  • Rest the knee for a day or two
  • Avoid running, squatting, or kneeling in the short term
  • Apply an ice pack if there is mild swelling
  • Monitor your symptoms and contact us if anything unusual arises

You may start noticing effects within a few days, though some individuals experience a delayed response.

Follow-Up and Next Steps

A follow-up appointment may be recommended, especially if:

  • The response is short-lived or incomplete
  • Other joints are affected
  • Additional assessment or imaging is needed

Our clinicians are available to provide ongoing support and will guide you on further options if required.

In Closing

Ultrasound-guided steroid injection of the knee is a targeted approach used to support the management of joint inflammation and discomfort. While responses may vary, it can form part of a structured plan to help restore mobility and ease joint irritation.

At Alton Pain Clinic, we offer tailored, clinician-led care with a focus on accurate diagnostics and image-guided procedures. Our goal is to provide each patient with considered support in a comfortable and professional setting.

If you would like to learn more or arrange a consultation, we welcome you to get in touch with our team.

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