Ultrasound Guided Injections
Advanced Procedures
We offer fast access to ultrasound guided injections which can help reduce pain, improve function and promote healing for injured tissues. Our private sports medicine clinic offers high quality end to end care at affordable prices
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What our patients say about Advanced Injection Procedures
Alternative Injection Options
Knee Joint Aspiration
What it is & why we do it
Knee aspiration is an in-clinic procedure to remove excess synovial fluid from a swollen knee: immediate symptom relief by reducing pressure, pain and stiffness. It’s the most common joint aspiration performed.
How it’s done & typical volumes
Under aseptic conditions we insert a needle into the joint using ultrasound guidance and withdraw fluid with a syringe. The volume removed varies widely: simple effusions may yield only a few milliliters, but large inflammatory or traumatic effusions can be tens to occasionally >100 ml. We will aim to remove as much fluid as is accessible and safe at the time.
Immediate and short-term effects
Many patients notice a rapid reduction in pressure and improved range of motion within hours after aspiration; pain relief can be immediate once the pressure is relieved, though full symptomatic improvement may continue over days as inflammation settles.
Longer-term outcomes & Recurrence
Aspiration is a symptomatic treatment, it addresses fluid and pressure but not the underlying disease. In conditions like inflammatory arthritis or infection, aspiration plus targeted therapy (antibiotics, steroid) is part of definitive care. In osteoarthritis, effusions often recur over weeks–months; repeated aspirations are sometimes necessary but do not alter disease progression. Overall long-term benefit depends on treating the underlying cause rather than the aspiration alone.
Risks & Aftercare
Risks are low but include transient pain, bleeding/bruising, local infection. Aftercare usually involves brief rest, avoiding excessive strain for 24–48 hours, and following up for analysis or further treatment as advised.
High-Volume Image-Guided Injection (HVIGI) -
For tendinopathy (Achilles, Patella Tendon)
What it is & how it’s done
HVIGI is an ultrasound-guided procedure in which a large volume of fluid (usually normal saline ± local anaesthetic, often with or without a small dose of corticosteroid) is injected into the tissue plane immediately adjacent to the diseased tendon (for example between the Achilles tendon and Kager’s fat pad or around the patellar tendon). The needle is placed under real-time ultrasound so the operator can target the plane safely and avoid an intra-tendinous injection. Typical injected volumes reported in the literature range from 20–50 mL
Proposed mechanism of benefit
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Mechanical hydrodissection — the injected fluid physically separates and strips neovessels and accompanying tiny nerve fibres that are associated with chronic tendinopathy pain.
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Local wash-out of algesic mediators
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Short-term analgesic effect from local anaesthetic and/or steroid that enables the patient to engage in effective rehabilitation.
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The intervention is therefore usually presented as a way to break the pain cycle and facilitate loading-based rehab rather than a magic “fix” by itself.
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Who tends to benefit
Patients with chronic mid-portion tendinopathy who have failed a structured loading/physiotherapy programme for at least 3 months are the most commonly treated group. HVIGI is aimed at people with persistent activity-limiting pain and ultrasound evidence of neovascularity or adhesions in the peritendinous plane. It is less appropriate for active intra-tendinous partial tears where different treatments may be indicated.
Efficacy & long-term outcomes
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Short-term (weeks to 6 months): many case series and cohort studies report clinically meaningful pain and function improvements after a single HVIGI when combined with a structured rehabilitation program.
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Mid-term (6–16 months): some prospective cohorts and small trials report maintained benefit to 12–16 months in a proportion of patients; reported “success” rates vary widely (some series report good outcomes in 50–70%, others lower).
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High-quality RCT evidence is limited and mixed with results that temper enthusiasm — some trials suggest limited benefit beyond placebo unless combined with targeted rehab, and results may depend on whether corticosteroid was included. In short, durable benefit (≥12 months) is achievable for many patients but is not guaranteed, and outcomes are improved when HVIGI is part of a package that includes supervised loading and progressive rehab.
Recovery & rehabilitation
Expect immediate procedural soreness and some transient numbness from local anaesthetic; many patients notice reduced pain in the first days because of the anaesthetic. Early relative rest for 48–72 hours is common, then a graded rehabilitation program begins, this rehab is critical for long-term improvement. Some patients require repeat injections or if symptoms recur.
You will follow the bespoke Regen X Health Rehab Plan
Risks & limitations
Minor risks: post-procedure pain, local bruising, transient neurapraxia, vasovagal reaction. Serious adverse events (infection, tendon rupture) are rare but possible; careful ultrasound technique and appropriate patient selection reduce risk.
Hydrodilatation or Hydrodistension Procedure
For adhesive capsulitis or “frozen shoulder”
What it is & how it’s done
Hydrodilatation is an ultrasound guided intra-articular injection that delivers a relatively large volume of fluid. A mixture of normal saline, local anaesthetic and usually corticosteroid into the glenohumeral joint to distend the contracted joint capsule. Techniques vary but volumes commonly used are 20–50 ml.
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How it works
Hydrodilatation improves range of motion and relieves pain by:
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Mechanical stretching of the contracted capsule (plastic elongation)
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Breaking adhesions if/when capsular rupture occurs
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Delivering intra-articular corticosteroid to reduce synovitis and inflammation.
Preserving the capsule under tension for a period may produce better stretching effects than immediate rupture, which is why some aim for a capsule-preserving distension to achieve a sustained stretch.
Who benefits & timing
Best results are often obtained when performed in the freezing to early frozen phase (when pain and stiffness are active) rather than late adhesive phase, though benefit can occur at different stages. Most patients with painful stiffness limiting daily activities, who have failed a period of structured physiotherapy and analgesia, are candidates. Patients with diabetes have higher recurrence/failure rates.
Efficacy & long-term outcomes
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Short term (days–weeks): hydrodilatation commonly produces rapid improvements in pain and passive external rotation; many patients report noticeable gains within days to weeks because of steroid and mechanical effects.
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Medium term (3–24 months): systematic reviews and RCTs show hydrodilatation is superior to steroid injection alone for early range-of-motion gains in many studies, and benefits are usually maintained at least 1–2 years when combined with physiotherapy.
Procedure experience & recovery
You’ll have local anaesthetic with ultrasound guidance; the distension is uncomfortable while the capsule stretches—this is brief. Immediately afterwards you may have soreness; a focused physiotherapy program. A home exercises and supervised mobilisation/strengthening plan is essential and is started promptly to consolidate gains. Most patients can resume normal light activities within days and progressive return to heavier tasks over several weeks.
You will follow the Regen X Health Rehabilitation Protocol to get you back to your best.
Risks & considerations
Common: transient post-procedure pain, steroid-related effects, local bleeding. Capsule rupture can happen deliberately or accidentally — many clinicians accept controlled rupture but some prefer capsule-preserving distension as it may produce longer-lasting stretch. Infection is rare. Diabetics: higher failure/recurrence. Expect to possibly repeat or consider alternative interventions if we feel outcomes are suboptimal.
Tendon Fenestration - Ultrasound-guided needling
Tennis elbow or lateral epicondylitis
What it is & why we do it
Fenestration, also called dry needling, percutaneous tenotomy/tenotomy-type needling, involves repeatedly passing a fine needle through degenerative tendon tissue under ultrasound guidance to stimulate a local healing response, break down diseased matrix, and promote tendon remodeling. It’s chosen when conservative loading programs, activity modification, & analgesia has failed.
Technique
Performed under local anaesthetic, ultrasound is used to identify the diseased area and avoid neurovascular structures. The clinician creates multiple small perforations through the tendon substance or the tendon-bone interface (fenestration).
What to expect after the procedure
Expect a few days of increased local soreness and bruising as the inflammatory/healing response is initiated. Pain reduction is typically gradual over weeks as the tendon remodels; many patients see meaningful improvement by 6–12 weeks and further gains from 6–12 months. A structured physiotherapy program of progressive loading is essential to convert the acute response into durable tendon healing.
You will follow the Regen X Health Tendon Loading Plan to get you back to your best. ​
Long-term outcomes
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Multiple cohort studies and RCTs show clinically important improvements in pain and function at 6–12 months after ultrasound-guided fenestration/needling; some trials report comparable outcomes to open surgical release for refractory cases at mid-term follow-up.
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Systematic reviews conclude needling is a safe, effective option with good mid-term outcomes, but study heterogeneity (technique, adjuncts, rehab protocols) makes precise long-term (>12 months) estimates variable.
Risks & Rehab
Minor risks include post-procedural pain, local bleeding, and transient neurapraxia; infection is rare with aseptic technique. Tendon rupture is uncommon with percutaneous fenestration (more a risk with intratendinous steroid injections). Progressive, supervised rehabilitation after the procedure is strongly associated with better functional recovery.