Ultrasound Guided Injections Evidence

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The two most important aspects to consider when comparing ultrasound vs landmark guided injections are accuracy and efficacy.

For accuracy, the research literature shows ultrasound to be superior to landmark guided injections. This has important implications for precision diagnosis with injection of local anaesthetic.[1]

The research on efficacy is less conclusive and more higher quality studies are needed. The current evidence shows that ultrasound guided injections are superior to landmark guided injections for the glenohumeral joint, subacromial space, biceps tendon sheath, joints of the hand and wrist, knee, ankle, and foot. [1]


  • Daniels et al 2018 (open access)[1]
  • Finnoff et al 2015[2]
Summary of Findings of Daniels et al for ultrasound guided injections (USGI) and landmark guided injections (LMGI)[1]
Structure USGI Accuracy LMGI Accuracy Efficacy Level of Evidence
Glenohumeral joint 92.5% 72.5% USGI superior 2
Acromioclavicular joint 90-100% 16.7-72% No difference 2-4
Subacromial space - - USGI superior 2
Biceps tendon 86.7% 26.7% USGI superior 1-2
Elbow joint 91% 64-100% - 1
Hand and wrist joints TMC, STT 94-100% 59-81.8% - 2-4
Hip joint 97-100% 66.7-77.5% USGI superior 1-4
Knee joint 95.8-100% 55-100% USGI superior 1-2
Foot and ankle 100% 58-85% No difference 2-4


  1. โ†‘ 1.0 1.1 1.2 1.3 Daniels et al.. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Orthopaedic journal of sports medicine 2018. 6:2325967118756576. PMID: 29511701. DOI. Full Text.
  2. โ†‘ Finnoff et al.. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. PM & R : the journal of injury, function, and rehabilitation 2015. 7:151-68.e12. PMID: 25708351. DOI.