Do ultrasound guided Prolotherapy injections provide more accuracy in treating a patient with chronic joint pain? The answer in our opinion is yes and no. Yes, because an ultrasound guided injection can lead a doctor to a specific target to inject. No, because the reliance on ultrasound may lead to incomplete treatment. Further, the experience of the doctor can be equal to or superior in some instances to ultrasound guidance.

 Problems with Ultrasound-Guided Prolotherapy

While the debate rages between doctors over whether to use ultrasound guided injections versus “blind” injections, some Prolotherapy offices opt not to rely on ultrasound. Here is why: Chronic pain is a diffuse problem, not a localized one. When someone has knee pain for instance, it is usually degeneration in many areas of the knee, if the the ACL is frayed, there is a chance that the MCL and PCL are also frayed. If the ACL is frayed and causing the knee to wobble, the meniscal and articular cartilage may be brought into play. All these areas of the knee must be strengthened. Doctors doing procedures like Prolotherapy under X-ray guidance are trying to hit one specific area, for instance the ACL, and somehow this is miraculously going to get rid of all of the patient’s chronic pain. This is not how Prolotherapy was designed to work – as a  single shot treatment at a single spot. Therefore depending on X-ray guidance may lead to incomplete treatment in that only part of the structure of the joint is treated when, in fact, most of the joint structure needs healing.

Another problem is the doctor’s experience level with ultrasound technology. A slight misinterpretation of the image can cause the doctor to guide the needle to the wrong spot. Experience is also needed to correctly manipulate the ultrasound equipment and the needle, ensuring the needle does not miss the intended target. Correct needle placement is also dependent on experience.¹

Higher-Skilled Doctor, Lower-Technology Treatment

Many times once a doctor acquires this “experience” he/she finds that ultrasound is not necessary to correctly locate the trouble spots. Studies have shown an experienced doctor is just as accurate as placing the injection without ultrasound guidance.^1,2 The more skilled the doctor, the less technology is needed.
Comprehensive Hackett Hemwall Prolotherapy requires many injections. For a low back treatment, the patient may need 60-80 injections. A knee or shoulder, most often 20-40 injections are required. The patients are not going to heal with one injection given under x-ray. If a person with a diffuse chronic painful condition goes to a doctor and receives Prolotherapy under x-ray, you can bet that this patient will get one to three shots, spend thousands of dollars and it won’t work.

Questions? Contact us.

1. Chen CP, Lew HL, Tsai WC, et al. Ultrasound-guided injection techniques for the low back and hip joint. Am J Phys Med Rehabil. 2011 Oct;90(10):860-7.

2. Dogu B, Yucel SD, Sag SY, Bankaoglu M, Kuran B.Blind or Ultrasound-Guided Corticosteroid Injections and Short-Term Response in Subacromial Impingement Syndrome: A Randomized, Double-Blind, Prospective Study. Am J Phys Med Rehabil. 2012 May 2. [Epub ahead of print]