This morning I shadowed Mr. Sean Russell, a physician assistant who specializes in joint injections through ultrasounds. He does injections in most any joints in the body, but today I was able to see in the shoulders, knees and hips.
The injections consist of cortisone, kenalog (a steroid) and either marcaine or lidocaine, depending on if they want short or long term effects. The syringes looked like normal shots, except the needles were all around 4 inches long. Each time the needle would go all the way deep into the skin, which caused visible discomfort to the patients.
The process began with an ultrasound on the section of the body needing the injection. The ultrasound allowed Mr. Russell to see where the needle needed to go exactly. The needles needed to go in precise spots, such as between the glenoid and humeral head in the shoulder. Using the ultrasound, he’d mark a specific location that he was going to insert the needle. His assistant would then spray a cold, numbing spray on the skin to help ease pain. He’d first insert a numbing medicine, then change the syringe (leaving the needle injected) to put the medicine into the body. It was a quick process, but was described as feeling similar to bee stings inside their body. These injections cause immediate relief because of the numbing medicine for 4-6 hours, but the cortisone won’t kick in until 48 hours later.
The patients receiving treatment were often patients who didn’t need surgery now, but would in the future because of arthritis in their joints. One older man walked into the room for his 6th time getting injections in his shoulders, and proclaimed, “Good ole Uncle Arthur is trying to break me, but he hasn’t got me yet!”
Below are pictures of the ultrasound machine and one of the syringes. 
