Sonoscope Ultrasound-Guided Injection Clinic Report

History: This 62-year-old gentleman presented with a 3-month history of worsening right knee pain, particularly aggravated by walking downhill and climbing stairs. He describes a dull ache that occasionally sharpens with movement. He has received no previous musculoskeletal injections. His main medical conditions include well-controlled hypertension and mild osteoarthritis, confirmed by an X-ray performed 6 months prior, showing moderate degenerative changes in the medial compartment of the right knee. He is currently on Amlodipine 5mg daily. Easing factors include rest and over-the-counter paracetamol. Previous investigations showed no signs of inflammatory arthritis. Clinical Findings: On examination, the right knee exhibited mild swelling over the medial joint line. Active range of motion was limited in flexion to 110 degrees and extension to 5 degrees, with pain at end-range. Passive range of motion was similarly restricted. Palpation revealed tenderness along the medial joint line. The Lachman test and pivot shift test were negative, indicating no significant ligamentous instability. McMurray's test elicited pain with internal rotation, suggesting possible meniscal involvement. Patellar tracking was normal, and no effusion was evident. Ultrasound Scan: The ultrasound scan of the right knee revealed mild joint effusions and significant osteoarthritic changes with spurring and cartilage thinning in the medial compartment. There was evidence of mild synovitis. No meniscal tears were visualised clearly on ultrasound. The quadriceps and patellar tendons appeared intact. Dynamic assessment showed some crepitus with knee movement. Potential treatment options discussed included intra-articular steroid injection or hyaluronic acid injection for symptomatic relief and further management with physiotherapy. Conclusion: - 3-month history of right knee pain exacerbated by weight-bearing activities. - Clinical examination showed limited range of motion and medial joint line tenderness. - Ultrasound confirmed osteoarthritic changes, mild effusion, and synovitis in the right knee. Intervention: The findings were discussed with this gentleman. We also discussed therapeutic options, including injection therapy. Following this discussion, Mr Smith agreed with the suggested procedure. After having confirmed his informed consent in accordance with the previously completed and signed online informed consent form, which required him to have read the information leaflet about steroid injections that explains the risks and side effects. The procedure was then followed by cleaning the ultrasound probe with Tristel Duo. Skin prepared and cleaned with a Chloraprep applicator (2% Chlorhexidine in 70% Isopropyl alcohol). I then proceeded to inject, under ultrasound guidance, 40 mg of Depo-Medrone (expiry date: 15/12/2025, batch number: DM456789) mixed with 2 ml of lidocaine 1% strength (expiry date: 20/08/2025, batch number: LIDO12345). The procedure was uneventful, and the steroid was accurately placed in the right knee joint. Recommendation: I have recommended relative rest for the next 2 days. Following that, a gradual return to normal activity is possible. It is recommended to avoid high-intensity physical stress on the body part affected for a period of 4 weeks. I will refer the patient to my expert physiotherapy colleagues at 'The Joint Clinic' for further physiotherapy management.