What Happens at an Ultrasound-Guided Injection Appointment?

Written by the LSRI clinical team and medically reviewed by Dr Prashant Sankaye, Consultant MSK Radiologist, on 2 October 2026.

If you have been booked for an ultrasound-guided injection, it is natural to wonder what will actually happen on the day. This guide walks you through each stage, from preparing beforehand to aftercare and follow-up. For an overview of the injections we offer, see our injections page, and for the most common type, our ultrasound-guided steroid injection page.

Before your appointment

What to bring

• A list of your current medicines, including any blood thinners, diabetes medicines and supplements.
• Any previous scan reports, X-ray or MRI results, or letters from your GP, physiotherapist or consultant.
• Details of any previous injections, including when they were given and whether they helped.
• Comfortable, loose clothing that lets us reach the area easily, for example shorts for a knee or a vest top for a shoulder.

If you take blood thinners

Please tell us when you book if you take an anticoagulant (such as warfarin, apixaban or rivaroxaban) or an antiplatelet medicine (such as aspirin or clopidogrel). NHS guidance notes that these medicines can increase the risks of an injection, including rare bleeding into a joint¹. Many injections can still be done safely, but we may need to check details such as a recent INR result if you take warfarin. Do not stop any blood-thinning medicine unless the doctor who prescribes it has advised you to.

If you have diabetes

Steroid injections can raise blood glucose for a few days. NHS advice for people with diabetes is to check blood glucose frequently for at least 72 hours after a steroid injection, as levels can rise, particularly in the first 24 to 72 hours². If your diabetes is difficult to control at the moment, let us know in advance, as it may be better to delay a steroid injection or consider another option.

Driving and getting home

Local anaesthetic can make a limb feel numb or weak for a few hours. Some NHS departments advise not driving for 24 hours after an ultrasound-guided injection¹. We recommend arranging a lift or using public transport or a taxi, particularly after an injection in your leg, foot, shoulder or right arm.

When to rearrange

Please contact us before your appointment if you feel unwell, have a fever, have any infection (including a skin infection near the injection site), or are taking antibiotics. It is also important to tell us if you are pregnant or might be.

The scan comes first, and why

Every injection at LSRI begins with a diagnostic ultrasound scan by Dr Sankaye, a Consultant MSK Radiologist. The scan has several purposes:

• It checks that the diagnosis is right. Sometimes the scan shows a different cause for your symptoms, such as a tendon tear or a cyst, which may need a different treatment.
• It shows the exact target, whether that is a joint, a bursa, a tendon sheath or the space around a nerve.
• It shows nearby structures such as blood vessels and nerves, so the needle path can be planned to avoid them.
• It can show fluid that may need draining (aspirating) before an injection.

If the scan shows that an injection is not the best option for you, Dr Sankaye will explain why and discuss alternatives. You will always have the chance to ask questions and give your consent before any injection.

The injection, step by step

1. Positioning. You will be helped into a comfortable position, lying or sitting, that gives the best view of the area.
2. Planning the route. Dr Sankaye uses the ultrasound probe to find the target and mark the best entry point on your skin.
3. Cleaning the skin. The skin is cleaned with antiseptic, and sterile equipment is used throughout to reduce the risk of infection.
4. Local anaesthetic. For most injections, a small amount of local anaesthetic is used to numb the skin and the tissues along the needle path. This may sting briefly before the area goes numb.
5. Guiding the needle. The needle is guided gently to the target while Dr Sankaye watches it on the ultrasound screen in real time. You can usually watch the screen too, if you would like to.
6. Giving the injection. Once the needle tip is in the right place, the medicine is injected. You may feel pressure or a deep ache, especially with a joint or a larger-volume injection. Tell us if you are uncomfortable at any time.
7. Finishing. The needle is removed and a small plaster is applied. The injection itself usually takes a few minutes, although the whole appointment, including the scan and discussion, takes longer.

After the injection you may be asked to stay for a short time so that we can check you feel well before you leave.

Ultrasound lets the clinician see the needle reach the intended target. It is worth being honest that research has not shown image guidance improves results for every type of injection: for example, a 2021 Cochrane review found that, for shoulder pain, ultrasound-guided injections probably give little or no extra benefit for pain or function compared with injections given without imaging³. The value of the scan at LSRI is that it also confirms the diagnosis, shows structures to avoid, and allows fluid to be drained, all in the same appointment.

After your injection

Rest and activity

It is usually sensible to take things easy for the rest of the day. Avoid strenuous activity for at least 24 hours, and avoid heavy lifting or repetitive use of the area for the period Dr Sankaye advises, which may be up to two weeks for some injections. Gentle movement is generally encouraged. If you have a physiotherapy plan, we will tell you when to restart it.

Post-injection flare

Some people have a temporary increase in pain after a steroid injection, often called a flare. Guy’s and St Thomas’ NHS patient information states that about 1 in 10 people feel more pain immediately after a steroid injection, and that this usually lasts up to 2 days⁴. Rest, a cold pack wrapped in a cloth, and simple pain relief such as paracetamol can help. Some people also notice facial flushing for a few hours⁴.

When the injection starts to work

The local anaesthetic may ease pain straight away, but this wears off within hours. A steroid usually starts to work within a few days. Other treatments, such as hyaluronic acid or PRP, tend to act more gradually. We will tell you what to expect for your specific injection.

Signs of infection: seek urgent help

Infection after an injection is rare, but it needs prompt treatment. Seek urgent medical help, by contacting NHS 111 or going to A&E, and let us know, if:

• the injected area becomes increasingly red, hot, swollen or painful, especially more than 24 hours after the injection;
• you develop a fever or feel generally unwell;
• pain keeps getting worse rather than settling after a couple of days.

Call 999 if you have signs of a serious allergic reaction, such as sudden swelling of the lips, mouth, throat or tongue, or difficulty breathing.

Follow-up and your results

You will receive a written report of your ultrasound scan, which can also be shared with your GP, physiotherapist or consultant. If you would like to go through the findings and the plan from here, you can book a consultation.

We usually suggest a review, often with your physiotherapist or referring clinician, a few weeks after the injection to see how you have responded. If the injection has not helped as hoped, we can discuss other options.

Frequently asked questions

Does an ultrasound-guided injection hurt?

Most people describe a sharp scratch followed by pressure. Local anaesthetic reduces discomfort, and the injection itself takes only a few minutes.

How long is the appointment?

Allow extra time beyond the injection itself for the scan, discussion and a short period afterwards. Please arrive a few minutes early to complete any paperwork.

Can I go back to work afterwards?

Many people return to desk-based work the same or next day. If your job is physical, you may need a little longer. We will advise you based on the area injected.

How many steroid injections can I have?

There is no single fixed limit, but repeated steroid injections into the same area are generally spaced out and limited. Dr Sankaye will review your previous injections and whether they helped before advising.

Do I need a referral?

No GP referral is needed if you are paying for yourself. If you are claiming through private medical insurance, your insurer may require a referral from a GP or specialist. If you have a referral letter or previous imaging, please bring it.

Book an appointment

Call 0203 633 5040 or book online. Clinics at Harley Street (W1G 9QJ) and Harrow (HA2 7SJ).

References

1. Chelsea and Westminster Hospital NHS Foundation Trust. Ultrasound-guided steroid injections (patient leaflet). https://www.chelwest.nhs.uk/your-visit/patient-leaflets/imaging/ultrasound-guided-injections
2. The Dudley Group NHS Foundation Trust. Post corticosteroid injection advice for people with diabetes (version 1, reviewed October 2025). https://www.dgft.nhs.uk/pil/post-corticosteroid-injection-advice-for-people-with-diabetes/
3. Zadro J, Rischin A, Johnston RV, Buchbinder R. Image-guided glucocorticoid injection versus injection without image guidance for shoulder pain. Cochrane Database Syst Rev 2021;CD009147. doi:10.1002/14651858.CD009147.pub3
4. Guy’s and St Thomas’ NHS Foundation Trust. Steroid injections for joint and tendon pain (patient information, last reviewed February 2026). https://www.guysandstthomas.nhs.uk/health-information/steroid-injections-joint-and-tendon-pain