Ultrasound-guided (USG) blocks are the modern gold standard for precise injections in pain medicine. Ultrasound enables real-time visualisation of nerves, blood vessels, tendons and joints, translating to maximum procedural efficacy and safety. At our Warsaw Centre we perform over 40 different types of ultrasound-guided blocks.

Why is Ultrasound Guidance So Important?

  • REAL-TIME VISUALISATION – we see the needle, nerve and target structure simultaneously. We can observe medication distribution after injection
  • SAFETY – we avoid puncturing blood vessels, pleura and peritoneum (critical e.g. in intercostal blocks, stellate ganglion block)
  • PRECISION – the medication reaches exactly where it should (to the nerve, into the joint, near the tendon)
  • NO RADIATION – unlike fluoroscopic X-ray, neither patient nor physician is exposed to ionising radiation
  • SMALLER MEDICATION VOLUMES – precise injection means we need less local anaesthetic/steroid to achieve the same effect
  • ABILITY TO CORRECT NEEDLE POSITION during the procedure

Full Range of Ultrasound-Guided Blocks at Neurolocus Warsaw

Temporomandibular Joints

  • Temporomandibular joint block – 1 side
  • Temporomandibular joint block – 2 sides
  • Temporomandibular joint lavage with hyaluronic acid injection (1 side)

Indications: Costen’s syndrome, temporomandibular joint dysfunction (TMJD), bruxism with joint pain, TMJ degeneration, ear pain of unclear aetiology. Lavage with HA is effective in disc tightness and restricted mobility.

Carpal Tunnel and Stellate Ganglion

  • Carpal tunnel hydrodecompression
  • Sympathetic trunk block at C6 level (1 side) – Stellate Ganglion

Carpal tunnel hydrodecompression (carpal tunnel syndrome) is a modern alternative to surgery – under ultrasound we inject fluid that mechanically separates the tissues around the median nerve, releasing it from compression by the fibrotic flexor retinaculum. Efficacy in 70–80% of patients. Stellate ganglion block – used in upper limb CRPS, post-herpetic neuralgia of the neck/face, certain peripheral circulation disorders, refractory hot flashes, PTSD.

Cervical Nerve Roots

  • 1 nerve root
  • 2 nerve roots
  • 3 nerve roots
  • 4 nerve roots

Indications: cervicobrachial neuralgia, cervical disc herniation with nerve root compression, cervical neuralgias. Perineural block combines a diagnostic effect (confirming the level) and a therapeutic effect (anti-inflammatory steroid + local anaesthetic).

Joints

  • Cervical facet joints – 1 side
  • Cervical facet joints – 2 sides
  • Periarticular/intra-articular block (knee, hip, shoulder, ankle)
  • Costovertebral joints
  • Paravertebral block
  • Heel spur – 1 side
  • Heel spur – bilateral
  • Intrabursal / peribursal block
  • Small hand joints – per 1 joint

Nerves and Tendon Insertions

  • Muscle insertions, ligaments
  • Peripheral nerves
  • Facial block (1–2 nerves)
  • Facial block (3–4 nerves)
  • Greater occipital nerve – 1 nerve
  • Greater occipital nerve – 2 nerves
  • Third occipital nerve – 1 nerve
  • Third occipital nerve – 2 nerves
  • Greater + third occipital nerve (2 nerves)
  • Greater + third occipital nerve bilateral (4 nerves)
  • Suprascapular nerve – 1 nerve
  • Suprascapular nerve – 2 nerves
  • Trigger points
  • Intercostal nerves (regardless of number of levels)
  • Pudendal nerves (1–2 nerves)
  • Pudendal nerves with nerve stimulator

Most Common Indications for Ultrasound-Guided Blocks

  • Peripheral joint pain (knee, hip, shoulder, elbow, ankle, small joints)
  • Tendinopathies and enthesopathies (tennis elbow, golfer’s elbow, jumper’s knee, heel spur)
  • Occipital neuralgia (headaches – occipital and neck area)
  • Chronic migraine – occipital nerve blocks as adjunct therapy
  • Shoulder pain in subacromial impingement syndrome
  • Back pain of muscular origin (trigger points, piriformis muscle)
  • Intercostal pain (shingles/herpes zoster, post-traumatic, post-thoracotomy)
  • Pudendal neuralgia (especially with neurostimulation – greater precision)
  • Peripheral nerve entrapment syndromes (carpal tunnel, Guyon’s canal, meralgia paraesthetica)
  • Complex Regional Pain Syndrome (CRPS) – stellate ganglion block

Procedure Sequence (using knee joint block as an example)

  • Qualifying consultation with review of medical records and, if necessary, diagnostic ultrasound of the joint.
  • Patient in the supine position. The physician disinfects the skin and prepares the ultrasound probe in a sterile manner.
  • Under ultrasound guidance (in-plane or out-of-plane technique), a fine 22–25G needle is introduced precisely into the joint space or nerve vicinity.
  • After confirming correct position, the medication mixture is administered: local anaesthetic (lidocaine, bupivacaine) + steroid (depo-medrol, diprophos) or hyaluronic acid.
  • Real-time medication distribution is observed on ultrasound.
  • The entire procedure takes 10–20 minutes. Brief post-procedure observation followed by discharge.

Effects

  • First relief: usually immediately after the procedure (local anaesthetic effect)
  • Full steroid effect: 3–7 days after the procedure
  • Duration of effect: typically 4–12 weeks (depending on indication, medication, individual response)
  • For hyaluronic acid (e.g. temporomandibular joint): effect up to 6–12 months
  • Can be repeated (steroid typically max 3–4×/year due to chondrotoxicity; HA and other medications – more frequently)

Possible Side Effects

  • Transient pain at the puncture site (1–3 days)
  • Minor subcutaneous haematoma
  • Post-injection flare inflammatory reaction (rarely, resolves within 24–48h)
  • Very rarely: infection (strict aseptic technique maintained), allergic reaction
  • After steroid: transient facial flushing, brief hyperglycaemia in diabetics, temporary blood pressure rise

FAQ

Is the ultrasound-guided block painful?

Most patients describe the sensation as barely noticeable with a fine needle. Additional local skin anaesthesia can be applied. The procedure itself is virtually painless.

How many blocks can I have in a year?

This depends on the medication. Intra-articular steroids are limited to 3–4 times per year per joint (chondrotoxicity). Hyaluronic acid and non-steroidal anti-inflammatory medications – more frequently. An optimal schedule is determined individually.

Can I work after a nerve block?

In most cases yes – after brief observation, normal activities can be resumed. Exceptions: blocks in the lower limb area (avoid driving for a few hours) and stellate ganglion blocks (possible transient pupil asymmetry requiring monitoring).