Upcoming Date:
December 8, 2018

Ultrasound-Guided Joint Injection Training Course, presented by the UC San Diego School of Medicine, is a 1-day hands-on course, to provide training in ultrasound-guided intraarticular needle placement, to perform joint injections and aspirations. Many practices caring for hemophilia patients have introduced musculoskeletal ultrasound for non-invasive management of painful hemophilic joints. Adding training to perform needle placement into joints using ultrasound guidance will greatly enhance providers’ ability to manage joint pains in the hemophilia population.

Musculoskeletal disease is common in hemophilia. Hemophilic arthropathy is a frequent and debilitating comorbidity caused by frequent joint bleeding. The hallmark of hemophilic arthopathy is osteochondral destruction and soft tissue proliferation, causing pain. Treatment options are limited and chiefly comprise conservative measures such as the administration of clotting factor concentrates, physical therapy, and oral analgesics or anti-inflammatory medications, which are often used to delay surgical interventions such as joint replacement at younger ages.

Intra-articular corticosteroid injections have been used to effectively treat joint pain and improve range of motion in patients with inflammatory or degenerative joint diseases since the 1950s, and are included in the American College of Rheumatology’s treatment guidelines for rheumatoid arthritis (RA) and osteoarthritis (OA). However, blind needle placement and fear to cause injury and bleeding in complicated hemophilic joints is a barrier to use this modality. Recently, it has been shown that ultrasound-guided needle placement for injections and aspirations in hemophilic arthropathy is safe and effective to reduce pain. This spurred interest amongst hemophilia providers to utilize intra-articular injections and joint aspiration for the management of hemophilic arthropathy.¬†However, hemophilia providers are not trained to perform ultrasound-guided procedures.¬†

Target Audience

This educational program is designed for physicians, physician assistants, nurse practitioners, nurses, and physical therapists involved and/or interested in point-of care ultrasound-guided intraarticular interventions to manage hemophilic joint disease. Other healthcare professionals involved in hemophilia clinical care may benefit from this education program as well.


Upon completion of this activity participants should be able to:

  • Describe techniques and protocols for performing ultrasound guided injections of elbow, knee, hip, ankle and foot
  • Review the benefits of guided versus unguided intra-articular injections
  • Describe the indications and contra-indications of performing ultrasound guided intra-articular injections
  • Perform ultrasound-guided needle placement into ankle, knees and elbows
  • Identify sonographic target interfaces for accurate injections of the elbow, knee, hip, ankle and foot
  • Operate a MSKUS machine to include beam steer and optimization techniques for needle visualization
  • Use the Color Flow and Power Doppler to visualize vessels
  • Practice various approaches to access the intraarticular space for needle placement based on underlying joint pathology
  • Apply sterile techniques for needle placement
  • Review advantages and limitations of current intraarticular treatment modalities for pain relief

Hemophilia and Thrombosis Treatment Center at UC San Diego Health

The Hemophilia and Thrombosis Treatment Center has cared for patients with hemophilia since its founding in 1989. It later became one of approximately 130 federally funded Hemophilia Treatment Centers, with a mandate to reach out to all patients with hemophilia and other bleeding disorders in the community in order to improve and specialize their care, as well as to ensure and afford access to life-saving clotting factors.

The mission of the Hemophilia and Thrombosis Treatment Center is to provide state-of-the art care to our patients with a team of specialized and highly trained physicians, nurses, physical therapists and social workers, as well as provide outreach and education for the patient and provider community.

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