Ultrasound-guided injections use real-time imaging to help target selected joints, tendons, ligaments, muscles, nerves, and soft tissue pain sources.
Learn how Dr. Siefferman uses ultrasound-guided injections to precisely target painful tissues, improve treatment accuracy, and help patients find lasting relief.
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Hi, I’m Dr. Jason Siefferman, interventional pain specialist and medical director at Manhattan Pain Medicine. When we are performing blocks, nerve blocks, joint injections, any injection in the office, we consider how we want to guide this injection. Many injections we do without any guidance at all just based on anatomic landmarks and experience. Sometimes we will use ultrasound guidance and sometimes we will use fluoroscopic guidance which is X-ray guidance.
Ultrasound we use in the office frequently because it allows us to see the soft tissue, the nerves, arteries, any of the vessels and we can see very clearly where a needle is going and where our injection is going. So it allows us great precision with the placement of medication. And because there’s no radiation, this is generally our preferred modality. It’s also quick and easy to do in the office. And at the same time while doing that we also get diagnostic value because we can visualize the tissues around the target and identify is there any other process going on in that area that may explain the pain. Fluoroscopic guidance we use when we need to see inside a bony structure like the spine because there we can use contrast.
We need to get into a deeper structure or a more complicated situation that requires a sterile environment or anesthesia monitoring. We will generally also use fluoroscopic guidance for added safety.”
Ultrasound-guided injections are targeted pain procedures performed with real-time imaging. Ultrasound allows the clinician to view selected joints, tendons, ligaments, muscles, nerves, soft tissue structures, and nearby anatomy during certain injections.
At Manhattan Pain Medicine, ultrasound-guided injections are used as part of diagnosis-first pain care, not as a standalone solution for every pain condition. They may be considered for selected patients with joint pain, tendon or ligament pain, nerve entrapment, foot pain, pelvic-region pain, abdominal wall pain, hernia-related pain, hypermobility-related pain, or complex chronic pain when the diagnosis, anatomy, and treatment goals support this approach.
MPM specialists evaluate whether ultrasound-guided injections may be appropriate by first identifying the likely pain generator. This may involve joint irritation, tendon injury, ligament pain, muscle pain, nerve entrapment, abdominal wall pain, hernia-related pain, pelvic-region pain, foot pain, or a complex overlapping pain pattern. The goal is not simply to inject where pain is felt.
MPM considers symptoms, exam findings, prior imaging, diagnostic ultrasound findings, treatment history, safety factors, and functional goals before selecting the target and injectate. When ultrasound guidance improves precision, safety, or diagnostic confidence, it may support a more targeted procedure.
Jordan Shankle, PA-C
Board-Certified Physician Assistant
Adam Rosenberg, PA-C
Board-Certified Physician Assistant
Tayyaba Ahmed, DO
Physical Medicine & Rehabilitation | Pelvic Pain
Luis Aranguren, MD
Interventional Pain Management
Jason W. Siefferman, MD
Medical Director | Interventional Pain Management | Headache Medicine
Nino Mikaberidze, MD
Director of Rheumatology & Internal Medicine
Ultrasound guidance can improve visualization during selected injections, but the value of the procedure depends on choosing the right target. Pain may come from a joint, tendon, ligament, muscle, bursa, nerve, soft tissue structure, abdominal wall, hernia-related region, or pelvic-region contributor. It may also be referred from the spine, driven by inflammation, related to hypermobility, or part of a broader complex chronic pain pattern.
At MPM, ultrasound-guided injections are used within a broader clinical framework. Some injections are diagnostic, meaning they help test whether a specific structure is contributing to pain. Others are therapeutic, meaning they are intended to reduce inflammation, irritation, or pain in a targeted area. Some may serve both purposes. The treatment plan may also include diagnostic ultrasound, MRI, CT, fluoroscopy-guided procedures, medication management, rehabilitation, pain psychology, rheumatology care, neurology care, pelvic specialty care, or surgical evaluation when appropriate.
Ultrasound-guided injections may support all of MPM’s Zones of Expertise because many pain conditions involve overlapping musculoskeletal, nerve, pelvic, inflammatory, hypermobility, and complex chronic pain contributors. In musculoskeletal care, ultrasound guidance may help target selected joints, tendons, ligaments, bursae, muscles, or soft tissue structures. In nerve-related pain, it may help guide peripheral nerve blocks or injections near entrapment sites when clinically appropriate.
For pelvic pain, abdominal wall pain, hernia-related pain, foot pain, and hypermobility-related joint pain, ultrasound guidance may help identify and reach specific targets that are difficult to evaluate with a general pain approach. MPM uses this tool selectively, always within a broader diagnosis-first plan that considers whether other imaging, procedures, rehabilitation, or specialty care may also be needed.
Before the procedure, MPM reviews the diagnosis, target structure, medication or injectate, expected goal, possible risks, and aftercare instructions. During the injection, ultrasound gel is placed on the skin and a probe is used to visualize the target area and nearby structures. The clinician then guides the needle toward the selected joint, tendon region, ligament, muscle, nerve, bursa, or soft tissue target when clinically appropriate.
Patients may feel pressure, pinching, temporary discomfort, or a brief increase in familiar symptoms. Local anesthetic may be used in some cases. After the procedure, soreness, bruising, temporary numbness, or temporary weakness may occur depending on the injection type and location. Relief, if it occurs, may be immediate, delayed, temporary, or gradual. MPM monitors the response to determine whether the injection helped clarify the diagnosis, support treatment, or guide next steps.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Ultrasound-guided injections are procedures that use real-time ultrasound imaging to help guide a needle toward a selected joint, tendon, ligament, muscle, nerve, bursa, or soft tissue target. In pain medicine, they may be used for selected musculoskeletal, nerve, foot, pelvic-region, abdominal wall, hernia-related, or complex pain patterns. At MPM, ultrasound-guided injections are chosen based on diagnosis, anatomy, safety, and treatment goals. They are not a cure for every pain condition and are not appropriate for every patient.
Regular injections may be performed using anatomical landmarks alone. Ultrasound-guided injections use real-time imaging to visualize selected structures during the procedure. This can help the clinician identify the target, avoid nearby structures, and place medication more precisely in certain areas. However, ultrasound guidance does not guarantee success. The most important factor is matching the injection to the correct diagnosis and pain generator. MPM uses ultrasound guidance when it adds meaningful value to the patient’s care plan.
Ultrasound guidance may help improve anatomical precision during selected pain injections. It can allow visualization of certain joints, tendons, ligaments, muscles, nerves, blood vessels, and soft tissue structures in real time. This may be useful when treating smaller targets, nerve entrapments, foot pain, pelvic-region pain, abdominal wall pain, or areas where nearby structures need to be avoided. MPM uses ultrasound guidance when it supports safer, more accurate, or more diagnostically useful treatment.
Ultrasound-guided injections may be considered for selected patients with joint pain, tendon pain, ligament injury, chronic sprain, bursitis, muscle pain, peripheral nerve entrapment, cluneal neuralgia, Morton’s neuroma, tarsal tunnel syndrome, foot pain, abdominal wall pain, hernia-related pain, pelvic-region pain, hypermobility-related pain, or certain complex chronic pain patterns. They may also support diagnostic blocks or treatment planning. MPM evaluates the diagnosis and anatomy before deciding whether an injection is appropriate.
Ultrasound-guided joint injections may help selected patients with joint pain when symptoms and exam findings suggest that the joint is a meaningful pain source. This may include certain shoulder, hip, knee, ankle, wrist, or small joint concerns when ultrasound is appropriate for the target. Joint pain can also come from arthritis, instability, inflammation, referred pain, tendon injury, ligament problems, or nerve irritation. MPM evaluates the full clinical picture before recommending an ultrasound-guided joint injection.
Ultrasound-guided injections may be considered for certain tendon or ligament pain patterns, including tendinopathy, chronic sprain, soft tissue irritation, or selected musculoskeletal injuries. The type of injectate depends on the diagnosis and treatment goal. Some patients may need rehabilitation, activity modification, bracing, regenerative medicine, steroid treatment, or additional imaging instead of, or in addition to, an injection. MPM determines whether the tendon or ligament is likely the pain generator before recommending treatment.
Ultrasound-guided injections may help selected nerve entrapment patterns by allowing visualization of certain peripheral nerves and surrounding tissues. This may be relevant for cluneal neuralgia, cubital tunnel syndrome, peroneal nerve entrapment, Morton’s neuroma, tarsal tunnel syndrome, or other superficial nerve-related pain patterns. The injection may be diagnostic, therapeutic, or both. It does not replace EMG, nerve conduction studies, MRI, neurology evaluation, or surgical evaluation when those are needed.
Ultrasound-guided injections may be considered for selected foot and ankle pain patterns, including Morton’s neuroma, tarsal tunnel syndrome, metatarsalgia, tendon pain, ligament injury, bursitis, or soft tissue irritation. Ultrasound may help guide medication toward a specific target when the diagnosis supports it. Foot pain can also come from fracture, arthritis, inflammatory disease, vascular issues, spine-related nerve pain, or systemic conditions. MPM evaluates these possibilities before recommending an injection.
Ultrasound-guided injections may be considered for selected pelvic-region or abdominal wall pain patterns when a specific soft tissue, nerve, muscle, or superficial structural target is suspected. This may include certain abdominal wall nerve entrapments, hernia-related pain patterns, pelvic-region soft tissue pain, or selected peripheral nerve targets. These injections do not replace pelvic specialty evaluation, gynecologic care, urologic care, GI evaluation, surgical evaluation, or emergency care when needed. MPM evaluates the broader clinical picture before treatment.
They can be diagnostic, therapeutic, or both. A diagnostic injection may help determine whether a specific structure is contributing to pain. A therapeutic injection may aim to reduce inflammation, irritation, or pain in a targeted area. Some injections provide both types of information. MPM clarifies the goal before the procedure so patients understand whether the injection is meant to test a pain source, treat symptoms, support rehabilitation, or guide next steps.
Most patients feel pressure, pinching, or brief discomfort during an ultrasound-guided injection. Some areas are more sensitive than others, especially when pain is already severe or the target is near an irritated nerve or tendon. Local anesthetic may be used in some procedures to reduce discomfort. Temporary soreness, bruising, numbness, or weakness may occur afterward depending on the injection type and location. MPM reviews what to expect before treatment.
The injectate depends on the diagnosis, target, and treatment goal. Ultrasound-guided injections may involve local anesthetic, corticosteroid, regenerative medicine, nerve block medication, or other treatment options when clinically appropriate. Steroid injections may help reduce pain, swelling, or irritation in selected cases but are not appropriate for every patient or every tissue. MPM selects the medication based on the suspected pain generator, safety factors, prior treatment response, and care plan.
The length of the procedure depends on the target area, complexity, imaging requirements, and type of injection. Many ultrasound-guided injections are performed in an outpatient setting and may take only a short amount of procedure time, although the full visit includes evaluation, preparation, consent, positioning, and post-procedure instructions. MPM reviews the expected process in advance based on the specific injection and treatment goal.
Risks can include pain, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, nerve irritation, vascular injury, incomplete relief, temporary relief, or symptom flare. If steroid is used, steroid-related side effects may also be possible. Risk varies by injection site, medication, diagnosis, and patient health. MPM reviews safety factors before the procedure, including medications, infection risk, bleeding risk, medical conditions, and whether the injection is appropriate for the suspected pain source.
Ultrasound-guided injections may not be appropriate when the diagnosis is unclear, the suspected pain generator cannot be safely targeted with ultrasound, or another evaluation is needed first. They may also need to be avoided or delayed with active infection, certain bleeding risks, unstable medical symptoms, or when surgery, vascular evaluation, rheumatology care, neurology care, pelvic specialty care, or emergency care is more appropriate. Urgent symptoms include fever, spreading redness, severe swelling, new weakness, new numbness, bowel or bladder dysfunction, chest pain, shortness of breath, limb discoloration, loss of pulses, or rapidly worsening symptoms.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Ultrasound-guided injections are targeted pain procedures performed with real-time imaging. Instead of relying only on surface landmarks, the clinician uses ultrasound to view selected anatomy while guiding the needle toward a specific target. This may include a joint, tendon region, ligament, muscle, bursa, peripheral nerve, soft tissue structure, abdominal wall area, hernia-related region, foot or ankle target, or superficial pelvic-region structure.
At Manhattan Pain Medicine (MPM), ultrasound-guided injections NYC care is part of a diagnosis-first model. The procedure is only as useful as the clinical reasoning behind it. MPM first evaluates whether the patient’s symptoms, exam findings, prior imaging, and treatment history point toward a specific structure that can be safely and meaningfully targeted.
Ultrasound provides real-time visualization of certain soft tissues, nerves, blood vessels, and musculoskeletal structures. This can help the clinician place the needle more precisely during selected injections and avoid nearby anatomy when possible. Ultrasound can also allow dynamic assessment, meaning the clinician may observe certain structures during movement or positioning when relevant.
Precision does not guarantee pain relief. Pain may come from more than one source, and not every structure visible on ultrasound is the primary pain generator. MPM uses ultrasound guidance when it improves diagnostic confidence, procedural accuracy, or safety for a specific clinical question.
Some ultrasound-guided injections are diagnostic. For example, a targeted local anesthetic injection may help determine whether a joint, nerve, tendon sheath, or soft tissue region is contributing to pain. If pain improves temporarily, that response may help guide the care plan. If pain does not improve, MPM may reconsider the diagnosis or evaluate another pain source.
Other injections are therapeutic. These may involve medication intended to reduce inflammation, irritation, or pain in a targeted area. In some cases, one injection may be both diagnostic and therapeutic. The goal should be clear before treatment begins.
Ultrasound-guided joint injections in Manhattan may be considered for selected shoulder, hip, knee, ankle, wrist, or small joint pain patterns. Ultrasound-guided injections for tendon pain may be considered for tendinopathy, chronic sprain, bursitis, soft tissue irritation, or ligament-related symptoms. Ultrasound-guided injections for nerve entrapment may be considered for selected cases of peripheral nerve entrapment, cluneal neuralgia, Morton’s neuroma, tarsal tunnel syndrome, peroneal nerve entrapment, or cubital tunnel syndrome.
For abdominal wall pain, hernia-related pain, sports hernia patterns, or groin pain, ultrasound guidance may help target selected superficial structures or nerves when clinically appropriate. For pelvic pain, pudendal neuralgia, pelvic floor dysfunction, pelvic dystonia, or PGAD, ultrasound-guided injections may be considered only when a specific target is identified and the broader pelvic pain evaluation supports the procedure.
Patients with hypermobility, EDS, joint instability, chronic sprains, or complex pain may also benefit from careful evaluation of whether an ultrasound-guided injection fits their treatment plan. These patients often require coordinated care, because pain may involve instability, muscle compensation, nerve sensitivity, inflammation, or central sensitization.
Ultrasound is useful for many superficial and soft tissue targets, but it is not appropriate for every injection or every pain condition. Some spine procedures may require fluoroscopy or CT guidance. Some deep pelvic, vascular, intracranial, or spinal conditions require MRI, CT, MRV, EMG, lab work, vascular imaging, or specialist evaluation. Ultrasound-guided injections do not replace diagnosis, rehabilitation, medication management, surgery, rheumatology care, neurology care, vascular evaluation, pelvic specialty care, or emergency care when needed.
Risks of ultrasound-guided injections may include pain, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, nerve irritation, vascular injury, incomplete relief, temporary relief, or symptom flare. If corticosteroid is used, steroid-related side effects may occur. Risk depends on the target, medication, patient health, and clinical context.
Patients should seek urgent evaluation for fever, spreading redness, severe swelling, new weakness, new numbness, bowel or bladder dysfunction, saddle anesthesia, chest pain, shortness of breath, sudden severe headache, severe abdominal or pelvic pain, loss of pulses, limb discoloration, suspected infection, major trauma, or rapidly worsening symptoms.
For selected patients, ultrasound-guided injections may be a valuable part of targeted pain care. MPM’s role is to determine whether the procedure fits the diagnosis, whether ultrasound is the right guidance tool, and how the injection should connect to the broader care plan.
