Image guided injections - high volume

Image guided high volume intra-articular injections are used to treat severe joint pain related to osteoarthritis or inflammatory joint disorders such as rheumatoid arthritis and psoriatic arthritis.

Joint pain can also occur as a result of a traumatic injury, joint surgery or crystal build up in the joints such as gout. Other causes of joint pain include sports injuries, general sprains and strains, frozen or unstable shoulder, and bleeding into joint spaces caused by torn ligaments.


Hydrodilatation is the procedure of injecting a high volume (between 10ml and 55ml) of saline solution into the joint. The solution may also contain some corticosteroid which contains someanaesthetic to provide quick pain relief and the steroid ‘cortisone’ to provide longer relief toease pain and swelling. The high volume of liquid is injected into the joint using imaging guidance through an x-ray(fluoroscopy), ultrasound or computed tomography (CT), which may help to identify the correct path to place the needle.


There is a small risk of infection, worse pain, stiffness and damage to the nerves and bloodvessels around the joint.

Eligibility criteria:

Due to the limited quality of clinical evidence to support the use of image-guided high volume intra-articular injections, these injections are not routinely commissioned. This means the patient’s NHS commissioning organisation (CCG), who is responsible for buying healthcare services on behalf of patients, will only fund the treatment if an IndividualFunding Request (IFR) application has shown exceptional clinical need and the CCG supports this.

Advice and further guidance:

Treatment policy for patients covered by NHS Birmingham and Solihull CCG

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