Advances in Knee Replacements

This new design allows surgeons to preserve the important central ligaments of the knee called the anterior and posterior cruciate ligaments. This design should allow a knee replacement to move, respond, and feel more like a normal knee.

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The Anterior Hip

Patients are being told by both surgeons and orthopedic implant companies that Anterior Hip Replacement approach offers something unique and different compared to other approaches. This is a flatly untrue, unscientifically supported myth...

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Outpatient Joint Replacement

With Outpatient Joint Replacement Surgery, patients are able to return home the same day as the procedure. Patients also begin physical therapy within hours of surgery.

Learn more about Outpatient Joint Replacement »

Ultrasound-Guided Injections

For those suffering from acute or chronic joint pain, conservative treatment methods may not always be enough to provide relief. Before turning to surgery, Dr. Ballard may suggest injected treatments, such as corticosteroids, platelet-rich plasma supplements, or viscosupplementation. Because accuracy is important to the success of these injections, the use of ultrasound guidance to help ensure proper placement is becoming more common.

Benefits of Ultrasound-Guided Injections

The most important benefit of ultrasound-guided injections is accuracy. With traditional "blind" injections, the doctor feels the injection area for certain muscles, bones, and tendons, and estimates where to place the injection; this can result in a high failure rate. Improperly placed injections are less likely to be helpful, and because the area that needs to be reached by the injection often measures just millimeters in size, it can be difficult to achieve proper placement with a blind approach. Ultrasound guidance can help minimize these complications.

Ultrasound guidance allows the doctor to see inside the joint, including the nerves. The needle can also be seen on the ultrasound screen as it goes into the skin. Because the doctor can see exactly where he is placing the injection, the procedure is quick, and often less painful than a blind injection. There is also a lesser likelihood of complications, like nerve damage, from accidental injection into a nerve. The accuracy of the injection is related to longer-lasting pain relief, and that reduction of pain can subsequently help physical therapy to be more effective. Additionally, there may be a cost benefit of ultrasound-guided injections—their accuracy and increased success rate often means that fewer injections are needed to achieve pain relief.

Ultrasound guidance may be used to provide pain relief from conditions such as arthritis and tendonitis. In addition to helping the doctor accurately place the injection, ultrasound guidance can be used to help the doctor remove fluid from a swollen joint.


Dr. Ballard will perform a preliminary scan of the injection area to pinpoint the correct location. This area is usually marked on the skin. You may receive local anesthesia before the injection to help with pain and discomfort during the procedure. The doctor may also use the ultrasound while inserting the needle into your joint to double-check placement. If there is any fluid in the joint that needs to be removed, this will be done prior to administering the injection.

If you receive anesthesia prior to the injection, you may not feel any pain at first, but the pain may return as the anesthesia wears off: usually within one to six hours. As with any injected treatment, it is even possible that the pain will get worse before it gets better.

Depending on the type of injection you receive, you may not feel immediate pain relief. In fact, injections such as corticosteroids, platelet-rich plasma supplements, and viscosupplementation often do not give immediate results. Corticosteroids, for example, can begin work in as little as two to three days, but may take as long as one to two weeks to take effect. It may be several weeks before you see results from platelet-rich plasma supplements or viscosupplementation.

Dr. Ballard will evaluate your condition and work with you to determine which injection treatment is best for you. It is important to note that injections do not work for everyone, but if your condition is mild to moderate, injections may be able to help you postpone or even avoid surgery. Following your procedure, Dr. Ballard will give you specific instructions to help ensure a successful recovery.

Joint Pain Relief in the Portland Area

Dr. James Ballard is a recognized joint pain expert in the area, and always recommends nonsurgical treatments whenever possible. If you have any questions about treatment or would like to schedule an appointment, please feel free to call his Oregon City office at (503) 656-0836, or his Tualatin office at (503) 656-0836.