8 June 2026 · By Dra. Alba Solís
Injection or surgery? How we decide in each case
«Do I have to have surgery?» is probably the question I hear most in clinic. And I understand the fear: nobody likes the idea of an operation. The good news is that, for a large part of shoulder, knee or hip injuries, the first step is not surgery, but exhausting the less aggressive options first. One of the most useful is ultrasound-guided injections.
It's not «injecting for the sake of it»
An injection is not a sticking plaster or a blind solution. Done with the ultrasound, I see the injury in real time and deliver the medication exactly where it is needed. That makes the difference between a «let's try» jab and a precise treatment that really helps to calm the pain and restore function.
When it makes sense to inject before operating
- Tendinopathies and bursitis that don't settle with physiotherapy.
- Knee or hip osteoarthritis with pain, before considering a prosthesis (with hyaluronic acid or PRP).
- Shoulder calcifications (sometimes resolved with ultrasound-guided barbotage).
- Pain limiting your daily life that hasn't yet tried a well-directed conservative treatment.
When surgery is the right option
Being honest also means knowing when it's time to operate. Surgery is the best decision for tears that must be repaired in the operating room, fractures that require it, or when well-performed conservative treatment has failed. In those cases I tell you clearly and guide you towards the orthopaedic surgeon.
How we decide together
In the first consultation I examine you, assess your injury with ultrasound on the spot and review your tests. With that, I explain, without jargon, what options you have, what to expect from each and the risks. We make the decision together, with clear information. Often, a well-indicated injection saves you the operating room; and when it doesn't, we'll know in good time.
Frequently asked questions
Is an injection just a quick fix?
It doesn't have to be. When combined with good rehabilitation and done under ultrasound guidance (reaching the exact spot), an injection can break the pain cycle and allow the injury to recover. It's not just masking it: it's gaining the window to treat the cause.
How many injections can be given?
It depends on the type of medication and the joint. It's not about injecting without limit: if one approach doesn't work, we should rethink the diagnosis or the treatment, not insist indefinitely.
If I have an injection, do I lose the option of surgery?
No. An injection closes no doors. If surgery is needed later, it is assessed as normal. That's why it usually makes sense to start with the least aggressive option.