Ultrasound-guided hyaluronic acid injection (viscosupplementation)
Millimetre precision in the treatment of osteoarthritis and tendinopathies — in Lisbon and Almada.
Dr Miguel Reis e Silva
Medical Director of Sport Lisboa e Benfica
Medical Director and Founder of the Myalgia Clinics
What is viscosupplementation?
Hyaluronic acid is a natural component of synovial fluid — the "lubricant" of our joints. In osteoarthritis, the amount and quality of this hyaluronic acid decline, which contributes to pain, stiffness and inflammation.
Viscosupplementation involves injecting hyaluronic acid directly into the affected joint, with two goals: restoring joint lubrication and cushioning, and reducing local inflammation. The expected result is less pain and more mobility — making it possible to return to physical activity and get more out of physiotherapy.
At Clínica Myalgia®, all injections are performed under real-time ultrasound guidance. We never inject "blind": ultrasound ensures the medication is placed exactly in the joint space, where it works, avoiding sensitive structures such as nerves and blood vessels.
When is it indicated?
Knee osteoarthritis — the most common indication, especially in mild to moderate osteoarthritis with limiting pain;
Osteoarthritis of the hip, ankle and shoulder — deep joints where ultrasound guidance is essential;
Thumb-base (rhizarthrosis) and small-joint osteoarthritis (hand, foot);
Tendinopathies — through peritendinous hydrodilatation with hyaluronic acid (for example, the Achilles tendon);
People who want to delay or avoid joint replacement surgery, or who are not candidates for surgery.
Viscosupplementation is never used on its own: at Myalgia it is always part of a treatment plan that may include physiotherapy, biomechanical correction, movement analysis or custom insoles — to treat the cause, not just the symptom.
Why have your injection at Clínica Myalgia?
✔️ 100% ultrasound-guided — direct visualisation of the needle and joint throughout the procedure;
✔️ Doctors with experience of thousands of procedures, including in elite sport;
✔️ Integrated approach — doctor, physiotherapist and movement analysis lab under one roof;
✔️ Individual product selection — different hyaluronic acids (molecular weight, cross-linking, number of injections) depending on the joint and the goal;
✔️ Two locations — Lisbon (Carnide) and Almada.
How does the procedure work?
Medical assessment — medical history, physical examination and review of imaging. We confirm whether viscosupplementation is the right option for you (or whether another approach, such as PRP or Arthrosamid®, would make more sense).
Diagnostic ultrasound — same-day assessment of the joint, including any effusion that needs draining before the injection.
Ultrasound-guided injection — disinfection, local anaesthetic if needed, and injection of hyaluronic acid under continuous ultrasound visualisation. It usually takes less than 15 minutes and is well tolerated.
Follow-up plan — guidance for the following 48 hours and integration with physiotherapy or therapeutic exercise to maximise and prolong the result.
Hyaluronic acid, PRP or Arthrosamid®?
There is no one-size-fits-all treatment. In short:
O hyaluronic acid acts mainly on lubrication and inflammation, with an effect that usually lasts several months; it can be repeated periodically.
O Platelet-rich plasma (PRP) uses the body's own growth factors, and is particularly useful in tendinopathies and osteoarthritis;
O Arthrosamid® is a single-injection hydrogel, designed for a longer-lasting effect in knee osteoarthritis.
At the assessment, the doctor explains the advantages and limitations of each option for your specific case — including the possibility of combining them with physiotherapy and biomechanical correction.
Frequently asked questions
Does a hyaluronic acid injection hurt? The procedure is usually well tolerated. We use local anaesthetic when needed, and ultrasound guidance allows a more precise and comfortable technique than injections without imaging. There may be mild discomfort for 24–48 hours afterwards.
How long does the effect last? It varies from person to person and with the degree of osteoarthritis, but relief typically lasts several months — in many cases between 6 and 12 months. The treatment can be repeated periodically, and results are enhanced when combined with therapeutic exercise and biomechanical correction.
How many injections are needed? It depends on the product chosen: there are single-injection regimens and regimens of 3 to 5 weekly injections. At the consultation, the doctor recommends the most suitable protocol for your joint and your goal.
How soon will I feel better? Unlike corticosteroids, the effect of hyaluronic acid is gradual: improvement usually develops over the first few weeks after the injection.
Can I drive and work on the same day? In most cases, yes. We only recommend avoiding strenuous use of the joint for the following 24–48 hours. We give you specific guidance at the end of the procedure.
What is the difference between an ultrasound-guided injection and a "normal" injection? In an ultrasound-guided injection, the doctor sees the needle and the joint in real time, ensuring the medication is placed exactly in the joint space. Without imaging, placement relies only on external anatomical landmarks, with a higher failure rate and a greater risk of hitting nearby structures.
Are there any contraindications? Yes — for example, active skin or joint infection, and known allergy to the product's components. Situations such as anticoagulant medication are assessed case by case at the consultation.