Ultrasound-Guided Shoulder Interventions: Techniques, Evidence, and Clinical Applications—A Narrative Review

Abstract Background: Shoulder pain is among the most common musculoskeletal complaints, with significant socioeconomic impact and persistent disability in a substantial proportion of patients. Conventional landmark-guided injections remain widely practiced but suffer from variable accuracy, inconsistent therapeutic response, and a higher risk of unintended tissue infiltration. Ultrasound (US) guidance allows real-time visualization of anatomical structures, potentially improving procedural precision and clinical outcomes. Purpose: This narrative review summarizes the sonoanatomy, procedural techniques, indications, and evidence for commonly performed US-guided (USG) shoulder interventions, including subacromial–subdeltoid (SASD) bursa injection, biceps tendon sheath injection, glenohumeral joint injection, acromioclavicular (AC) joint injection, suprascapular nerve block, and regenerative procedures such as platelet-rich plasma (PRP) therapy. Materials and Methods: A narrative synthesis of clinical trials, cadaver studies, systematic reviews, and meta‑analyses relevant to USG shoulder procedures was performed using the references provided in the draft and standard textbooks. Key outcomes included procedural accuracy, pain relief, functional improvement, and safety. Results: Across all interventions, USG techniques consistently demonstrated superior accuracy—often 90%–100%—compared with 40%–70% for landmark methods. Improved accuracy translated into better pain reduction, faster recovery, and fewer complications for SASD bursa injections, biceps tendon sheath injections, and AC and glenohumeral joint injections. Suprascapular nerve block studies similarly revealed earlier analgesic onset and enhanced functional outcomes with US. Regenerative therapies, particularly PRP, showed promising results when delivered under USG, with significant symptomatic improvement and favorable imaging outcomes in chronic rotator cuff tendinopathy. Conclusion: USG shoulder procedures offer substantial advantages in accuracy, safety, and clinical efficacy compared with blind techniques. Despite operator dependency and limited long-term comparative data, current evidence supports USG interventions as a cornerstone of modern shoulder pain management. Continued standardization, expanded training, and research on regenerative applications will further enhance their clinical utility.