# Implementation of Ultrasound-Guided Musculoskeletal Injections in a South Trinidad Medical Practice: A Perspective From a Resource-Limited Setting

## TL;DR

This paper describes the successful use of ultrasound-guided injections for musculoskeletal pain in a resource-limited setting in Trinidad, showing improved patient outcomes without major complications.

## Contribution

The paper provides a practical perspective on implementing ultrasound-guided musculoskeletal injections in a low-resource clinical environment.

## Key findings

- 115 patients with chronic musculoskeletal pain showed qualitative improvement after ultrasound-guided injections.
- No major complications were observed during the two-year implementation period.
- The procedures were found to be feasible and safe in a setting with limited access to advanced imaging or surgery.

## Abstract

Musculoskeletal pain (MSP) is a general term for pain varying by source, characterized into nociceptive (tissue pain), neuropathic (nerve pain), and nociplastic (centralized pain). It affects muscles, bones, joints, tendons, and ligaments due to multiple etiologies, including trauma, degenerative changes, or autoimmune and inflammatory disorders, presenting as either acute or chronic pain with symptoms such as sharp, dull, tingling, or burning sensations. It is a leading cause of disability globally, particularly in low and middle-income countries. We want to highlight a real-world implementation that aims to illustrate translational feasibility, and not a comparative efficacy trial on degenerative (wear and tear) conditions such as osteoarthritis and tendinous injuries. Ultrasound-guided musculoskeletal (MSK) injections offer a minimally invasive and accurate treatment option for these two conditions, especially in settings where patients can face barriers to surgical care. Traditionally, management of such cases includes analgesia, physiotherapy, and surgery. This article highlights the implementation of ultrasound-guided musculoskeletal injection procedures in a general medical and surgical clinical setting in southern Trinidad, including hyaluronic acid (HA), platelet-rich plasma (PRP), and diluted corticosteroid injections. Over the course of two years (2023-2025), a total of 115 adult patients with chronic MSP who had an unsatisfactory response to treatment with oral analgesics were treated under ultrasound guidance. The patients largely reported qualitative improvement in pain and increased functionality post-intervention. No major complications due to the procedures were observed. Through this perspective/observational experience, we do not aim to quantify the treatment effect sizes, but rather to bring to attention the practical procedural techniques, associated safety, potential workflow advantages, and practical considerations of ultrasound-guided musculoskeletal injections, thereby highlighting their use as a radiation-free, feasible, and efficient intermediate treatment option in resource-limited settings that have limited access to advanced imaging or surgical services.