Musculoskeletal Ultrasound for Referring Clinicians: Image Guided Therapies

Many joint and musculoskeletal complaints are readily treated with the following outpatient procedures which are well-tolerated with low risks.

Ultrasound steroid/anesthetic injections

  • Nearly any joint, tendon sheath or bursa can be injected.

Special Procedures Fluoroscopy


  • Indication: frozen shoulder/adhesive capsulitis
  • The glenohumeral joint is distended with saline under fluoroscopic imaging to stretch and possibly rupture the scarred fibrous capsule.

Special Procedures Ultrasound

Tendon fenestration

Indication: tendinosis

  • A needle is repeatedly placed into an abnormal tendon, disrupting the degenerative process and inciting an inflammatory response to promote healing.
  • Typically done for the rotator cuff tendons, common extensor tendon in tennis elbow, Achilles tendon, gluteal tendons for greater trochanteric pain syndrome, or the patellar tendon.

Calcific tendinosis barbotage

Indication: calcific tendinosis

  • Procedure: A needle is placed into calcium deposits within an abnormal tendon. A small amount of saline and lidocaine is repeatedly injected into the deposit followed by immediate aspiration in a series of pulses. This incites an inflammatory response by the body to resorb these deposits.
  • Considerations: Most patients need only one treatment and many have no radiographic evidence of retained calcium within the tendon at 6-12 months.

Aspiration – nearly any fluid collection in the musculoskeletal system is amenable to aspiration usually under ultrasound guidance.

Fluoroscopic Injections

  • All foot and ankle
  • Shoulder
  • Radiocarpal/distal radioulnar joint
  • Elbow
  • Hip
  • Knee