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
- 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.
- All foot and ankle
- Radiocarpal/distal radioulnar joint