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Review
. 2013 Apr 30;16(2):45-55.
doi: 10.1007/s40477-013-0018-9. eCollection 2013.

Interventional musculoskeletal US: an update on materials and methods

Guido Robotti  1 , Maria Grazia Canepa, Chandra Bortolotto, Ferdinando Draghi
Affiliations
Review

Interventional musculoskeletal US: an update on materials and methods

Guido Robotti et al. J Ultrasound. .

Abstract
in English, German

Pain is one of the most common causes of reduced productivity. The annual cost of health-related reductions in productivity has been estimated at approximately 225 billion dollars in the United States alone. Ultrasound-guided locoregional infiltration procedures have frequently been shown to offer economical, effective, lasting relief of pain. In-depth familiarity with the equipment (probes and needles) and techniques used to perform these procedures are fundamental for safe, effective treatment. In fact, depending on the characteristics of the patient and the clinical problem, the approach and technique may have to be modified to simplify the procedure and ensure better results. Up-to-date knowledge of the drugs used for these infiltrations (indications, how they are used) is equally important. Our aim is to provide an update on the techniques and materials used in interventional musculoskeletal ultrasonography based on a review of the most recent literature as well as on our personal experience.

Il dolore è una delle cause più frequenti di riduzione della produttività. Si stima che i costi della riduzione della produttività legata a problemi di salute siano di circa 225 miliardi di dollari per anno, nei soli Stati Uniti. Tra i trattamenti che hanno più frequentemente dimostrato di possedere caratteristiche di economicità, efficacia e durevolezza nella riduzione del dolore vi sono indubbiamente i trattamenti infiltrativi loco-regionali eco-guidati. E’ fondamentale avere una conoscenza approfondita delle apparecchiature (sonde e aghi) e delle diverse tecniche per raggiungere il sito di iniezione efficacemente ed in sicurezza. Infatti, in base alle caratteristiche del paziente e al problema clinico, può essere necessario cambiare approccio e tecnica al fine di raggiungere più semplicemente il miglior risultato. Non meno importante è un costante aggiornamento sulla corretta selezione e impiego delle sostanze da iniettare. Ci proponiamo pertanto di realizzare un update sulle tecniche e sui materiali utilizzati in ecografia interventistica muscoloscheletrica, alla luce sia della letteratura più recente che della nostra personale esperienza.

Keywords: Interventional ultrasonography; Musculoskeletal pain; Pain management.

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Figures

Fig. 1
Fig. 1
Use of sclerosing agents to treat tendinopathies. Longitudinal US scan of the Achilles tendon using a high-frequency transducer. Color Doppler is used to identify the area to be treated, which is the most highly vascularized zone (a). Longitudinal US scan of the Achilles tendon using a high-frequency linear transducer. Under US guidance, the needle is inserted in the previously identified area of the tendon (b)
Fig. 2
Fig. 2
Morton’s neuroma. Axial STIR T2-weighted MRI scan. The neuroma is clearly visualized in the space between the third and fourth metatarsals (a). Scan performed along the short axis of the nerve with a high-frequency linear transducer. The neuroma is clearly visualized as a hypoechoic lesion located in the space between the metatarsal heads (b). The needle tip is inserted into the neuroma (c). After treatment, the neuroma appears hyperechoic (d)
Fig. 3
Fig. 3
Needles used during US-guided musculoskeletal interventional procedures. 20-gauge needle (a), 23-gauge needle (b)
Fig. 4
Fig. 4
Intralesional flow. US reveals an intramuscular hematoma whose content appears hypoechoic. Injection of normal saline is associated with a hyperechoic ‘spurt’ of fluid within the lesion (arrow), which confirms that the needle tip has been correctly placed
Fig. 5
Fig. 5
de Quervain syndrome. US shows marked hyperechoic thickening of the extensor retinaculum. The needle tip (arrow) can be visualized as it advances to the injection site
Fig. 6
Fig. 6
Lateral epicondylitis. US-guided infiltration. The needle tip (arrow) is positioned in the peritendinous soft tissues and the contents of the syringe injected
Fig. 7
Fig. 7
US-guided infiltration of the subdeltoid bursa. Anteroposterior radiograph: the arrow identifies the trajectory of the needle and the arrowhead the bursa (a). Coronal US scan performed with a high-frequency linear array transducer. The needle is advanced into the bursa, which is located between the deltoid muscle and the rotator cuff (b). Coronal US scan performed with a high-frequency linear array transducer. The image confirms uniform distribution of the injected substance within the bursa (c)
Fig. 8
Fig. 8
US-guided infiltration of enthesitis of the supraspinatus tendon. Coronal MRI scan (proton density weighted with fat suppression): the arrows indicate an area of degenerative changes at the insertion of the supraspinatus tendon (a). US scan along the long axis of the tendon with a high-frequency linear array transducer (b). The tip of the needle is visualized as it is advanced toward the degenerated zone of the tendon
Fig. 9
Fig. 9
Calcifications of the supraspinatus tendon. Anteroposterior radiograph reveals gross calcifications on the tendon of the supraspinatus muscle (a). Sonographic scan along the long axis of the tendon with a high-frequency linear transducer. The calcifications are delimited by the calipers (b). The needle is placed near the calcification and the area flushed with normal saline (c)
Fig. 10
Fig. 10
Coxofemoral joint. Sonography: longitudinal scan with a 9 MHz linear transducer. Detail of the image showing the tip of the needle as it advances toward the anterior synovial recess
Fig. 11
Fig. 11
Tibiotalar joint. Anterior longitudinal scan with a high-frequency linear transducer. The tip of the needle is placed at the level of the joint, identifying the space between the tibia and the talus
See this image and copyright information in PMC

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