Anaesthetics, steroids and platelet-rich plasma (PRP) in ultrasound-guided musculoskeletal procedures

Abstract

This review aims to evaluate the role of anaesthetics, steroids and platelet-rich plasma (PRP) employed with ultrasound-guided injection in the management of musculoskeletal pathology of the extremities. Ultrasound-guided injection represents an interesting and minimally invasive solution for the treatment of tendon and joint inflammatory or degenerative diseases. The availability of a variety of new drugs such as hyaluronic acid and PRP provides expansion of the indications and therapeutic possibilities. The clinical results obtained in terms of pain reduction and functional recovery suggest that the use of infiltrative procedures can be a good therapeutic alternative in degenerative and inflammatory joint diseases.

Figure 1.

The top image on the left (a) is showing the hypoechoic focal area of tendinopathy at the level of the insertional portion of the supraspinatus tendon (white arrow); in the middle (b) and on the right (c), T₁ and T₂ weighted images of the same lesion (black arrows) are shown. The bottom images report the good results obtained after platelet-rich plasma treatment at both the ultrasound (d) and MRI (e, f) examinations with the reduction of the lesion [white arrow in (d) and black arrows in (e, f)].

Figure 2.

The sagittal plane on the T₁ (a) and STIR (b) images demonstrate Achilles tendinopathy at the level of the insertional area (white arrows); the sagittal plane on the T₁ (c) and STIR (d) images are showing the results after platelet-rich plasma treatment with reduction of the thickness of this area (white arrows).

Figure 3.

In the T₁ weighted image (a) and the STIR image (b), the coronal planes are showing the femoral and tibial chondral damages (white arrows) on the lateral side, with joint effusion in the anterior recess on the axial plane (c). After platelet-rich plasma treatment, the coronal MR images are demonstrating the disappearance of the chondral damages in (d, e) (coronal planes) and the reduction of the joint effusion in (f) (axial plane).