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DOI: 10.1055/s-0041-1740349
Ultrasound-Guided Musculoskeletal Injections
Abstract
Musculoskeletal injections serve a variety of diagnostic and therapeutic purposes, with ultrasonography (US) guidance having many advantages: no ionizing radiation, real-time guidance, high spatial resolution, excellent soft tissue contrast, and the ability to identify and avoid critical structures. Sonography can be cost effective and afford flexibility in resource-constrained settings. This article describes US-guided musculoskeletal injections relevant to many radiology practices and provides experience-based suggestions. Structures covered include multiple joints (shoulder, hip), bursae (iliopsoas, subacromial-subdeltoid, greater trochanteric), peripheral nerves (sciatic, radial), and tendon sheaths (posterior tibial, peroneal, flexor hallucis longus, Achilles, long head of the biceps). Trigger point and similar targeted steroid injections, as well as calcific tendinopathy barbotage, are also described.
Publication History
Article published online:
22 December 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Jacobson JA. Interventional techniques. In: Fundamentals of Musculoskeletal Ultrasound. 3rd ed.. Philadelphia, PA: Elsevier; 2018: 407-443
- 2 Adler RS. Percutaneous ultrasound-guided interventions in the musculoskeletal system. In: Beggs I. ed. Musculoskeletal Ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins; 2013: 303-325
- 3 Waldman SD. Atlas of Interventional Pain Management. 4th ed.. Philadelphia, PA: Elsevier; 2015
- 4 Crim JR. Specialty Imaging: Arthrography. 2nd ed.. Philadelphia, PA: Elsevier; 2018
- 5 Shi J, Mandell JC, Burke CJ, Adler RS, Beltran LS. Review of interventional musculoskeletal US techniques. Radiographics 2020; 40 (06) 1684-1685
- 6 Strakowski JA. Ultrasound-guided peripheral nerve procedures. Phys Med Rehabil Clin N Am 2016; 27 (03) 687-715
- 7 Yablon C. Ultrasound-guided interventions of the foot and ankle. Semin Musculoskelet Radiol 2013; 17 (01) 60-68
- 8 Wijesekera N, Calder J, Lee J. Imaging in the assessment and management of Achilles tendinopathy and paratendinitis. Semin Musculoskelet Radiol 2011; 15 (01) 89-100
- 9 Peck E, Jelsing E, Onishi K. Advanced ultrasound-guided interventions for tendinopathy. Phys Med Rehabil Clin N Am 2016; 27 (03) 733-748
- 10 Unverferth LJ, Olix ML. The effect of local steroid injections on tendon. J Sports Med 1973; 1 (04) 31-37
- 11 Gottlieb NL, Riskin WG. Complications of local corticosteroid injections. JAMA 1980; 243 (15) 1547-1548
- 12 Ford LT, DeBender J. Tendon rupture after local steroid injection. South Med J 1979; 72 (07) 827-830
- 13 Honcharuk E, Monica J. Complications associated with intra-articular and extra-articular corticosteroid injections. JBJS Rev 2016; 4 (12) e2
- 14 Rand E, Welbel R, Visco CJ. Fundamental considerations for ultrasound-guided musculoskeletal interventions. Phys Med Rehabil Clin N Am 2016; 27 (03) 539-553
- 15 Nwawka OK, Miller TT. Ultrasound-guided peripheral nerve injection techniques. AJR Am J Roentgenol 2016; 207 (03) 507-516
- 16 Dettori N, Choudur H, Chhabra A. Ultrasound-guided treatment of peripheral nerve pathology. Semin Musculoskelet Radiol 2018; 22 (03) 364-374
- 17 Rastogi AK, Davis KW, Ross A, Rosas HG. Fundamentals of joint injection. AJR Am J Roentgenol 2016; 207 (03) 484-494
- 18 Beigi P, Salcudean SE, Ng GC, Rohling R. Enhancement of needle visualization and localization in ultrasound. Int J CARS 2021; 16 (01) 169-178
- 19 Scholten HJ, Pourtaherian A, Mihajlovic N, Korsten HHM. A Bouwman R. Improving needle tip identification during ultrasound-guided procedures in anaesthetic practice. Anaesthesia 2017; 72 (07) 889-904
- 20 Rowbotham EL, Grainger AJ. Ultrasound-guided intervention around the hip joint. AJR Am J Roentgenol 2011; 197 (01) W122–W127
- 21 Pourcho AM, Colio SW, Hall MM. Ultrasound-guided interventional procedures about the shoulder: anatomy, indications, and techniques. Phys Med Rehabil Clin N Am 2016; 27 (03) 555-572
- 22 Reisenauer C, Fazzio RT, Hesley G. Ultrasound-guided breast interventions: low incidence of infectious complications with use of an uncovered probe. AJR Am J Roentgenol 2017; 208 (05) 1147-1153
- 23 Frazee BW, Fahimi J, Lambert L, Nagdev A. Emergency department ultrasonographic probe contamination and experimental model of probe disinfection. Ann Emerg Med 2011; 58 (01) 56-63
- 24 Luchs JS, Sofka CM, Adler RS. Sonographic contrast effect of combined steroid and anesthetic injections: in vitro analysis. J Ultrasound Med 2007; 26 (02) 227-231
- 25 Jüni P, Hari R, Rutjes AW. et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev 2015; (10) CD005328
- 26 Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003; (01) CD004016
- 27 Jayaram P, Kennedy DJ, Yeh P, Dragoo J. Chondrotoxic effects of local anesthetics on human knee articular cartilage: a systematic review. PM R 2019; 11 (04) 379-400
- 28 Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought?. Radiology 2019; 293 (03) 656-663
- 29 Boutin RD, Pai J, Meehan JP, Newman JS, Yao L. Rapidly progressive idiopathic arthritis of the hip: incidence and risk factors in a controlled cohort study of 1471 patients after intra-articular corticosteroid injection. Skeletal Radiol 2021; 50 (12) 2449-2457
- 30 Simeone FJ, Vicentini JRT, Bredella MA, Chang CY. Are patients more likely to have hip osteoarthritis progression and femoral head collapse after hip steroid/anesthetic injections? A retrospective observational study. Skeletal Radiol 2019; 48 (09) 1417-1426
- 31 MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009; 252 (03) 647-661
- 32 Freire V, Bureau NJ. Injectable corticosteroids: take precautions and use caution. Semin Musculoskelet Radiol 2016; 20 (05) 401-408
- 33 Weinhammer AP, Shields BE, Keenan T. Intralesional corticosteroid-induced hypopigmentation and atrophy. Dermatol Online J 2020; 26 (01) 3
- 34 Stout A, Friedly J, Standaert CJ. Systemic absorption and side effects of locally injected glucocorticoids. PM R 2019; 11 (04) 409-419
- 35 Steinbach LS, Palmer WE, Schweitzer ME. Special focus session. MR arthrography. Radiographics 2002; 22 (05) 1223-1246
- 36 Gokalp G, Dusak A, Yazici Z. Efficacy of ultrasonography-guided shoulder MR arthrography using a posterior approach. Skeletal Radiol 2010; 39 (06) 575-579
- 37 Zwar RB, Read JW, Noakes JB. Sonographically guided glenohumeral joint injection. AJR Am J Roentgenol 2004; 183 (01) 48-50
- 38 Sconfienza LM, Chianca V, Messina C, Albano D, Pozzi G, Bazzocchi A. Upper limb interventions. Radiol Clin North Am 2019; 57 (05) 1073-1082
- 39 Collins JMP, Smithuis R, Rutten MJCM. US-guided injection of the upper and lower extremity joints. Eur J Radiol 2012; 81 (10) 2759-2770
- 40 Scher CE, Siegal DS. Video: Common upper extremity injections utilizing musculoskeletal ultrasound. AJR Am J Roentgenol 2014; 203 (01) 162-162
- 41 Lee KS, Rosas HG. Musculoskeletal ultrasound: how to treat calcific tendinitis of the rotator cuff by ultrasound-guided single-needle lavage technique. AJR Am J Roentgenol 2010; 195 (03) 638
- 42 Messina C, Sconfienza LM. Ultrasound-guided percutaneous irrigation of calcific tendinopathy. Semin Musculoskelet Radiol 2016; 20 (05) 409-413
- 43 Bureau N. Calcific tendinopathy of the shoulder. Semin Musculoskelet Radiol 2013; 17 (01) 80-84
- 44 Payne JM. Ultrasound-guided hip procedures. Phys Med Rehabil Clin N Am 2016; 27 (03) 607-629
- 45 Allen G, Obradov M, Chianca V, Messina C, Sconfienza LM. Ultrasound-guided musculoskeletal interventions for the most common hip and pelvis conditions: a step-by-step approach. Semin Musculoskelet Radiol 2019; 23 (03) e58-e67
- 46 Kantarci F, Ozbayrak M, Gulsen F, Gencturk M, Botanlioglu H, Mihmanli I. Ultrasound-guided injection for MR arthrography of the hip: comparison of two different techniques. Skeletal Radiol 2013; 42 (01) 37-42
- 47 Blaichman JI, Chan BY, Michelin P, Lee KS. US-guided musculoskeletal interventions in the hip with MRI and US correlation. Radiographics 2020; 40 (01) 181-199
- 48 Jacobson JA, Bedi A, Sekiya JK, Blankenbaker DG. Evaluation of the painful athletic hip: imaging options and imaging-guided injections. AJR Am J Roentgenol 2012; 199 (03) 516-524
- 49 Philippon MJ, Devitt BM, Campbell KJ. et al. Anatomic variance of the iliopsoas tendon. Am J Sports Med 2014; 42 (04) 807-811
- 50 Chalmers BP, Sculco PK, Sierra RJ, Trousdale RT, Berry DJ. Iliopsoas impingement after primary total hip arthroplasty: operative and nonoperative treatment outcomes. J Bone Joint Surg Am 2017; 99 (07) 557-564
- 51 Blankenbaker D, Tuite M. Iliopsoas musculotendinous unit. Semin Musculoskelet Radiol 2008; 12 (01) 13-27
- 52 Burke CJ, Adler RS. Ultrasound-guided percutaneous tendon treatments. AJR Am J Roentgenol 2016; 207 (03) 495-506
- 53 He L, Genin J, Delzell P. Ultrasound diagnosis and percutaneous treatment of Achilles tendon tethering: a case series. Skeletal Radiol 2016; 45 (09) 1293-1298
- 54 Nagpal AS, Moody EL. Interventional management for pelvic pain. Phys Med Rehabil Clin N Am 2017; 28 (03) 621-646
- 55 Singh V, Trescot A, Nishio I. Injections for chronic pain. Phys Med Rehabil Clin N Am 2015; 26 (02) 249-261
- 56 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am 2014; 25 (02) 357-374
- 57 Bonder JH, Chi M, Rispoli L. Myofascial pelvic pain and related disorders. Phys Med Rehabil Clin N Am 2017; 28 (03) 501-515
- 58 Yürük D, Akkaya ÖT, Polat ÖE, Alptekin HA. Ultrasound-guided erector spinae plane block and trapezius muscle injection for myofascial pain syndrome. J Ultrasound Med 2021 March 13 (Epub ahead of print)
- 59 Metin Ökmen B, Ökmen K, Altan L. Comparison of the efficiency of ultrasound-guided injections of the rhomboid major and trapezius muscles in myofascial pain syndrome: a prospective randomized controlled double-blind study. J Ultrasound Med 2018; 37 (05) 1151-1157
- 60 Michel F, Decavel P, Toussirot E. et al. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med 2013; 56 (05) 371-383
- 61 Lam KHS, Hung CY, Chiang YP. et al. Ultrasound-guided nerve hydrodissection for pain management: rationale, methods, current literature, and theoretical mechanisms. J Pain Res 2020; 13: 1957-1968
- 62 Cass SP. Ultrasound-guided nerve hydrodissection: what is it? A review of the literature. Curr Sports Med Rep 2016; 15 (01) 20-22
- 63 Buntragulpoontawee M, Chang KV, Vitoonpong T. et al. The effectiveness and safety of commonly used injectates for ultrasound-guided hydrodissection treatment of peripheral nerve entrapment syndromes: a systematic review. Front Pharmacol 2021; 11: 621150