Musculoskeletal Ultrasound Intervention: Principles and Advances
Section snippets
General principles
The choice of ultrasound probe is critical. High-frequency (7–12 MHz), linear array transducers should be used routinely. To visualize deep structures such as the hip in larger patients, lower frequency curvilinear probes may be required. However, such probes should be avoided when possible because they are prone to anisotropic artifact. Anisotropy is a phenomenon in which the appearance of a structure varies depending on the angle from which it is being examined. Anisotropic artifact is common
Medications
The most common medications used in musculoskeletal intervention are for local anesthesia. Lidocaine 2% (Xylocaine) is the author's drug of choice and has rapid onset with a duration of action of up to 5 hours.6 Bupivacaine (Sensorcaine, Marcaine) is an alternate slower-onset anesthetic but one which can last up to 12 hours and is available in 0.25%, 0.5%, and 0.75% concentrations. The duration of action of both drugs is shorter with lower concentration formulations.6
Corticosteroids have potent
Intra-articular intervention
Eustace and colleagues27 found that blind injections for shoulder pain, even in the hands of musculoskeletal specialists, are successful only in the minority of cases. In their series, only 29% of subacromial injections and 42% of glenohumeral joint injections were performed accurately without image guidance. In another recent study that compared ultrasound-guided and blind aspirations of suspected joint effusions, only 32% of cases returned fluid when performed blindly. In contrast, fluid was
Intratendinous intervention
Calcific and noncalcific tendinosis are two potentially symptomatic diseases that are often refractory to conservative management. The ability of ultrasound scan to accurately depict and localize tendon abnormalities makes ultrasound-guided calcium aspiration and prolotherapy invaluable in treating these conditions.
Intervention of ganglion cysts and bursae
Ultrasonography is the ideal modality for image-guided aspiration and injection of most cysts and bursae in the musculoskeletal system. The ability of ultrasound imaging to target even very small collections while avoiding adjacent critical structures in real time is essential in treating these lesions successfully.
Summary
Ultrasound-guided intervention is probably underutilized currently in North America. However, the dynamic, multiplanar capability of ultrasonography makes it an attractive alternative to procedures that might otherwise be performed under fluoroscopic or computed tomography guidance. Indeed, the majority of joints, cysts, and bursae can be accessed routinely under sonographic control. In the cases of barbotage and prolotherapy, ultrasonography has given fresh breath to old concepts and has
Acknowledgments
This article would not have been possible without the outstanding contributions of the medical sonography team at UBC Hospital. In particular, the author wishes to thank Anne Hope, Maureen Kennedy, and Pam Grossman for their unwavering enthusiasm and support. The author also wishes to recognize Paulina Louis for her invaluable help in preparing the manuscript.
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