Original articleUltrasound-Guided Therapeutic Procedures in the Musculoskeletal System
Section snippets
General Requirements
Before starting any procedure, the lesion to be treated must be identified, defined, and located with precision. So, a careful US study of the area where the lesion is located is required. Usually, high-resolution (more than 7 MHz) lineal array transducers are the most suitable to carry out most of the explorations and interventions in the musculoskeletal system. Occasionally, for lesions or structures deeply located, it may be necessary to use 3.5- or 5-MHz curved array probes.1 Convex probes
Arthrocentesis
The puncture of joints for arthrocentesis and the injection of substances is a routine procedure performed by orthopedists and rheumatologists. In most cases, they carry it out without image aid, using palpation for guidance. However, the reliability of the intra-articular location of the injection is relatively low.5, 6 Similarly, the failure of arthrocentesis performed without imaging control is quite high, especially in obese patients and small effusions. The puncture of joints guided by US
Joint and Soft-Tissue Injections
Similar to arthrocentesis, joint and soft-tissue injections are also routinely performed by orthopedists and rheumatologists under palpation, without image aid. However, the accuracy of the location of the injection cannot be guaranteed. US guidance is excellent to confirm that the injection is placed in the point where it is most effective.
Drainage of Hematomas
Hematomas of soft tissue are generally of traumatic origin, although they appear more easily in patients with bleeding diatheses, especially in those who are being treated with anticoagulant drugs. In patients with soft-tissue or muscular hematomas, the drainage can relieve the associated symptoms and reduce the time required to heal the lesion.
Treatment of Popliteal Cysts
Popliteal or Baker's cysts are distended bursae within the popliteal space, particularly of the semimembranous-gastricnemius bursa. They are usually caused by an increase in synovial fluid volume and pressure associated with diverse pathologies of the knee of traumatic, degenerative, or inflammatory origin.18 Baker's cysts are generally asymptomatic and require no treatment. However, they may cause symptoms due to inflammation, rupture, intracystic hemorrhage, increased internal pressure, or
Aspiration of Calcific Tendinitis in the Shoulder
Calcific tendinitis is the deposit of calcium in the tendons of the rotator cuff, and especially, in the supraspinatus tendon. It can be bilateral. Its pathogenesis is unknown. Calcifications usually appear in adults between 30 and 60 years of age. In general, it is a self-limited process in which the calcifications tend to be reabsorbed and disappear. Reabsorption of the calcifications is observed in 9% of patients after 3 years and in 27% after 10 years.20 However, in 50% of the patients,
Conclusions
Ultrasound is the simplest and most efficient imaging method to guide intervention procedures in the musculoskeletal system. These procedures are easy to perform, inexpensive, and available to any unit, whatever its size. Its efficiency rate is very high.
The involvement of radiologists in this type of procedure is very important, both as a service to the patient and to maintain our position in the use of the musculoskeletal US.
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