Elsevier

Current Problems in Diagnostic Radiology

Volume 37, Issue 5, September–October 2008, Pages 203-218
Current Problems in Diagnostic Radiology

Original article
Ultrasound-Guided Therapeutic Procedures in the Musculoskeletal System

https://doi.org/10.1067/j.cpradiol.2007.08.001Get rights and content

Ultrasound allows the exploration of most of the musculoskeletal system, including lytic bone lesions. Its flexibility, availability, and low cost make it the best tool to guide interventional therapeutic procedures in any musculoskeletal system lesion visible on ultrasound. These techniques include drainages of abscesses, bursitis, hematomas or muscular strains, treatment of cystic lesions (ganglions, Baker's cysts), arthrocentesis, injection of substances in joints and soft tissues, and aspiration of calcific tendinitis. Although the puncture of joints for arthrocentesis and injection of substances are performed by clinicians using palpation, the use of ultrasound guidance improves the effectiveness of the technique especially for small or poorly accessible lesions and joints and for obese patients. Drainage can be performed using catheters or needles and can avoid a more aggressive approach most of the time. Intracavitary urokinase helps when the aim is to drain clotted hematomas or fibrinous collections. Injection of corticoids is useful in the treatment of ganglia, Baker's cysts, tendinitis, and noninfected arthritis. Calcific tendinitis of the shoulder can be effectively treated using percutaneous “lavage” with lidocaine. Calcifications usually disappear and symptoms improve in nearly 90% of the cases within a year. Most of these techniques are low cost and require only a moderate skill. Ultrasound-guided procedures are useful tools to effectively treat some diseases of the musculoskeletal system and should be routine in any imaging department.

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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