Role of Ultrasonography in Upper Limb Musculoskeletal Interventions
Abdel-Rahman Mohamed Saad Mahmoud;
Abstract
The ultimate goal of all image-guided procedures is to maximize patient safety, improve procedural accuracy, and optimize clinical outcomes. In addition to facilitating these objectives, ultrasound-guidance also offers the benefit of eliminating ionizing radiation exposure during procedures.
Not only is ultrasound a readily available diagnostic technique for evaluating cysts, tendons, soft tissue masses, and joints, it has proved to be a valuable tool in guiding percutaneous procedures within the musculoskeletal system. Using ultrasound guidance for musculoskeletal interventions is rapidly growing in popularity because its utility and ease is becoming increasingly recognized not only by radiologists, but also by other clinicians such as orthopaedic surgeons, rheumatologists, sports medicine, and physical medicine and rehabilitation physicians.
Ultrasound-guidance has been demonstrated to be helpful in improving the ability of physicians to diagnose and treat pathologic conditions in the upper limb. It also has been demonstrated to increase procedure accuracy compared to palpation-guided procedures. Some authors indicate that complete accuracy of needle placement may not be essential for satisfactory outcome. This statement could be partially true when dealing with corticosteroids, which spread quite easily trough the tissues. However, a similar concept cannot be applied when hyaluronic acid is used. As its action is explicated only in the synovial space (e.g., joint, tendon sheath), precise in-site injection is mandatory. This implies that procedures that involve the use of hyaluronic acid should be always performed under guidance.
Some of the reported procedures can be performed also without ultrasound guidance. This is the case of intrarticular injections. However, when joint space is remarkably narrowed, ultrasound guidance may help to reach the target safely and with less discomfort for patients. Similarly, procedures to be performed on small anatomic structures (e.g., thickened but non-distended synovial sheath, as it happens in trigger finger) require ultrasound guidance.
It should be emphasized that an experienced operator is vital to ensure the success of the procedure and to minimize potential complications. Sonographic techniques are also applied in the therapeutic management of cysts, bursa infiltration, and aspiration of intra-tendon calcifications. Ultrasound procedures also play an important role as adjuvant therapy in various types of sports-related tendinopathies and muscular injuries, by injecting stimulators for tissue regeneration. The radiologist performing the procedure should be familiar with the condition to be treated, the regional anatomy and the pharmacologic arsenal to be used to achieve the maximum possible clinical benefit.
Not only is ultrasound a readily available diagnostic technique for evaluating cysts, tendons, soft tissue masses, and joints, it has proved to be a valuable tool in guiding percutaneous procedures within the musculoskeletal system. Using ultrasound guidance for musculoskeletal interventions is rapidly growing in popularity because its utility and ease is becoming increasingly recognized not only by radiologists, but also by other clinicians such as orthopaedic surgeons, rheumatologists, sports medicine, and physical medicine and rehabilitation physicians.
Ultrasound-guidance has been demonstrated to be helpful in improving the ability of physicians to diagnose and treat pathologic conditions in the upper limb. It also has been demonstrated to increase procedure accuracy compared to palpation-guided procedures. Some authors indicate that complete accuracy of needle placement may not be essential for satisfactory outcome. This statement could be partially true when dealing with corticosteroids, which spread quite easily trough the tissues. However, a similar concept cannot be applied when hyaluronic acid is used. As its action is explicated only in the synovial space (e.g., joint, tendon sheath), precise in-site injection is mandatory. This implies that procedures that involve the use of hyaluronic acid should be always performed under guidance.
Some of the reported procedures can be performed also without ultrasound guidance. This is the case of intrarticular injections. However, when joint space is remarkably narrowed, ultrasound guidance may help to reach the target safely and with less discomfort for patients. Similarly, procedures to be performed on small anatomic structures (e.g., thickened but non-distended synovial sheath, as it happens in trigger finger) require ultrasound guidance.
It should be emphasized that an experienced operator is vital to ensure the success of the procedure and to minimize potential complications. Sonographic techniques are also applied in the therapeutic management of cysts, bursa infiltration, and aspiration of intra-tendon calcifications. Ultrasound procedures also play an important role as adjuvant therapy in various types of sports-related tendinopathies and muscular injuries, by injecting stimulators for tissue regeneration. The radiologist performing the procedure should be familiar with the condition to be treated, the regional anatomy and the pharmacologic arsenal to be used to achieve the maximum possible clinical benefit.
Other data
| Title | Role of Ultrasonography in Upper Limb Musculoskeletal Interventions | Authors | Abdel-Rahman Mohamed Saad Mahmoud | Issue Date | 2018 |
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