Ultrasound-Guided Musculoskeletal Procedures

Chapter 128 discusses US-guided musculoskeletal (MSK) procedures. US is an effective imaging modality to guide MSK interventions, such as joint and soft tissue injections and aspirations. Preferred anatomical approaches for needle access for arthrocentesis, injection of contrast for MR arthrography, or injection of local corticosteroid for antiinflammatory effects to different joints are reviewed. A comprehensive US scanning of the targeted area should be performed prior to the intervention. Linear high-frequency transducers provide better detail in superficial locations, but curvilinear array transducers may be needed when targeting deeper structures. Aspiration of abscesses, hematomas, and ganglion cysts, and soft tissue biopsies are readily performed with US guidance. US guidance is effective for lavage and aspiration of calcific tendinosis and for guiding more novel interventions such as platelet-rich plasma injections for degenerative overuse injuries to the tendons and muscles.