MUSCULOSKELETAL ULTRASOUND

GUIDED INJECTIONS

MUSC

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www.mskus.com

THOMAS B. CLARK

Handbook of Ultrasound Guided InjectionsTable of Contents

Anterior Biceps TendonSuperior Acromioclavicular (AC) Joint Subacromial BursaLateral Rotator Cuff Rotator Cuff IntervalPosterior Posterior Glenohumeral (GH) Joint Suprascapular Nerve

Lateral Lateral EpicondyleAnterior Elbow JointMedial Medial Epicondyle

Flexor Carpal Tunnel (Median Nerve)Extensor Wrist Joint

Extensor De Quervain’s (1st Compartment)Flexor 1st CMC Joint

Anterior Anterior Hip JointLateral Greater Trochanteric BursaPosterior Hamstrings

Piriformis

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Chapter 1 Shoulder

Chapter 2 Elbow

Chapter 3 Wrist

Chapter 4 Hand

Chapter 5 Pelvis

Chapter 6 Hip

Anterior Ankle Joint ATF LigamentSuperior Posterior Tibial NerveLateral Subtalar JointPosterior Achilles Tendon

Suprapatellar Suprapatellar Knee Joint Infrapatellar Pes Anserine BursaLateral Distal Iliotibial Band (ITB)Posterior Peroneal Nerve

Cervical Greater Occipital NerveThoracic Costotransverse Joint (upper, mid, low)Sacral Sacroiliac Joint

Plantar Plantar Fascia

Needling Techniques

Physics, Knobology, & Nomenclature

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Chapter 7 Knee

Chapter 8 Ankle

Handbook of Ultrasound Guided InjectionsTable of Contents

Chapter 9 Foot

Chapter 10 Spine

Chapter 11 Physics, Knobology, Nomenclature

Chapter 12 Needling Techniques

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6

Rotator CuffShoulder

Patient Position:

Doctor Position:

Probe Position:

Needle Approach:

laying on side with hand on hip, US machine cross table with patient facing US machine

standing behind pa-tient facing slightly cau-dally towards US machine

long axis to supraspinatus (in-fraspinatus/teres minor) (probe pointed toward patients um-bilicus, 48 degrees off sagital)

in plane approach, close to probe to keep needle work within the super-ficial curve cuff. (try to not with-draw needle from tendon to pre-vent excess bolus leakage). As well as seal needle pressure if perform-ing calcific lavage (calcific lavage necessitates having syringe below the calcification to utilize gravity to pull calcium slurry into syringe)

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Distal Iliotibial Band (ITB)Knee

Patient Position:

Doctor Position:

Probe Position:

Needle Approach:

laying on side affected leg up and only slightly flexed with pillow between thighs,US machine cross table but dependent on doctors

standing, side of table opposite his dominant hand (left side of table for right hand dominant doctor)

long axis, distal to medial (unless approach is toward Gerde’s tubercle) with ITBoverlying lateral femoral con-dyle. *Confirm location of lateral geniculate arteries

in plane approach, caudal to cephalad. (In plane cephalad to caudal to approach Gerde’s tubercle. *Reconfirm ge-niculate artery location)

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Plantar FasciaFoot

Patient Position:

Doctor Position:

Probe Position:

Needle Approach:

on side (same position to per-form tibial nerve block prior to this approach) but US machine and doc-tor position switched to opposite sides.

seated facing from anterior to posterior and facing US machine contra-lateral side from patients feet

long axis to plantar fascia

in plane slightly out of plane from arch side of probe to attain superficial approach needed. *If tibial block is incomplete, abort approach and redo tibial nerve block, re-member calcaneal branch of tibial nerve leaves bundle most cephalad. *Approach level to probe by confirming target depth

*Approach without tibial block: probe long axis and medial plantar fat pad from con-firmed depth in an out of plane aproach