Interventional Musculoskeletal Ultrasound

  • 188 Accesses


Rather than try and perform a comprehensive review of ultrasound-guided musculoskeletal intervention, this article is arranged to focus on specific topics by revisiting and discussing the practical ways of improving the commonly performed procedures including the treatment of De Quervain’s tenosynovitis and calcific tendinopathy in addition to addressing recent and newly developed procedures such as platelet-rich protein and ultrasound-guided nerve ablation.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7


    Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

    1. 1.

      Sabeti-Aschraf M, Lemmerhofer B, Lang S, et al. Ultrasound guidance improves the accuracy of the acromioclavicular joint infiltration: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc. 2011;19:292–5.

    2. 2.

      Bum Park Y, Ah Choi W, Kim YK, Chul Lee S, Hae Lee J. Accuracy of blind versus ultrasound-guided suprapatellar bursal injection. J Clin Ultrasound. 2012;40:20–5.

    3. 3.

      Sibbitt WL Jr, Kettwich LG, Band PA, et al. Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee? Scand J Rheumatol. 2012;41:66–72.

    4. 4.

      Sibbitt WL Jr, Peisajovich A, Michael AA, et al. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J Rheumatol. 2009;36:1892–902.

    5. 5.

      Rutten MJ, Maresch BJ, Jager GJ, de Waal Malefijt MC. Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided? Acta Orthop. 2007;78:254–7.

    6. 6.

      Rousset P, Vuillemin-Bodaghi V, Laredo JD, Parlier-Cuau C. Anatomic variations in the first extensor compartment of the wrist: accuracy of US. Radiology. 2010;257:427–33.

    7. 7.

      Jackson WT, Viegas SF, Coon TM, Stimpson KD, Frogameni AD, Simpson JM. Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. J Bone Joint Surg Am. 1986;68:923–6.

    8. 8.

      Fabrizio PA, Clemente FR. A variation in the organization of abductor pollicis longus. Clin Anat. 1996;9:371–5.

    9. 9.

      Lee JC, Healy JC. Normal sonographic anatomy of the wrist and hand. Radiographics. 2005;25:1577–90.

    10. 10.

      Daenen B, Houben G, Bauduin E, Debry R, Magotteaux P. Sonography in wrist tendon pathology. J Clin Ultrasound. 2004;32:462–9.

    11. 11.

      De Leao L. Quervain’s disease; a clinical and anatomical study. J Bone Joint Surg Am. 1958;40:1063–70.

    12. 12.

      •• Mahakkanukrauh P, Mahakkanukrauh C. Incidence of a septum in the first dorsal compartment and its effects on therapy of de Quervain’s disease. Clin Anat. 2000;13:195–8. Key article in understanding the importance of identifying the septum in the first dorsal compartment and the effect on treatment of de Quervain's tenosynovitis.

    13. 13.

      Gousheh J, Yavari M, Arasteh E. Division of the first dorsal compartment of the hand into two separated canals: rule or exception? Arch Iran Med. 2009;12:52–4.

    14. 14.

      Minamikawa Y, Peimer CA, Cox WL, Sherwin FS. De Quervain’s syndrome: surgical and anatomical studies of the fibroosseous canal. Orthopedics. 1991;14:545–9.

    15. 15.

      Mirzanli C, Ozturk K, Esenyel CZ, Ayanoglu S, Imren Y, Aliustaoglu S. Accuracy of intrasheath injection techniques for de Quervain’s disease: a cadaveric study. J Hand Surgery Eur Vol. 2012;37:155–60.

    16. 16.

      Harvey FJ, Harvey PM, Horsley MW. De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg. 1990;15:83–7.

    17. 17.

      Witt J, Pess G, Gelberman RH. Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am. 1991;73:219–22.

    18. 18.

      Anderson BC, Manthey R, Brouns MC. Treatment of De Quervain’s tenosynovitis with corticosteroids. A prospective study of the response to local injection. Arthritis Rheum. 1991;34:793–8.

    19. 19.

      Sawaizumi T, Nanno M, Ito H. De Quervain’s disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31:265–8.

    20. 20.

      MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009;252:647–61.

    21. 21.

      • Dwek J, Pfirrmann C, Stanley A, Pathria M, Chung CB. MR imaging of the hip abductors: normal anatomy and commonly encountered pathology at the greater trochanter. Magn Reson Imaging Clin N Am. 2005;13:691–704 vii. Key article detailing the normal anatomy and common pathology around the greater trochanter.

    22. 22.

      Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88:988–92.

    23. 23.

      •• Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. Am J Roentgenol. 2013;201:1083–6. One of the first articles to discuss the primary pathology associated with greater trochanteric pain and demonstrate the relative lack of greater trochanteric bursitis in this patient population.

    24. 24.

      Labrosse JM, Cardinal E, Leduc BE, et al. Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. Am J Roentgenol. 2010;194:202–6.

    25. 25.

      • McEvoy JR, Lee KS, Blankenbaker DG, del Rio AM, Keene JS. Ultrasound-guided corticosteroid injections for treatment of greater trochanteric pain syndrome: greater trochanter bursa versus subgluteus medius bursa. Am J Roentgenol. 2013;201:W313–7. Article describes improved efficacy of image guided injections for greater trochanteric pain syndrome if one targets the site of maximal tenderness and the greater trochanteric bursa overlying the gluteus medius tendon.

    26. 26.

      Balke M, Bielefeld R, Schmidt C, Dedy N, Liem D. Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment. Am J Sports Med. 2012;40:657–61.

    27. 27.

      Gosens T, Hofstee DJ. Calcifying tendinitis of the shoulder: advances in imaging and management. Curr Rheumatol Rep. 2009;11:129–34.

    28. 28.

      Speed CA, Hazleman BL. Calcific tendinitis of the shoulder. N Engl J Med. 1999;340:1582–4.

    29. 29.

      Uhthoff HK, Loehr JW. Calcific Tendinopathy of the Rotator Cuff: pathogenesis, Diagnosis, and Management. J Am Acad Orthop Surg. 1997;5:183–91.

    30. 30.

      Sorensen L, Teichert G, Skjodt T, Dichmann OL. Preoperative ultrasonographic-guided marking of calcium deposits in the rotator cuff facilitates localization during arthroscopic surgery. Arthroscopy. 2004;20(Suppl 2):103–4.

    31. 31.

      Leduc BE, Caya J, Tremblay S, Bureau NJ, Dumont M. Treatment of calcifying tendinitis of the shoulder by acetic acid iontophoresis: a double-blind randomized controlled trial. Arch Phys Med Rehabil. 2003;84:1523–7.

    32. 32.

      Daecke W, Kusnierczak D, Loew M. Long-term effects of extracorporeal shockwave therapy in chronic calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 2002;11:476–80.

    33. 33.

      Wang CJ, Yang KD, Wang FS, Chen HH, Wang JW. Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Am J Sports Med. 2003;31:425–30.

    34. 34.

      Rompe JD, Zoellner J, Nafe B. Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder. Clin Orthop Relat Res. 2001;387:72–82.

    35. 35.

      •• Comfort TH, Arafiles RP. Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis. Clin Orthop Relat Res. 1978;(135):171–8. Key article describing image guided barbotage of calcific tendinitis. Changed the way we treated patients and demonstrated a much less invasive means of treating this particular entity.

    36. 36.

      • del Cura JL, Torre I, Zabala R, Legorburu A. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. Am J Roentgenol. 2007;189:W128–34. Article demonstrates good long term outcomes following image guided lavage of calcific tendonitis.

    37. 37.

      Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment–nonrandomized controlled trial. Radiology. 2009;252:157–64.

    38. 38.

      Sconfienza LM, Bandirali M, Serafini G, et al. Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment? Radiology. 2012;262:560–6.

    39. 39.

      Jelsing EJ, Maida E, Smith J. A simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff tendinopathy. PM R. 2013;5:242–4.

    40. 40.

      Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37:2259–72.

    41. 41.

      Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surgery Br. 2009;91:987–96.

    42. 42.

      Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering RM. Use of autologous platelet-rich plasma to treat muscle strain injuries. Am J Sports Med. 2009;37:1135–42.

    43. 43.

      Hildebrand KA, Woo SL, Smith DW, et al. The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament. An in vivo study. Am J Sports Med. 1998;26:549–54.

    44. 44.

      Lyras DN, Kazakos K, Verettas D, et al. The effect of platelet-rich plasma gel in the early phase of patellar tendon healing. Arch Orthop Trauma Surg. 2009;129:1577–82.

    45. 45.

      Virchenko O, Aspenberg P. How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? Interplay between early regeneration and mechanical stimulation. Acta Orthop. 2006;77:806–12.

    46. 46.

      Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34:1774–8.

    47. 47.

      • Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010;38:255–62. One of the early studies on PRP which was a double blind randomized controlled study. Also one of the first articles to demonstrate a positive effect of PRP.

    48. 48.

      Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011;39:1200–8.

    49. 49.

      de Vos RJ, Weir A, van Schie HT, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303:144–9.

    50. 50.

      McShane JM, Nazarian LN, Harwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med. 2006;25:1281–9.

    51. 51.

      Housner JA, Jacobson JA, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 2009;28:1187–92.

    52. 52.

      Housner JA, Jacobson JA, Morag Y, Pujalte GG, Northway RM, Boon TA. Should ultrasound-guided needle fenestration be considered as a treatment option for recalcitrant patellar tendinopathy? A retrospective study of 47 cases. Clin J Sport Med. 2010;20:488–90.

    53. 53.

      Ohberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med. 2002;36:173–5 discussion 6-7.

    54. 54.

      Alfredson H, Ohberg L. Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial. Knee Surg, Sports Traumatol Arthrosc. 2005;13:338–44.

    55. 55.

      Chan BP, Fu SC, Qin L, Rolf C, Chan KM. Supplementation-time dependence of growth factors in promoting tendon healing. Clin Orthop Relat Res. 2006;448:240–7.

    56. 56.

      Liu Y, Kalen A, Risto O, Wahlstrom O. Fibroblast proliferation due to exposure to a platelet concentrate in vitro is pH dependent. Wound Repair Regen. 2002;10:336–40 official publication of the Wound Healing Society [and] the European Tissue Repair Society 2002.

    57. 57.

      Liu SS, Ngeow JE, Yadeau JT. Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med. 2009;34:47–59.

    58. 58.

      Leggett LE, Soril LJ, Lorenzetti DL, et al. Radiofrequency ablation for chronic low back pain: a systematic review of randomized controlled trials. Pain Res Manag. 2014;19:e146–53.

    59. 59.

      Kastler A, Aubry S, Barbier-Brion B, Jehl J, Kastler B. Radiofrequency neurolysis in the management of inguinal neuralgia: preliminary study. Radiology. 2012;262:701–7.

    60. 60.

      Rosas HG. Ultrasound Guided Neurolysis Utilizing Microwave Ablation Technology. Las Vegas: American Institute of Ultrasound in Medicine Annual Convention; 2014.

    Download references

    Author information

    Correspondence to Humberto G. Rosas.

    Additional information

    This article is part of the Topical Collection on Musculoskeletal Ultrasound.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Supplementary material 1 (AVI 26046 kb)

    Supplementary material 1 (AVI 26046 kb)

    Rights and permissions

    Reprints and Permissions

    About this article

    Verify currency and authenticity via CrossMark

    Cite this article

    Rosas, H.G. Interventional Musculoskeletal Ultrasound. Curr Radiol Rep 3, 24 (2015) doi:10.1007/s40134-015-0105-0

    Download citation


    • Musculoskeletal
    • Ultrasound
    • Platelet-rich plasma
    • Calcific tendinitis
    • De Quervain’s tenosynovitis
    • Greater trochanteric pain syndrome