Complications in image-guided musculoskeletal injections

Abstract

Complications in musculoskeletal interventions are rare and where they do occur tend to be minor, and often short-lived or self-limiting. Nonetheless, the potential for significant complications exists, and a thorough understanding of both the mechanisms which contribute and the manner in which they may clinically present is of critical importance for all musculoskeletal radiologists involved in performing procedures, both to mitigate against the occurrence of complications and to aid rapid recognition. The purpose of this review is to analyse the relevant literature to establish the frequency with which complications occur following musculoskeletal intervention. Furthermore, we highlight some of the more commonly discussed and feared complications in musculoskeletal intervention, such as the risk of infection, potential deleterious articular consequences including accelerated joint destruction and the poorly understood and often underestimated systemic effects of locally injected corticosteroids. We also consider both extremely rare but emergent scenarios such as anaphylactic reactions to medications, and much more common but less significant complications such as post-procedural pain. We suggest that meticulous attention to detail including strict adherence to aseptic technique and precise needle placement may reduce the frequency with which complications occur.

Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial

“…The side effect of the steroid varies based on the body site where it is injected; in the joint, muscle or spine. A review done by Hynes and Kavanagh, 2022 reveals that extra-articular steroid injection reports minor and major events in 0.81% and 0.5 to 8%, respectively while the injection in shoulder joints presents the major reaction in 18.1% [ 68 ]. As in our study, the injection was locally applied to the heel region; there were few chances of side effects like pain and discomfort for a few days, temporary bursitis, and flushing of the face for a few hours.…”

Tips and tricks in ultrasound-guided musculoskeletal interventional procedures

“…The most important preventable complication for any US-guided percutaneous MSK intervention is iatrogenic infection, including septic arthritis, which can be devastating if not promptly recognized and treated. Strict adherence to universal precautions, aseptic technique, and precise needle placement are critical to minimizing infection risk (17) .…”

“…The universal precautions exercised in accordance with individual institutional policies and common clinical practice guidelines for all interventional procedures should be no different for US-guided interventions. Indeed, US-guided interventions are not known to be associated with an increased risk of infectious complications (17) . However, the transducer utilized for real-time guidance is neither disposable nor single-use as is the case for all other instruments used in the procedure.…”