Ultrasound-guided interventions of the upper extremity joints

Abstract

Ultrasound guidance is valuable for performing precise joint interventions. Joint interventions may be requested for therapeutic and diagnostic pain injections, joint aspiration in the setting of suspected infection, or contrast injection for arthrography. In practice, interventions of the shoulder girdle, elbow, and hand/wrist joints may be performed without any imaging guidance. However, imaging guidance results in more accurate interventions and better patient outcomes than those performed by palpation alone. When compared to other modalities used for imaging guidance, ultrasound has many potential advantages. Radiologists should be prepared to perform ultrasound-guided upper extremity joint interventions utilizing recommended techniques to optimize clinical practice and patient outcomes. Key points 1. Ultrasound-guided injections of the glenohumeral, acromioclavicular, sternoclavicular, elbow, and hand/wrist joints have higher accuracy than injections performed without imaging guidance. 2. Ultrasound-guided aspirations of upper extremity joints have advantages to fluoroscopic-guided aspirations because of the potential to identify effusions, soft tissue abscess, or bursitis. 3. Ultrasound-guided contrast injection prior to MR arthrography is as accurate as fluoroscopic-guided injection for upper extremity joints.

In-Plane Ultrasound-Guided Botulinum Toxin Injection to Lumbrical and Interosseus Upper Limb Muscles: Technical Report

“…The depth setting should be configured to capture the target muscles effectively while avoiding excessive penetration into surrounding tissues. Typically, a 27-gauge needle with a 3-4 cm length is employed [ 2 , 4 ].…”

“…Physicians should evaluate the merits and drawbacks of each technique to determine the most suitable approach for specific cases. Both techniques are applicable to the lumbrical and interosseous muscles of the hand [ 2 , 4 ].…”

“…However, these approaches possess limitations that can lead to inaccurate needle placement and suboptimal treatment outcomes. Moreover, the absence of real-time visualization during the injection procedure increases the risk of adverse effects and potentially compromises patient safety [ 4 , 5 ].…”

“…In-plane ultrasound guidance has the potential to revolutionize precision and safety in BTX injections for the lumbrical and interosseous muscles of the upper limb. Ultrasound imaging facilitates real-time visualization of the musculoskeletal structures, enabling clinicians to accurately pinpoint the target muscles, surrounding neurovascular structures, and any patient-specific anatomical variations [ 1 , 4 ].…”

High-resolution ultrasound in the evaluation of musculoskeletal infections

“…In particular, US helps the proceduralist avoid passing through infected soft tissues or fluid collections, and reduces the risk of iatrogenic seeding when attempting aspiration of deeper structures such as joints (6,7) . US guidance also prevents inadvertent injury to surrounding structures.…”