Use of ultrasonographic guidance in interventional musculoskeletal procedures - A review from a single institution

We have evaluated the utility of ultrasonographic guidance for intervention in the musculoskeletal system. All interventional musculoskeletal procedur es using ultrasonographic guidance performed at our institution from July 1 998 through November 1999 were reviewed. Examinations were performed using either a linear or curved phased array transducer, based on depth and local geometry. The choice of needle was likewise optimized for specific anatomi c conditions. One hundred ninety-five procedures were performed on 167 pati ents from July 1998 through November 1999. Thirty-one procedures had magnet ic resonance correlation within 6 months beforehand. Excluding large-joint aspirations and injections, we found that 180 of the procedures were more r eadily performed using ultrasonography than any other imaging modality. The se included therapeutic injections into tendon sheaths (biceps, flexor digi torum longus, posterior tibial, and iliopsoas), Morton's neuromas, plantar fascia, wrist ganglia, and tarsal tunnel cysts; peritendinous hamstring inj ections; and synovial cyst and muscle biopsies. In all cases, the target of interest was identified easily with ultrasonography, and needle position w as documented readily. Also in all cases, aspiration or medication delivery to the site of interest was observed during real time and was documented o n postprocedure images of the area. No significant complications (e.g., ble eding, infection, and neurovascular compromise) were encountered during or immediately after any procedure. Ultrasonography is a readily available ima ging modality useful for guiding interventional procedures in the musculosk eletal system. The ability to document exact needle placement in real time confirms accurate placement of therapeutic injections, fluid aspiration, an d soft tissue biopsies.