Thursday , 23 November 2017
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Ultrasound guided MSK injection case studies

Ultrasound Guided Injection of the hip joint: Technique Tutorial – Dr Daniel Fascia (@danfascia) , Consultant MSK and Sports Radiologist, Yorkshire Radiology

Why use ultrasound? Whilst it still remains more popular to inject joints using fluoroscopy across the world, one cannot deny the attractions of ultrasound being cheap, small in form and readily accessible in the clinic / office environment. Advances in ultrasound equipment have improved needle guiding, tissue detail and penetration. Technologies such as virtual convex on linear probes and beam steering make accurately aiming of an obliquely travelling needle into deep tissue ever more straightforward. In the hands of a skilled operator, ultrasound is actually safer than fluoroscopy. There is no radiation (for the patient and operator) and needle guidance …

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Could ultrasound guidance have a role in reducing the risk of depigmentation and fat atrophy with steroid injections? – Dave Baker, Extended Scope Physiotherapist

Intralesional and intra-articular glucocorticosteroid injections have been used for over sixty years in musculoskeletal treatments and now around 500,000 such injections are believed to be performed in primary care in the UK alone each year (Deane 2014). The main advantages from a localised injection is to deposit a high concentration of medication at the desired treatment area without significant systemic absorption and thus markedly reducing the risk and severity of many of the more serious potential systemic side effects of oral steroid usage. Total dosage is also significantly reduced as a result of using this method of administration (Rogojan 2004, …

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Ultrasound guided injections and knee osteoarthritis – Dave Baker (@DaveBakerPhysio) Extended Scope Physiotherapist

Ultrasound guided injections and knee osteoarthritis Use of glucocorticosteroid injections have been around since 1950 and there are now around half a million steroid injections performed per year in the UK in primary care with the knee joint being one of the commonest targets for injection treatment (Maricar 2013).  The exact mechanism of their action is only still slowly unravelling.  They appear to work at the level of the nucleus of the cell, altering DNA gene transcription and production of proteins and enzymes.  There appears to be some inhibition of inflammatory during expression and some up regulation of natural anti-inflammatory …

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Wrist effusion and ‘out of plane’ guided radiocarpal joint injection – Rob Mast, Extended Scope Physiotherapist

This is a case study of a patient with a wrist effusion and 'out of plane' guided radiocarpal joint injection. The patient was a jeweller in their 30's with a six month history of left wrist pain. The pain was felt more towards the radial side of the wrist and there was pain predominantly during gripping activities. Her work entailed gripping objects for extended periods of time and was therefore problematic. If she ignored the pain and continued working she then could experience some pins and needles in the fingers in the median nerve distribution reminiscent of Carpal Tunnel Syndrome …

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Carpal Tunnel Syndrome – Rob Mast, Extended Scope Physiotherapist

Figure 1: Bifid median nerve at the carpal tunnel

I recently saw this middle aged lady with unilateral carpal tunnel syndrome. She presented with a four month history of right sided carpal tunnel syndrome type symptoms. Four years earlier she was diagnosed with the same and received a steroid injection which completely settled her symptoms. Clinically there was certainly a mild carpal tunnel syndrome and this fitted with the history of waking at night with numbness in the hand. Carpal tunnel provocation tests were mildly positive. Musculoskeletal ultrasound showed a bifid median nerve (as seen above) . Lanz et al (1977) were the first to describe anatomical variations of …

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De Quervains Tenosynovitis – Stuart Wildman, MSK Sonographer and Extended Scope Physiotherapist

I wanted to post a case on this very common condition, De Quervains Tenosynovitis. Ultrasound allows easy visualisation of the tendons and assists guidance of steroid injections if required. This is particularly common in young mothers through lifting their baby and also with occupations where repetitive thumb use is involved. Pain is localised to the radial aspect of the wrist, and there can be a localised effusion and redness to the skin. There is inflammation of the cellular lining membrane of the fibrous tunnel through which the tendons of abductor pollicis longus (APL) and extensor pollicis (EPB) brevis move, at the radial …

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