Ultrasound Guided Injections
in a Sports Medicine Practice
Edward W. Kelly, MD
October 7, 2013
Annual Orthopedic Care Team
Conference
Ultrasound Guided Injections
in a Sports Medicine Practice
Nothing to disclose
Musculoskeletal Ultrasound
Goals
• Review Musculoskeletal Ultrasound
• Advantage and disadvantages of MSK US
• Demonstrate therapeutic US Guided Injections
Musculoskeletal Ultrasound
What is Ultrasound
• High frequency sound wave
• Audible sound 20 Hz – 20,000 Hz
• Diagnostic US > 1,000,000 Hz (1MHz)
– Above human hearing
• Musculoskeletal Ultrasound – 7-18 MHz
Musculoskeletal Ultrasound
What is Ultrasound
• Sound waves travel through tissues at same
speed
• How fast they return determines image
Musculoskeletal Ultrasound
What Can MSK Ultrasound Image
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Bone
Muscle
Tendon
Nerve
Subcutaneous Tissue
Fluid
Musculoskeletal Ultrasound
What Joints Can MSK Ultrasound Image
• Small joints- Foot/Ankle – Hand/Wrist
• Knee
• Hip
Musculoskeletal Ultrasound
What Joints Can MSK Ultrasound Image
Shoulder/Elbow
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Glenohumeral
Subacromial space
AC joint
Biceps
Lateral epicondylitis
Musculoskeletal Ultrasound
What Are Ultrasound Advantages
The Rehabilitator
Fact or Fantasy?
https://www.youtube.com/watch?v=v1GGFR2mc9g
Musculoskeletal Ultrasound
What Are Ultrasound Advantages
• Images muscle, soft tissue, and cortical bone
surfaces
• No known long term side effects
• Dynamic or “live” images
Musculoskeletal Ultrasound
What Are Ultrasound Advantages
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Portable
No special room needed
High resolution – 1 mm
Accurate!
Musculoskeletal Ultrasound
What Are Ultrasound Advantages
• 2009 Meta-analysis Am J Radiology
• 65 studies
US as sensitive and specific as MRI to diagnose
RC Tears
Musculoskeletal Ultrasound
What Are Ultrasound Advantages
• Relatively inexpensive
Musculoskeletal Ultrasound
What Are Ultrasound Advantages
• MRI shoulder cost $ 750 Medicare
• US diagnostic shoulder cost = $124 Medicare
• US guided needle placement $208 Medicare
Musculoskeletal Ultrasound
What Are Ultrasound Disadvantages
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Can not see thru bone or gas
Relatively limited depth of penetration
Operator dependant
Steep learning curve – about 100 scans
Ultrasound Guided Intra-Articular
Injections
Do you need guidance?
• Poor ability to get into desired joints blindly
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Glenohumeral 90% vs. 27%
Biceps
87% vs. 40%
Subacromial 90% vs. 30%
AC Joint
90% vs. 60%
Hip
90% vs. 30%
Ultrasound Guided Intra-Articular
Injections
Do you need guidance?
• Better therapeutic response
• Less pain for patient
• Less likely to injure other structures
Ultrasound Guided Intra-Articular
Injections
Examples
Ultrasound Guided Intra-Articular
Injections
Glenohumeral Joint
Ultrasound Guided Intra-Articular
Injections
Glenohumeral Joint
Ultrasound Guided Intra-Articular
Injections
Subacromial Space
Ultrasound Guided Intra-Articular
Injections
Biceps Tendon Sheath
Ultrasound Guided Intra-Articular
Injections
Biceps Tendon Sheath
Ultrasound Guided Intra-Articular
Injections
AC Joint
Ultrasound Guided Intra-Articular
Injections
AC Joint
Ultrasound Guided Intra-Articular
Injections
AC Joint
AC joint injection
Ultrasound Guided Intra-Articular
Injections
AC Joint
Small Joints
Elbow
• Lateral Epicondylitis
Small Joints
Elbow
• Lateral Epicondylitis
Small Joints
Elbow
• Lateral Epicondylitis
• F.A.S.T procedure
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FOCUSED
ASPIRATION AND REMOVAL
SOFT
TISSUE
• http://www.fast-technique.com/
FAST for Patellar Tendonitis
FAST for Patellar Tendonitis
FAST for Patellar Tendonitis
FAST for Shoulder Calcific Tendonitis
FAST for Shoulder Calcific Tendonitis
FAST for Shoulder Calcific Tendonitis
Ultrasound Guided Injections in a Sports
Medicine Practice
Summary
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Ultrasound provides reliable in office diagnosis
Lower cost
guided injections more effective
In-office procedure
Can be used for any joint
Steep learning curve