Musculoskeletal Ultrasound for Referring Clinicians: Image Guided Therapies

Many joint and musculoskeletal complaints are readily treated with the following outpatient procedures which are well-tolerated with low risks.

Brisement

Indication: frozen shoulder/adhesive capsulitis
The glenohumeral joint is distended with saline under fluoroscopic imaging to stretch and possibly rupture the scarred fibrous capsule.

Tendon fenestration

Indication: tendinosis

A needle is repeatedly placed into an abnormal tendon, disrupting the degenerative process and inciting an inflammatory response to promote healing.
Typically done for the rotator cuff tendons, common extensor tendon in tennis elbow, Achilles tendon, gluteal tendons for greater trochanteric pain syndrome, or the patellar tendon.

Calcific tendinosis barbotage

Indication: calcific tendinosis

Procedure: A needle is placed into calcium deposits within an abnormal tendon. A small amount of saline and lidocaine is repeatedly injected into the deposit followed by immediate aspiration in a series of pulses. This incites an inflammatory response by the body to resorb these deposits.
Considerations: Most patients need only one treatment and many have no radiographic evidence of retained calcium within the tendon at 6-12 months.

Aspiration – nearly any fluid collection in the musculoskeletal system is amenable to aspiration usually under ultrasound guidance.