Intervention Using Ultrasonography

Hyun Seok Song; Dong-Yeop Kim; Kee-Sik Yoon

doi:10.4055/jkoa.2013.48.5.342

Journal List > J Korean Orthop Assoc > v.48(5) > 1013249

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Song, Kim, and Yoon: Intervention Using Ultrasonography

Instructional Course Lecture

Introduction to Musculoskeletal Ultrasonography

Journal of the Korean Orthopaedic Association 2013; 48(5): 342-349.

Published online: 25 October 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.5.342

Intervention Using Ultrasonography

Hyun Seok Song, M.D., Dong-Yeop Kim, M.D., Kee-Sik Yoon, M.D.

Department of Orthopedic Surgery, St. Paul's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea.

Correspondence to: Hyun Seok Song, M.D. Department of Orthopedic Surgery, The Catholic University of Korea St. Paul's Hospital, 180 Wangsan-ro, Dongdaemun-gu, Seoul 130-709, Korea. TEL: +82-2-958-2159, FAX: +82-2-965-1456, hssongmd@yahoo.com

Received 5 August 2013 Revised 18 August 2013 Accepted 19 August 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Intervention using ultrasonography includes injection, aspiration, needling (barbotage), nerve block, tumor biopsy, and removal of the foreign body. The principles of disinfection during skin preparation, as well as handling of the transducer and needle should be maintained. The needle could be visualized on the ultrasonographic image, and could be tracked during the intervention. Factors affecting visualization of the needle on ultrasonography include the diameter and the incidence angle of the needle. Ultrasonography can be classified as an indirect technique or a real-time technique according to constant use. According to the angle between the transducer and needle, it can be classified as a lateral approach or a coaxial approach.

Keywords: ultrasonography, intervention, angle of incidence, approach

Figures and Tables

Figure 1

Sterile envelope for the transducer: (A) sterile-packed and (B) wrapped and rubber-banded.

Figure 2

Ultrasonography shows the reverberation by the needle (arrow). Dotted arrows indicate the comet-tail artifact behind the needle.

Figure 3

Long needle with a stylet.

Figure 4

Ultrasonography of the posterior approach to the shoulder joint shows no reverberation by the needle. Arrows indicate the needle.

Figure 5

Incidence angle of the needle can be increased by change of the puncture site apart from the transducer: (A) near the transducer, (B) apart from the transducer.

Figure 6

Incidence angle of the needle can be increased by pressing on the opposite side of the transducer: (A) before, (B) after the heel-toe maneuver.

Figure 7

The indirect technique. Two perpendicular lines crossing the center of the lesion are marked with dotted lines.

Figure 8

Lateral approach (in-plane technique) for injection into the aromioclavicular joint. The needle is aligned with the small side of the transducer.

Figure 9

Coaxial approach (out-of-plane technique) for injection into the aromioclavicular joint. The needle is aligned with the broad side of the transducer.

References

1. Douglas BR, Charboneau JW, Reading CC. Ultrasound-guided intervention: expanding horizons. Radiol Clin North Am. 2001; 39:415–428.

2. Lento PH, Strakowski JA. The use of ultrasound in guiding musculoskeletal interventional procedures. Phys Med Rehabil Clin N Am. 2010; 21:559–583.

3. Zwar RB, Read JW, Noakes JB. Sonographically guided glenohumeral joint injection. AJR Am J Roentgenol. 2004; 183:48–50.

4. Chiou HJ, Chou YH, Wu JJ, et al. Alternative and effective treatment of shoulder ganglion cyst: ultrasonographically guided aspiration. J Ultrasound Med. 1999; 18:531–535.

5. Aina R, Cardinal E, Bureau NJ, Aubin B, Brassard P. Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique. Radiology. 2001; 221:455–461.

6. Ootaki C, Hayashi H, Amano M. Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches. Reg Anesth Pain Med. 2000; 25:600–604.

7. Torriani M, Etchebehere M, Amstalden E. Sonographically guided core needle biopsy of bone and soft tissue tumors. J Ultrasound Med. 2002; 21:275–281.

8. Mizel MS, Steinmetz ND, Trepman E. Detection of wooden foreign bodies in muscle tissue: experimental comparison of computed tomography, magnetic resonance imaging, and ultrasonography. Foot Ankle Int. 1994; 15:437–443.

9. Bianchi S, Zamorani MP. US-guided interventional procedures. In : Bianchi S, Zamorani MP, editors. Ultrasound of the musculoskeletal system. New Delhi: Springer Berlin Heidelberg;2007. p. 891–917.

10. Saker MB, Kane RA, Matalon TAS. Factors affecting and techniques to improve needle visualization. Semin intervent Radiol. 1997; 14:471–475.

11. Bisceglia M, Matalon TA, Silver B. The pump maneuver: an atraumatic adjunct to enhance US needle tip localization. Radiology. 1990; 176:867–868.

TOOLS

Similar articles