US-guided percutaneous treatment facilitated prompt shoulder function recovery and pain relief. Treated patients had better outcomes than did nontreated patients at 1 year. However, 5 and 10 years after the procedure, the nontreated group reported outcomes similar to those of the treated group.

The ankle is the most frequently injured major joint in the body, and ankle sprains are frequently encountered in individuals playing football, basketball, and other team sports, in addition to occurring in the general population. Imaging plays a crucial role in the evaluation of ankle ligaments. Magnetic resonance imaging has been proven to provide excellent evaluation of ligaments around the ankle, with the ability to show associated intraarticular abnormalities, joint effusion, and bone marrow edema. Ultrasonography (US) performed with high-resolution broadband linear-array probes has become increasingly important in the assessment of ligaments around the ankle because it is low cost, fast, readily available, and free of ionizing radiation. US can provide a detailed depiction of normal anatomic structures and is effective for evaluating ligament integrity. In addition, US allows the performance of dynamic maneuvers, which may contribute to increased visibility of normal ligaments and improved detection of tears. In this article, the authors describe the US techniques for evaluation of the ankle and midfoot ligaments and include a brief review of the literature related to their basic anatomic structures and US of these structures. Short video clips showing dynamic maneuvers and dynamic real-time US of ankle and midfoot structures and their principal pathologic patterns are included as supplemental material. Use of a standardized imaging technique may help reduce the intrinsic operator dependence of US. Online supplemental material is available for this article.

Purpose:To determine whether saline temperature infl uences procedure performance and outcome in patients undergoing ultrasonography (US)-guided lavage for the treatment of rotator cuff calcifi c tendinitis (RCCT). Materials and Methods:This study was approved by the institutional review board, and informed consent was obtained from all patients. , and analysis of variance tests. Results:Procedure duration was signifi cantly shorter ( P , .001) in patients treated with warm saline (mean, 576 seconds 6 121) than in those treated with room-temperature saline (mean, 777 seconds 6 151). Calcium dissolution was signifi cantly easier in patients treated with warm saline (median score, 1) than in those treated with roomtemperature saline (median score, 2). Subgroup analysis according to calcifi cation appearance at US showed a signifi cant difference between groups for both soft ( P = .003) and hard ( P , .001) calcifi cations. No overall signifi cant differences were found for VAS score (warm saline group: baseline = 8.9 6 0.6, 1 month = 4.7 6 0.6, 2 months = 4.0 6 0.7, 3 months = 3.4 6 0.4, 1 year = 3.0 6 0.7; roomtemperature saline group: baseline = 9.2 6 0.4, 1 month = 4.5 6 0.7, 2 months = 4.1 6 0.9, 3 months = 3.1 6 0.7, 1 year = 3.2 6 0.8; P = .491). Postprocedural bursitis was observed in eight patients in the warm saline group and 20 in the room-temperature saline group ( P , .022). Conclusion:In the treatment of RCCT, warm saline appears to reduce procedure duration and improve calcifi cation dissolution while reducing the frequency of postprocedural bursitis.q RSNA, 2011

KEYWORDSPlatelet-rich plasma; Achilles tendon; Patellar tendon; Jumper's knee; Achilles tendinopathy.Abstract Purpose: The efficacy of platelet-rich plasma (PRP) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies. The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy. Materials and methods: Autologous PRP was injected under US-guidance into the Achilles and patellar tendons (30 Achilles tendons, 28 patellar tendons) in 48 prospectively selected patients (30 males, 18 females, mean age 38 AE 16 years, range 20e61 years). All patients were previously evaluated according to the Victoria Institute of Sport Assessment (VISA) scale, which assessed pain and activity level, and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months. Statistical analysis was performed with Chi-square and Wilcoxon tests. Results: 20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms. At the 6-month follow-up VISA score increased from a mean value of 57 e75.5 (p < .01). US evaluation revealed a reduction of hypoechoic areas in 26 tendons (p < .01) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler. Conclusion: PRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions. US-guidance allows PRP injection into the tendon with great accuracy. Sommario Scopo: Il plasma ricco di piastrine (PRP), provocando un iperafflusso di citochine nel sito di iniezione si è dimostrato efficace, sia in vitro che in studi clinici in vivo, come promotore della rigenerazione tissutale. Lo scopo di questo studio è quello di valutare l'efficacia dell'iniezione ecoguidata di PRP autologo nel trattamento delle tendinopatie croniche del rotuleo e dell'achilleo. Materiali e metodi: Il PRP autologo è stato iniettato sotto guida ecografica in tendini rotulei e achillei (30 tendini di Achille, 28 tendini rotulei) di 48 pazienti selezionati in modo prospettico (30 maschi, 18 femmine, età media 38 AE 16 anni, range 20e61 anni). Tutti i pazienti erano stati precedentemente valutati mediante questionario Victoria Institute of Sport di valutazione (VISA) in cui si analizza il punteggio del dolore e il livello di attività. È stata poi eseguita una valutazione ecografica dei tendini mirata a valutarne l'ecostruttura e vascolarizzazione. La valutazione statistica dei dati ottenuti è stata eseguita mediante i test del Chi-quadrato e di Wilcoxon. Risultati: Venti giorni dopo l'iniezione di PRP è stato rilevato un miglioramento dei sintomi clinici non significativo. Il punteggio VISA è migliorato da una base di 57 a 75,5 a 6 mesi (p < .01). La v...

Treatment of meralgia paresthetica with ultrasound-guided perineural injections resulted in substantial symptom relief in most patients 2 months after injection. Randomized placebo-controlled trials of this treatment should be considered in the future.

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US-guided viscosupplementation is a beneficial therapeutic option in the first months of treatment.

• US-PICT of rotator cuff is a safe and effective procedure. • On average 55% pain improvement with 10% minor complication rate. • No evidence exists in favour of using a specific size/number of needles. • Future need to assess outcome using Constant Score with 1-year minimum follow-up.