Ultrasound-guided musculoskeletal interventional procedures around the elbow, hand and wrist excluding carpal tunnel procedures

Abstract

Ultrasound is a fast, reliable and radiation-free method for the assessment of a wide range of pathological conditions, as well as for the guidance of percutaneous interventional procedures around the elbow, hand and wrist. Intraarticular and periarticular interventional procedures can be easily performed under continuous ultrasound monitoring to ensure correct needle positioning and medication delivery to a specific target. The most common ultrasound-guided procedures performed around the elbow, wrist, and hand are described in this review, excluding carpal tunnel procedures. Specifically, elbow steroid injections are performed in patients with inflammatory disorders, while hyaluronic acid can be administered in case of osteoarthritis. Septic olecranon bursitis requires percutaneous drainage for diagnosis and appropriate treatment. Dry needling and injection of regenerative medications, such as blood derivatives, are among the treatment options for lateral epicondylosis. Steroid injections are performed to give symptom relief in patients with ulnar neuropathy at the elbow. Hand and wrist steroid injections are performed in case of osteoarthritis, subsequently followed by hyaluronic acid injections, and in inflammatory disorders. Wrist ganglia can be safely aspirated and injected with steroids under ultrasound guidance. De Quervain’s tenosynovitis and trigger finger are chronic tenosynovitides of the wrist and digits, respectively, which can be treated with steroid injections, subsequently followed by hyaluronic acid injections. In conclusion, proper knowledge of the musculoskeletal disorders around the elbow, hand and wrist, as well as US-guided treatment options and operator training, are prerequisites to achieve good outcomes.

Percutaneous ultrasound-guided ulnar nerve release technique compared to open technique: A cadaveric study

“…Finally, the mean incision length of the ultrasound-guided procedure was smaller than for the open technique (7.2 mm ± 0.5 [6; 10] in the ultrasound group, versus 42.4 mm ± 8.1 [40,50] in the open release technique one (p = 0.96).…”

“…Later, in an effort to improve the effectiveness furthermore of in situ decompression while minimizing complication rates, URUN was developed by Poujade et al in 2014 [10]. Ultrasounds are a cheap and radiation-free tool for anatomical and dynamic evaluation of upper extremity nerves and other soft tissues [50,51]. Moreover, the anatomy of the ulnar nerve and its surroundings in CuTs is well documented and detailed in the scientific literature [52], with studies demonstrating its ability to identify and localize the compression better than electromyography [53,54].…”

The access route through the anatomical snuffbox in ultrasound-guided synovial biopsy of the wrist allows for a safe and effective collection of tissue samples in inflammatory arthritis

“…Although specific head-to-head studies are required, the safe wide range of motion allowing entry from the anatomical snuffbox is likely to offer potential advantages over the most used dorsal entry ports [ 13 – 15 ]. They stand in the soft tissue concavity between the tendons of the extensor pollicis longus and the extensor digitorum or between the extensor pollicis longus and the extensor carpi radialis longus or between the extensor digitorum and the extensor carpi ulnaris, approximately 1 cm distal to the Lister’s tubercle.…”

“…In this context, the radiocarpal (RC) joint offers the most suitable alternative, being larger and containing a greater amount of synovium [ 8 , 12 ]. Usually, access to the RC joint, whether to perform intra-articular injections [ 13 ], arthroscopies [ 14 ], or synovial biopsies [ 15 ], is performed between the extensor tendons compartments III and IV, IV and V, and V and VI on the dorsal side. Nonetheless, in our experience, the anatomical characteristics of the RC joint and the course of the various periarticular structures, particularly the tendons, may condition the path and the inclination of the surgical instrument within the joint cavity, with the possibility that part of the synovial surface remains unreachable.…”

Accuracy and Safety of Carpometacarpal Joint Injection Using Anatomical Landmarks: A Cadaver Study and Review of Literature Running title: Carpometacarpal Joint Injection Using Anatomical Landmarks

“…Immobilization with splint, antiin ammatory medications, or intra-articular corticosteroid injection are the main non-operative treatments for such conditions (3). CMC joint injection can be performed with or without imaging aids (4)(5)(6). Without imaging guidance injection may occur in improper site rather than the CMC joint.…”