Both high level and recreational athletes are subject to many injuries, both acute and chronic. Many of these injuries are handled conservatively, and others need immediate surgical attention. However, in patients who have failed conservative management ultrasound affords the opportunity to perform real time dynamic imaging for diagnosis. Subsequently, ultrasound guided percutaneous intervention can be performed to treat the symptoms. All procedures are performed with aseptic technique and local anesthetic. Therapeutic injections of corticosteroid and local anesthetic can be performed under ultrasound guidance for a wide range of symptomatic conditions
such as tendinitis, arthritis, and bursitis. In tenosynovitis, i.e.inflammation of tendon sheaths, the injection is instilled directly into the
sheath. Real time ultrasound can monitor the installation of the medication to make sure it is reaching the proper location. For tendons without sheaths such as the Achilles, injections are performed into the paratenon. Ultrasound guided aspiration can be performed for symptomatic ganglion cysts, liquefying hematomas, and Baker’s cysts. Calcific tendinitis can be treated using 18-20 gauge needles, a procedure best documented for the rotator cuff. After local anesthesia, the needle is advanced into tendon, and the calcification is gently fragmented by the needle and lavaged with sterile saline if necessary. Even if calcifications are not present, areas
of mucoid degeneration, or tendinosis, can also be fenestrated using the needle tip, as we have demonstrated in chronic tennis elbow. Other ultrasound-guided therapeutic approaches for tendinosis include injections of autologous blood, platelet rich plasma, hypertonic dextrose solutions, and sclerosing agents such as polidocanol. The frontiers of ultrasound guided therapies are also being advanced with innovative treatments for such common conditions as plantar fasciitis, trigger finger, and carpal tunnel syndrome. With increasing emphasis on minimally invasive surgical techniques, ultrasound-guided percutaneous interventions should become increasingly popular for the treatment of musculoskeletal disorders.
