MUSCULOSKELETAL ULTRASOUND
GUIDED INJECTIONS
MUSC
ULOSKELETA
L ULTRASO
UND
GUID
ED IN
JECTIO
NS
www.mskus.com
THOMAS B. CLARK
Handbook of Ultrasound Guided InjectionsTable of Contents
Anterior Biceps TendonSuperior Acromioclavicular (AC) Joint Subacromial BursaLateral Rotator Cuff Rotator Cuff IntervalPosterior Posterior Glenohumeral (GH) Joint Suprascapular Nerve
Lateral Lateral EpicondyleAnterior Elbow JointMedial Medial Epicondyle
Flexor Carpal Tunnel (Median Nerve)Extensor Wrist Joint
Extensor De Quervain’s (1st Compartment)Flexor 1st CMC Joint
Anterior Anterior Hip JointLateral Greater Trochanteric BursaPosterior Hamstrings
Piriformis
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Chapter 1 Shoulder
Chapter 2 Elbow
Chapter 3 Wrist
Chapter 4 Hand
Chapter 5 Pelvis
Chapter 6 Hip
Anterior Ankle Joint ATF LigamentSuperior Posterior Tibial NerveLateral Subtalar JointPosterior Achilles Tendon
Suprapatellar Suprapatellar Knee Joint Infrapatellar Pes Anserine BursaLateral Distal Iliotibial Band (ITB)Posterior Peroneal Nerve
Cervical Greater Occipital NerveThoracic Costotransverse Joint (upper, mid, low)Sacral Sacroiliac Joint
Plantar Plantar Fascia
Needling Techniques
Physics, Knobology, & Nomenclature
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Chapter 7 Knee
Chapter 8 Ankle
Handbook of Ultrasound Guided InjectionsTable of Contents
Chapter 9 Foot
Chapter 10 Spine
Chapter 11 Physics, Knobology, Nomenclature
Chapter 12 Needling Techniques
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6
Rotator CuffShoulder
Patient Position:
Doctor Position:
Probe Position:
Needle Approach:
laying on side with hand on hip, US machine cross table with patient facing US machine
standing behind pa-tient facing slightly cau-dally towards US machine
long axis to supraspinatus (in-fraspinatus/teres minor) (probe pointed toward patients um-bilicus, 48 degrees off sagital)
in plane approach, close to probe to keep needle work within the super-ficial curve cuff. (try to not with-draw needle from tendon to pre-vent excess bolus leakage). As well as seal needle pressure if perform-ing calcific lavage (calcific lavage necessitates having syringe below the calcification to utilize gravity to pull calcium slurry into syringe)
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Distal Iliotibial Band (ITB)Knee
Patient Position:
Doctor Position:
Probe Position:
Needle Approach:
laying on side affected leg up and only slightly flexed with pillow between thighs,US machine cross table but dependent on doctors
standing, side of table opposite his dominant hand (left side of table for right hand dominant doctor)
long axis, distal to medial (unless approach is toward Gerde’s tubercle) with ITBoverlying lateral femoral con-dyle. *Confirm location of lateral geniculate arteries
in plane approach, caudal to cephalad. (In plane cephalad to caudal to approach Gerde’s tubercle. *Reconfirm ge-niculate artery location)
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Plantar FasciaFoot
Patient Position:
Doctor Position:
Probe Position:
Needle Approach:
on side (same position to per-form tibial nerve block prior to this approach) but US machine and doc-tor position switched to opposite sides.
seated facing from anterior to posterior and facing US machine contra-lateral side from patients feet
long axis to plantar fascia
in plane slightly out of plane from arch side of probe to attain superficial approach needed. *If tibial block is incomplete, abort approach and redo tibial nerve block, re-member calcaneal branch of tibial nerve leaves bundle most cephalad. *Approach level to probe by confirming target depth
*Approach without tibial block: probe long axis and medial plantar fat pad from con-firmed depth in an out of plane aproach