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

Authors
  • Tortora, Silvia1
  • Messina, Carmelo2, 3
  • Albano, Domenico3, 4
  • Serpi, Francesca1
  • Corazza, Angelo3
  • Carrafiello, Gianpaolo5, 6
  • Sconfienza, Luca Maria2, 3
  • Gitto, Salvatore2
  • 1 Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Italy , (Italy)
  • 2 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy , (Italy)
  • 3 Unità di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, Italy , (Italy)
  • 4 Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Italy , (Italy)
  • 5 Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy , (Italy)
  • 6 Unit of Radiology, IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy , (Italy)
Type
Published Article
Journal
Journal of Ultrasonography
Publisher
Exeley Inc.
Publication Date
Jun 07, 2021
Volume
21
Issue
85
Identifiers
DOI: 10.15557/JoU.2021.0027
Source
Exeley
Keywords
Disciplines
  • Medicine
License
Green

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.

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