Ultrasound-Guided Musculoskeletal Injections

Thumb carpometacarpal joint

Cause, clinical and ultrasound findings Reasons for the injection include inflammatory arthritis and osteoarthritis. Functionally limiting pain and swelling should be present. Findings may include hypoechoic fluid and tissue (synovial proliferation) with or without neovascularity bulging out of the joint,…

Wrist ganglia aspirations

Cause, clinical and ultrasound findings Ganglia of the wrist are cystic lesions filled with fluid that derive from the degeneration of periarticular or peritendinous soft tissues. The lesions present either as palpable asymptomatic swellings (cosmetic deformity) or as painful or…

Carpal tunnel

Cause, clinical and ultrasound findings Carpal tunnel syndrome results from compression of the median nerve at the level of the wrist due to abnormal anatomy (thick retinaculum, accessory muscles, etc.), systematic conditions (diabetes, pregnancy, etc.) and space-occupying lesions (flexor tendon…

Wrist extensor tendon sheath

Cause, clinical and ultrasound findings Inflammatory arthritis or chronic overuse due to occupational or athletic activities may cause tendinopathy or tenosynovitis of the extensor wrist tendons. Common sites of the disease include compartment I (de Quervain’s tenosynovitis), the compartment I…

De quervain’s tenosynovitis

Cause, clinical and ultrasound findings Chronic overuse due to repetitive movements of the thumb (typists, mothers feeding babies) or athletic activities (tennis, golf) may cause tendinopathy of the first compartment extensor wrist tendons. Pain and palpable swelling at the affected…

Radiocarpal joint

Cause, clinical and ultrasound findings Reasons for the injection include inflammatory arthritis and osteoarthritis. Functionally limiting pain and swelling may be present. Findings may include hypoechoic fluid as well as tissue (synovial proliferation) with or without neovascularity bulging out of…

Distal radioulnar joint

Cause, clinical and ultrasound findings Reasons for the injection include inflammatory arthritis and osteoarthritis. Functionally limiting pain and swelling may be present. Ulnar-sided wrist pain can be referred from this joint. Findings may include hypoechoic fluid and tissue (synovial proliferation)…

Cubital tunnel

Cause, clinical and ultrasound findings Compression of the ulnar nerve at the level of the elbow is due to anatomy (thickened Osborne ligament, accessory muscles such as anconeus epitrochlearis), systematic conditions (diabetes, pregnancy, etc.) and space-occupying lesions (ganglia, etc.). Numbness…

Olecranon bursa

Cause, clinical and ultrasound findings Repetitive use, inflammatory arthritis and injury or infection may cause effusion/synovial proliferation in the bursa. Pain and swelling over the olecranon may be found. Hypoechoic or hyperechoic fluid/synovial proliferation with or without neovascularity and calcifications…

Dry needling in lateral epicondylitis

Cause, clinical and ultrasound findings Inflammatory arthritis, chronic injury or overuse may cause inflammation/microtearing of the common extensor tendon origin. Pain and swelling may occur at the affected area. Hypoechoic areas and clefts with or without neovascularity and calcifications may…