Cause, clinical and ultrasound findings Injury can result from overuse, but it also can occur with tendon overload after a cuff tear. Clinically, the patient complains of point pain over the long head of biceps tendon. Resisted shoulder flexion with supination and passive shoulder extension are painful. Ultrasound shows fluid in the biceps tendon sheath, and the long head of biceps tendon can appear thickened and…

Cause, clinical and ultrasound findings Sternoclavicular joint problems can be either traumatic or as a result of overuse in a degenerative shoulder. Clinically, it presents with pain. Resisted tests are usually strong and painless. Pain is usually point specific to the sternoclavicular joint, but it can radiate to the neck. Ultrasound findings include a thickened and bulging joint capsule, osteophytic lipping and cortical irregularities of the…

Cause, clinical and ultrasound findings Recurrent dislocation of the shoulder Clinically, the patient presents with pain and a reduced range of motion. No specific features present on ultrasound. Sometimes a small effusion is present. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Cause, clinical and ultrasound findings Capsulitis can be idiopathic, but it can also be due to trauma or can be degenerative or the result of inflammatory arthropathy. It can be due to a secondary disorder such as diabetes mellitus. Clinically, the patient presents with pain and a reduced range of motion with a hard end feel compared with the unaffected side. Usually the loss of movement…

Cause, clinical and ultrasound findings This joint injury can result from either trauma or overuse in a degenerative shoulder. Clinically, the joint presents with pain at the end of passive range of motion, especially the cross-arm test (scarf or horizontal adduction). Resisted tests are usually strong and painless. Pain is usually point specific to the acromioclavicular joint, but it can radiate to the upper trapezius and…

Cause, clinical and ultrasound findings The therapy is used to treat chronic tendinopathy. Studies on patellar and Achilles tendinopathy have been published. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Cause, clinical and ultrasound findings The therapy is for the treatment of chronic pain by injecting quantities of irritant substances at multiple sites of a ligament, tendon or joint. Prolotherapy was brought into popularity in the 1950s by Dr George Hackett and subsequently Dr Gustav Hemwall in the United States. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

Cause, clinical and ultrasound findings Extracorporeal shock wave therapy (ESWT) is used in Achilles tendinosis and in refractory tendinopathies and enthesopathies (plantar fasciitis, greater trochanteric insertion overload and lateral epicondylitis). It is also used in calcific tendonitis, most commonly in the shoulder but also in other locations. Equipment and drugs Commercially available shock wave apparatus are available. Ultrasound guidance is often incorporated into the hardware. Syringe…

Cause, clinical and ultrasound findings The technique is used to treat tendinopathy, most often the rotator cuff, the epicondylitis insertions at the elbow and the plantar fascia. Coblation has been used for the Achilles and patellar tendon; however, tendon rupture is a substantial risk. The technique is regarded as an alternative to surgical debridement. It is intended to trigger a ‘controlled inflammatory process to initiate healing’.…

Cause, clinical and ultrasound findings A biopsy is performed when tissue is needed to obtain a histological diagnosis, which is usually when a lesion is considered to be a possible malignancy, inflammatory mass or infection. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Cause, clinical and ultrasound findings A barbotage is performed to treat calcium deposits within a tendon, usually the supraspinatus tendon. These deposits are commonly the result of calcific tendinopathy. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Cause, clinical and ultrasound findings Inflammatory arthritis, athletic activity or injury may cause a ganglion. Pain and swelling are typical. The tendon sheath is distended with fluid and possible synovial tissue (tenosynovitis), with a large amount of low-echo ‘fluid’ either in a separate ‘sac’ or distending the tendon sheath massively. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

Cause, clinical and ultrasound findings Chronic tendinopathy may be associated with overuse injury, athletic activity, being overweight or inflammatory arthritis. Pain and swelling occur with impaired performance. The condition is associated with thickening of the tendon and intratendinous hypoechoic areas with varying degrees of neovascularity. Equipment and drugs Syringe Needle Lidocaine 1% Normal saline 0.9% Bupivacaine hydrochloride 0.25% ( Marcaine ) 10 mL 23G Orange or…

Cause, clinical and ultrasound findings Inflammatory arthritis, chronic injury or overuse may cause inflammation/microtearing of the tendon. Pain and swelling are present at the affected area. Hypoechoic areas and clefts with or without neovascularity and calcifications in the tendon. Irregularity of the cortex of the bone is in keeping with enthesopathy at the site of tendon insertion. You’re Reading a Preview Become a Clinical Tree membership…

Cause, clinical and ultrasound findings Autologous conditioned plasma (ACP) and platelet-rich plasma (PRP) are used to treat tendinopathy. The National Institute for Health and Care Excellence (NICE) has reviewed the evidence and has issued guidance that the methods are unproven and should be used in research environments only. Equipment and drugs Syringe Needle Lidocaine 1% Autologous conditioned plasma Platelet-rich plasma 5 mL 21G Green 5 mL…

Cause, clinical and ultrasound findings Autologous blood injection is used as a treatment for tendinopathy. It is a recognised procedure in the United Kingdom. The National Institute for Health and Care Excellence (NICE) has reviewed the evidence and has issued guidance that the method is unproven and should be used only in research environments. Equipment and drugs Syringe Needle Lidocaine 1% To obtain blood 5 mL…

Mechanism of action Steroids act on the inflammatory cascade to reduce prostaglandin synthesis by up to 50% and to increase Interleukin-1 secretion by the synovial membranes. Steroids decrease immune cell migration and reduce vasodilatation and vessel permeability. This action increases the concentration of hyaluronic acid and the viscosity of the synovial fluid. All of this decreases inflammation and swelling, but it takes from 3 to 5…

A number of anaesthetics are used routinely in clinical practice. Those most commonly used are all amino amides, which are very stable in solution and metabolised by the liver. Amino amides Lidocaine Lidocaine is a short-acting local anaesthetic. It has a half-life of 1.5 hours and a duration of action of 3 hours. In recent in vitro studies, it was shown that the 1% and 2%…

Decide whether injection is appropriate A history and examination should be taken. Perform a diagnostic ultrasound to confirm diagnosis. Discuss with the patient what injection will entail and how it will be performed. Previous medical history to determine contraindication (relative or absolute) A history of the patient’s previous medical problems and medications is important. You’re Reading a Preview Become a Clinical Tree membership for Full access…