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 in the olecranon bursa may be present. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If…

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 be found in the common extensor tendon origin. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…

Radiocapitellar joint

Cause, clinical and ultrasound findings Inflammatory arthritis or injury may cause effusion/synovial proliferation. Pain and swelling may be present at the affected area. Hypoechoic fluid/synovial proliferation with or without neovascularity may be present in the elbow joint recesses. 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

Elbow joint

Cause, clinical and ultrasound findings Inflammatory arthritis or injury may cause effusion/synovial proliferation. Pain and swelling may be noted at the affected area. Hypoechoic fluid/synovial proliferation may be found with or without neovascularity in the elbow joint recesses. 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

Suprascapular notch

Cause, clinical and ultrasound findings The suprascapular nerve runs through the suprascapular notch, innervating the supraspinatus and infraspinatus muscles. The nerve provides sensory innervation to the acromioclavicular joint and glenohumeral joint. The notch may be identified with the probe in the coronal plane just medial to the superior glenoid brim. The nerve is identified as several round hypoechoic bundles within the notch. Suprascapular nerve block is…

Subacromial subdeltoid bursa

Cause, clinical and ultrasound findings The onset of bursitis is mainly from overuse, but it can be associated with trauma. Clinically, it presents with pain on a mixture of both passive and resisted tests. A painful arc in abduction may or may not be present. Pain is felt local to the shoulder but can refer down the arm to the base of the thumb in severe…

Long head of biceps tendon

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…

Sternoclavicular joint

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…

Glenohumeral joint arthrogram

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

Glenohumeral joint including hydrodilatation

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…

Acromioclavicular joint

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…

Sclerosant therapy

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

Prolotherapy

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…

Extracorporeal shock wave therapy

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…

Coblation

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’.…

Biopsy

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

Barbotage

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

Tendon sheath ganglion aspiration

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…

Saline stripping for tendinopathy (high-volume injection or brisement)

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…

Dry needling (peppering, fenestration)

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…