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Ultrasound Guided Injections in a Sports Medicine Practice

Ultrasound Guided Injections in a Sports Medicine Practice. Edward W. Kelly, MD October 7, 2013 Annual Orthopedic Care Team Conference. Ultrasound Guided Injections in a Sports Medicine Practice. Nothing to disclose. Musculoskeletal Ultrasound. Goals Review Musculoskeletal Ultrasound

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Ultrasound Guided Injections in a Sports Medicine Practice

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  1. Ultrasound Guided Injections in a Sports Medicine Practice Edward W. Kelly, MD October 7, 2013 Annual Orthopedic Care Team Conference

  2. Ultrasound Guided Injections in a Sports Medicine Practice Nothing to disclose

  3. Musculoskeletal Ultrasound Goals • Review Musculoskeletal Ultrasound • Advantage and disadvantages of MSK US • Demonstrate therapeutic US Guided Injections

  4. Musculoskeletal Ultrasound What is Ultrasound • High frequency sound wave • Audible sound 20 Hz – 20,000 Hz • Diagnostic US > 1,000,000 Hz (1MHz) • Above human hearing • Musculoskeletal Ultrasound – 7-18 MHz

  5. Musculoskeletal Ultrasound What is Ultrasound • Sound waves travel through tissues at same speed • How fast they return determines image

  6. Musculoskeletal Ultrasound What Can MSK Ultrasound Image • Bone • Muscle • Tendon • Nerve • Subcutaneous Tissue • Fluid

  7. Musculoskeletal Ultrasound What Joints Can MSK Ultrasound Image • Small joints- Foot/Ankle – Hand/Wrist • Knee • Hip

  8. Musculoskeletal Ultrasound What Joints Can MSK Ultrasound Image Shoulder/Elbow • Glenohumeral • Subacromial space • AC joint • Biceps • Lateral epicondylitis

  9. Musculoskeletal Ultrasound What Are Ultrasound Advantages The Rehabilitator Fact or Fantasy? https://www.youtube.com/watch?v=v1GGFR2mc9g

  10. Musculoskeletal Ultrasound What Are Ultrasound Advantages • Images muscle, soft tissue, and cortical bone surfaces • No known long term side effects • Dynamic or “live” images

  11. Musculoskeletal Ultrasound What Are Ultrasound Advantages • Portable • No special room needed • High resolution – 1 mm • Accurate!

  12. Musculoskeletal Ultrasound What Are Ultrasound Advantages • 2009 Meta-analysis Am J Radiology • 65 studies US as sensitive and specific as MRI to diagnose RC Tears

  13. Musculoskeletal Ultrasound What Are Ultrasound Advantages • Relatively inexpensive

  14. Musculoskeletal Ultrasound What Are Ultrasound Advantages • MRI shoulder cost $ 750 Medicare • US diagnostic shoulder cost = $124 Medicare • US guided needle placement $208 Medicare

  15. Musculoskeletal Ultrasound What Are Ultrasound Disadvantages • Can not see thru bone or gas • Relatively limited depth of penetration • Operator dependant • Steep learning curve – about 100 scans

  16. Ultrasound Guided Intra-Articular Injections Do you need guidance? • Poor ability to get into desired joints blindly • Glenohumeral 90% vs. 27% • Biceps 87% vs. 40% • Subacromial 90% vs. 30% • AC Joint 90% vs. 60% • Hip 90% vs. 30%

  17. Ultrasound Guided Intra-Articular Injections Do you need guidance? • Better therapeutic response • Less pain for patient • Less likely to injure other structures

  18. Ultrasound Guided Intra-Articular Injections Examples

  19. Ultrasound Guided Intra-Articular InjectionsGlenohumeral Joint

  20. Ultrasound Guided Intra-Articular InjectionsGlenohumeral Joint

  21. Ultrasound Guided Intra-Articular InjectionsSubacromial Space

  22. Ultrasound Guided Intra-Articular InjectionsBiceps Tendon Sheath

  23. Ultrasound Guided Intra-Articular InjectionsBiceps Tendon Sheath

  24. Ultrasound Guided Intra-Articular InjectionsAC Joint

  25. Ultrasound Guided Intra-Articular InjectionsAC Joint

  26. Ultrasound Guided Intra-Articular InjectionsAC Joint

  27. AC joint injection

  28. Ultrasound Guided Intra-Articular InjectionsAC Joint

  29. Small JointsElbow • Lateral Epicondylitis

  30. Small JointsElbow • Lateral Epicondylitis

  31. Small JointsElbow • Lateral Epicondylitis • F.A.S.T procedure • FOCUSED • ASPIRATION AND REMOVAL • SOFT • TISSUE • http://www.fast-technique.com/

  32. FAST for Patellar Tendonitis

  33. FAST for Patellar Tendonitis

  34. FAST for Patellar Tendonitis

  35. FAST for Shoulder Calcific Tendonitis

  36. FAST for Shoulder Calcific Tendonitis

  37. FAST for Shoulder Calcific Tendonitis

  38. Ultrasound Guided Injections in a Sports Medicine Practice Summary • Ultrasound provides reliable in office diagnosis • Lower cost • guided injections more effective • In-office procedure • Can be used for any joint • Steep learning curve

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