Ultrasound-guided Joint Injection Research Articles

Assessing the effectiveness of a cadaveric workshop in improving resident physicians' confidence in performing ultrasound-guided joint injections.

Our study showed that an educational workshop using a cadaveric specimen is effective in improving resident physicians' confidence in performing ultrasound-guided, as well as landmark-based, joint injections. Participants also reported a strong interest in future cadaveric workshops on ultrasound-guided joint injections and believe such workshops would be a valuable educational resource for other physicians. Implementing cadaver-based ultrasound-guided joint injection workshops similar to the one discussed in this manuscript could be used to supplement training for these procedures in medical education and provide residents with the early experience they need to be able to perform these injections independently in clinic settings.

Ultrasound-Guided Joint Injections: Tips and Tricks

Joint injections have emerged as a crucial aspect of a radiologist’s role, regularly employed for both diagnostic and therapeutic purposes. Ultrasound guidance is an invaluable tool in this regard, due to its accessibility, low cost, and absence of radiation. Pain relief through the use of corticosteroids, local anesthetics, or viscosupplements, joint aspiration in cases of suspected infection, and contrast injection for arthrography are all common indications for these procedures. In this article, we aim to provide guidance for common joint procedures (as well as one nonjoint but frequently performed procedure) while also revealing some valuable trade secrets and tips.

Top-Ten Tips for Ultrasound-Guided Joint Injection.

Ultrasound-guided joint injection is more accurate than palpation-guided injection and performed more frequently. Joint injection is helpful for therapeutic and diagnostic purposes as well as for injecting contrast agents for magnetic resonance imaging or computed tomography arthrography. Ultrasound-guided joint injection helps ensure intra-articular injection and minimizes injury to para-articular soft tissues.

Platelet-rich plasma and plasma for treatment of knee osteoarthritis: a double-blind placebo-controlled randomized clinical trial

Purpose: To evaluate whether platelet-rich plasma or intra-articular plasma are superior to placebo in improving pain and function in patients with knee osteoarthritis (OA) in a 6-month follow-up period. Methods: Randomized, double-blind, clinical trial with 3 groups. Compared intra-articular treatment of knee OA of two experimental groups, one with PRP (N = 20) and other with plasma (N = 20), with a control group receiving saline solution (N = 21). Two ultrasound-guided joint injections were performed at intervals of 2 weeks. PRP injected was fresh, obtained by double centrifugation, leucocyte-poor, nonactivated and contained on average 1 million platelets/mm3. The primary endpoint was general pain in the injected knee measured by the visual analogue scale (VAS) 0-10 cm evaluated at week 24, with intermediate evaluations at weeks 6 and 12. The secondary outcomes were: WOMAC (Western Ontario McMaster University Osteoarthritis Index), KOOS (Knee Injury and Osteoarthritis Outcome Score), OMERAC-OARSI criteria and TUGT (Timed Up and Go Test). Results: The general pain (VAS) assessment in week 24 showed significant improvement regarding the 3 groups (p = 0.000 for all), but there was no statistical difference between them (p = 0.891). The PRP group presented reduction of the mean of pain from 6.1 (SD 1.6) to 3.2 (SD 2.5), which represented a decrease of 2.9 cm or 47.5%. The plasma group presented reduction of the mean of pain from 5.9 (SD 1.4) to 3.5 (SD 2.4), which represented a decrease of 2.4 cm or 40.7%. The placebo group showed a decrease in mean of pain from 6.6 (SD 1.4) to 3.1 (SD 2.6), which represented a decrease of 3.5 cm or 53.0%. In week 6, mean of pain was 3.6 (SD 2.4), 3.7 (SD 2.5) and 3.5 (SD 2.1) in the PRP, plasma and placebo groups, respectively, and in week 12 it was 2.0 (SD 1.4), 3.2 (SD 2.9) and 3.9 (SD 2.7), respectively. In weeks 6 and 12 there was also no statistical difference between the groups, despite the PRP group demonstrated a trend of improvement of pain in week 12 (see attached graphic). In WOMAC and KOOS there was significant improvement in all domains of the 3 groups, with no statistical difference between them in weeks 6, 12 and 24. The same occurred with TUGT. The percentage of patients who achieved OMERACT-OARSI improvement criteria in week 24 for the PRP, Placebo and Plasma groups were, respectively, 80%, 86% and 80%, and there was no statistical difference between the groups. Similar values were found in weeks 6 and 12. Adverse effects were more common within the PRP group, with the most frequent of them being mild to moderate knee pain lasting 2 days on average. Conclusions: PRP, plasma and saline improved knee OA pain and function outcomes in weeks 6, 12 and 24 with statistical and clinical significance. There was no difference between the groups, despite a favourable trend for PRP superiority in week 12.

Using 3D Printing (Additive Manufacturing) to Produce Low-Cost Simulation Models for Medical Training.

This work describes customized, task-specific simulation models derived from 3D printing in clinical settings and medical professional training programs. Simulation models/task trainers have an array of purposes and desired achievements for the trainee, defining that these are the first step in the production process. After this purpose is defined, computer-aided design and 3D printing (additive manufacturing) are used to create a customized anatomical model. Simulation models then undergo initial in-house testing by medical specialists followed by a larger scale beta testing. Feedback is acquired, via surveys, to validate effectiveness and to guide or determine if any future modifications and/or improvements are necessary. Numerous custom simulation models have been successfully completed with resulting task trainers designed for procedures, including removal of ocular foreign bodies, ultrasound-guided joint injections, nerve block injections, and various suturing and reconstruction procedures. These task trainers have been frequently utilized in the delivery of simulation-based training with increasing demand. 3D printing has been integral to the production of limited-quantity, low-cost simulation models across a variety of medical specialties. In general, production cost is a small fraction of a commercial, generic simulation model, if available. These simulation and training models are customized to the educational need and serve an integral role in the education of our military health professionals.

Effectiveness of Ultrasound Guidance on Intraarticular and Periarticular Joint Injections: Systematic Review and Meta-analysis of Randomized Trials.

The aim of this study was to evaluate the effectiveness and accuracy of ultrasound-guided intraarticular and periarticular joint injections as compared with landmark-guided injections technique. A systematic literature search was performed in Medline, Web of Science, Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and other sources. Only randomized controlled trials were included. Two reviewers independently selected and assessed each study for quality and extracted data. Twelve randomized controlled trials were included in the meta-analysis. The results indicated that ultrasound-guided intraarticular and periarticular joint injections were more accurate than the landmark-guided injections (odds ratio, 0.36; 95% confidence interval, 0.22-0.60). Ultrasound-guided joint injections significantly decreased the visual analog scale scores at both 2 wks (mean difference, -9.57; 95% confidence interval, -13.14 to -5.99) (P < 0.00001) and 6 wks (mean difference, -14.21; 95% confidence interval, -18.20 to -10.21) (P < 0.00001) after injection. There was no statistically significant difference in visual analog scale score at 12 wks between ultrasound-guided and landmark-guided intraarticular and periarticular joint injections (mean difference, -4.42; 95% confidence interval, -11.71 to 2.87) (P = 0.23). Intraarticular and periarticular injections using ultrasound guidance significantly improves the accuracy of joint injections, and there is a significant decrease in visual analog scale scores for up to 6 wks after injection. The effect of ultrasound guidance on the long-term outcome of joint injections is inconclusive. The improved accuracy of injections was associated with pain relief. The authors recommend routine ultrasound guidance for intraarticular and periarticular injections.

Ultrasound-guided joint injections for MR arthrography in pediatric patients: how we do it.

In children, MR arthrography is typically performed using fluoroscopic guidance. This article explores the role of US-guided joint injections as an alternative for MR arthrography in children, discussing its advantages and disadvantages compared to standard methods. We describe techniques for performing US-guided injection of the shoulder, elbow, hip, knee, ankle and posterior subtalar joints, highlighting pertinent anatomy, routes of access and unique considerations for this modality in children. Written descriptions, images and links to video clips are used to illustrate proper arthrographic technique. We conclude that US provides effective guidance for intra-articular injection prior to MR arthrography, with the advantages of improved visualization of internal structures, reduced radiation exposure, convenience of performing the procedure portably and ease of performance. Although this paper does not address therapeutic steroid injections, these techniques could easily be translated for such purposes. We propose US guidance as a viable alternative to fluoroscopic technique for arthrography in children.

Technical tips to perform safe and effective ultrasound guided steroid joint injections in children.

BackgroundThe aim of this article is to describe the technique used to perform ultrasound guided steroid joint injections in children in a group of joints that can be injected using ultrasound as the only image guidance modality.FindingsThe technique is described and didactic figures are provided to illustrate key technical concepts.ConclusionIt is very important to be familiar with the sonographic appearance of the pediatric joints and the developing bone when performing ultrasound-guided joint injections in children.

Ultrasound-guided joint injection in difficult locations

Ultrasound-guided joint injection in difficult locations