Musculoskeletal interventions of various joints
Post by: Dr. Yajush Jain and Dr. Shekhar Kalia
MSK Interventions of shoulder:
| Pathology | MSK Interventions | Comparison | Other Key Points |
|---|---|---|---|
| Rotator Cuff Calcific Tendinopathy | - US-PICD (ultrasound-guided percutaneous irrigation of calcific tendinopathy) - SASD (Subacromial–subdeltoid) bursa steroid injection - Extracorporeal shockwave therapy (ESWT) | US-PICT for Calcific Tendinopathy is safe and effective. It has better results than SASD and EWSL with reduce risk of adverse effects. | SASD bursa corticosteroid injection is more effective than hyaluronic acid injection |
| Rotator Cuff Tendinopathy | - Ultrasound-guided PRP injection | Injecting PRP under ultrasound guidance for patients who have undergone arthroscopic repair of rotator cuff tears does not show clear advantages in reducing postoperative pain | |
| Supraspinatus Tendinopathy | - US-Guided PRP Injection - US-Guided Dry needling - US-Guided Prolotherapy (hypertonic dextrose injection ) | PRP is superior to dry needling | Prolotherapy involves the use of irritant substances in injections, which stimulate the healing process of tendons by triggering an inflammatory response. |
| Long Head of Biceps Tendon (LHBT) Sheath | - US-Guided LHBT Sheath Injection - Fluoroscopy-guided injections - US-Guided LHBT Tenotomy | US guidance more accurate and diagnostically beneficial. | |
| Glenohumeral Joint (GHJ) | - US-Guided GHJ Injections - Palpation-Guided GHJ Injections | Ultrasound guidance improves GHJ injections. | |
| Acromioclavicular Joint (ACJ) | - US-Guided GHJ Injections - Palpation-Guided GHJ Injections | Image-guided injections are significantly more accurate. |
MSK interventions in elbow and wrist:
| Pathology | MSK Interventions | Comparison | Other Key Points |
|---|---|---|---|
| Lateral Epicondylitis | - Ultrasound-guided Dry Needling - Ultrasound-guided PRP Injection - Ultrasound-guided Steroid Injections | PRP superior to corticosteroid therapy. Ultrasound-guided release shows better success rate compared to palpation-guided release. | Needling alone effective for lateral epicondylitis, without additional therapies. |
| Medial Epicondylitis and Tendinopathy | - Ultrasound-guided Dry Needling - Ultrasound-guided PRP Injection - Ultrasound-guided Steroid Injections | Ultrasound-guided release shows better success rate compared to palpation-guided release. | |
| Distal Biceps Tendinopathy | - Ultrasound-guided Dry Needling - Ultrasound-guided PRP Injection - Ultrasound-guided Steroid Injections | Ultrasound-guided release shows better success rate compared to palpation-guided release. | Posterior approach considered easy and safe with no neurovascular structures in the needle path. |
| Triceps Tendinopathy | - Ultrasound-guided Dry Needling - Ultrasound-guided PRP Injection - Ultrasound-guided Steroid Injections | Ultrasound-guided release shows better success rate compared to palpation-guided release. | |
| De Quervain’s Disease (the first extensor compartment) | - Ultrasound-guided Steroid Injection - Ultrasound-guided percutaneous release (retinaculum release using a 21-G needle) | Ultrasound-guided release shows better success rate compared to palpation-guided release. | |
| Extensor tendon sheaths (other than first tendon) | Ultrasound-guided injections | Ultrasound-guided release shows better success rate compared to palpation-guided release. | |
| Trigger Finger | - Ultrasound-guided Percutaneous Trigger Finger Release - Ultrasound-guided Steroid Injections for Trigger Finger - Ultrasound-guided PRP for Trigger Finger - Open Surgery vs. Ultrasound-guided Steroid Injection for Trigger Finger - Ultrasound-guided Intra-articular Needle Placement in Hand Joints - Palpation-guided Percutaneous Trigger Finger Release | - Ultrasound-guided release shows better success rate, pain reduction, and patient satisfaction compared to palpation-guided release. - Open surgery seems to be superior to intra-sheath steroid injection but has a higher complication rate. |
MSK Interventions hip joint:
| Pathology | MSK Interventions | Comparison | Other Key Points |
|---|---|---|---|
| Iliopsoas Peri-tendinous/Bursal Injections | - Ultrasound-guided Injections with Local Anesthetic and Corticosteroids | Can be used to exclude iliopsoas tendon as a cause of hip/groin pain. | |
| Pubalgia Treatments | - Single Ultrasound-guided Corticosteroid-Anesthetic Injection into the symphyseal cleft, Rectus Abdominis/Adductor Longus - Fluoroscopy-guided Injections | ||
| Hamstring Tendinopathy | - Ultrasound-guided Needling - Ultrasound-guided Autologous Blood Product Injection | Both methods may improve clinical symptoms. | |
| Greater Trochanteric Pain Syndrome (GTPS) | - Image guided corticosteroid-anesthetic Injections - Palpation-guided corticosteroid-anesthetic Injections - Image guided Needling - Image guided PRP injection | Ultrasound-guided injections more effective. PRP may have longer-lasting clinical improvement. | Ultrasound- and palpation-guided injections are safe and effective. |
| Intra-Articular Hip Injections | - Image guided corticosteroid-anesthetic Injections - Palpation-guided corticosteroid-anesthetic Injections - Image guided PRP injection | More accurate and effective than palpation-guided injections. | - Positive response can help confirm intra-articular origin of hip pain. - Corticosteroid or Hyaluronic Acid can be used for Hip Injection |
MSK Interventions knee joint:
| Pathology | MSK Interventions | Comparison | Other Key Points |
|---|---|---|---|
| Knee Joint Procedures | - Intra-Articular US-Guided Procedures (e.g., arthrocentesis, injections) | US-guidance significantly improves accuracy in procedures around the knee, leading to better fluid aspiration and injection outcomes. | - |
| Inflammatory arthritis | - US-Guided Corticosteroid-Anesthetic Injections | ||
| Knee osteoarthritis | - US-Guided HA Intra-Articular Injections - US-Guided Injections of Regenerative Medications (PRP, autologous blood) - US-Guided Corticosteroid-Anesthetic Injections | HA injections are effective and superior to steroids in the long term. Limited evidence supports the use of regenerative medications. |
|
| Patellar Tendinopathy | - US-Guided Dry Needling - Other US-Guided Treatments (like corticosteroid, high-volume injections, prolotherapy, sclerosing injections with polidocanol, and HA) | Dry needling is highly effective in improving function and pain in patellar tendinopathy. | PRP combined with dry needling enhances outcomes, but standalone PRP efficacy is uncertain. |
| Baker’s Cysts | - US-Guided Procedures (US-guided aspiration, wall fenestration, and corticosteroid injection) | US-guided interventions are safe and effective in relieving pain and reducing cyst volume in patients with Baker’s cysts due to internal knee derangement. | Effective for Baker's cysts. |
| Pes Anserinus Bursitis | - US-Guided Corticosteroid Injections | US-guided injections are the preferred method. | |
| Fat pad-related anterior Knee Pain Syndromes | US-guided corticosteroid-anesthetic injection and fat pad alcohol ablation | Effective in short-term pain reduction associated with anterior knee pain syndromes. | Beneficial for short-term pain reduction. |
MSK Interventions foot and ankle:
| Pathology | MSK Interventions | Comparison | Other Key Points |
|---|---|---|---|
| Achilles Degenerative Tendinopathy | - Image-Guided Injections | Limited RCT evidence supports image-guided injections for Achilles tendinopathy, but not enough to favor them over conservative treatments. PRP injections showed no superiority over placebo in RCTs. | Limited evidence for image-guided injections. |
| Tibial Tendon Tenosynovitis | - US guided Corticosteroid - Anesthetic Injections | Corticosteroid-anesthetic injections are preferred for tenosynovitis unresponsive to conservative management. | Effective for tenosynovitis. |
| Plantar Fasciitis | - US-Guided Corticosteroid Injections - US-Guided PRP Injections - Other Injections (ozone, hyaluronic acid, or botulinum toxin type ) | US-guided injections for plantar fasciitis are preferred over palpation-guided. PRP over corticosteroid injections for chronic plantar fasciitis. The effectiveness of US-guided injections with ozone, hyaluronic acid, or botulinum toxin type A has not been sufficiently proven to be recommended for plantar fasciitis. | Corticosteroid injections are highly effective for plantar fasciitis. PRP injections are superior for chronic plantar fasciitis. Limited evidence for alternative injections. |
| Foot and Ankle Joint Injections | - Image-Guided Corticosteroid Injections | Imaging guidance highly accurate. | |
| Midfoot Joint Osteoarthritis | - Image-Guided Corticosteroid Injections | Limited evidence for midfoot joint osteoarthritis. | |
| Talus Osteochondral Lesions | - US guided PRP injection - US guided Prolotherapy | Safe options for talus osteochondral lesions. | |
| Morton’s Neuroma | - US-Guided Corticosteroid Injections - US-Guided Ethanol Injection - Image-Guided Thermal Ablation - Other Interventions | US guidance enhances intervention effectiveness. | Effective for Morton’s neuroma. |
- Sconfienza, Luca Maria et al. “Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part I, shoulder.” European radiology vol. 30,2 (2020): 903-913. doi:10.1007/s00330-019-06419-x
- Sconfienza, Luca Maria et al. “Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VI, foot and ankle.” European radiology vol. 32,2 (2022): 1384-1394. doi:10.1007/s00330-021-08125-z