Ultrasound-guided musculoskeletal interventional procedures around the shoulder
Silvia Tortora, Carmelo Messina, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, Salvatore Gitto, Vito Chianca, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonese (EOC), Lugano, Switzerland, Diagnostica per Immagini, Ospedale Evangelico Betania, Italy, Francesca Serpi, A. F. Gambino, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, Luigi Pedone Anchora, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, Gianpaolo Carrafiello, Luca Maria Sconfienza, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, Domenico Albano, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
Abstract
Ultrasound is a fast, accessible, reliable, and radiation-free imaging modality routinely used to assess the soft tissues around the shoulder. It enables to identify a wide range of pathological conditions. Furthermore, most ultrasound-guided musculoskeletal interventional procedures around the shoulder produce better results in terms of accuracy and clinical efficacy than those performed in a blinded fashion. Indeed, intra-articular and peri-articular interventional procedures can be easily performed under continuous ultrasound monitoring to ensure the correct position of the needle and to deliver the medication to a specific target. Several technical approaches and medications can be used to treat different causes of painful shoulder. Intra-articular injections are applied to treat acromioclavicular osteoarthritis as well as glenohumeral joint osteoarthritis and adhesive capsulitis. Subacromial-subdeltoid bursitis, either presenting as a primary inflammatory condition or secondary to rotator cuff disorders, can be easily approached using ultrasound guidance to aspirate synovial effusion and to inject medications. Ultrasound-guided percutaneous irrigation is a well-established technique increasingly applied to treat patients with rotator cuff calcific tendinopathy. Also, degenerative rotator cuff tendinopathy can be conservatively treated by image-guided interventions, specifically with needling under ultrasound guidance that can be associated with injections of platelet-rich plasma. Lastly, periarticular peripheral nerve block can be quickly and safely performed under ultrasound guidance, particularly in conditions involving the suprascapular nerve in the setting of pre-operative analgesia or pain treatment in glenohumeral osteoarthritis and adhesive capsulitis. In this article, the most common ultrasound-guided procedures around the shoulder have been reviewed to discuss indications and techniques.