Bologna – Istituto Rizzoli
Misano Adriatico – Mendel
San Marino – Nova Clinic
Roma – Salvator Mundi
San Lucido – Studi Medici ARS

Echo-guided infiltration

Ultrasound-guided infiltrations are a safe and minimally invasive approach to the treatment of joint pain. Drugs routinely used include corticosteroids, local anesthetics, PRP PRP (platelet-rich plasma) and joint lubricants such as hyaluronic acid..

Stem cells derived from adipose tissue cellule staminaliadipose tissue . may also be injected under ultrasound guidance.

Joint injections, to be effective, must be administered within the joint space and not into the surrounding soft tissues.

The use of ultrasonographic technique has, in recent years, made it possible to increase the accuracy and effectiveness of infiltrative therapy.[1]

Any joint can be treated with infiltration, but those that benefit most from the use of ultrasound guidance are the deeper joints, which are more difficult to reach based on topographic anatomy alone.

The first joint to be infiltrated under ultrasound guidance was the hip. Ultrasound-guided infiltration of the hip allows the femoral neck to be visualized and the needle path to be followed, thus avoiding injury to deep vessels and nerves surrounding it. There are 3 different access routes to perform this infiltration (antero-superior, lateral, and antero-inferior) (Fig. 1). In my opinion, from clinical experience, the least invasive and safest is the lateral one. Here is a video where I show how to perform this type of infiltration (Video 1). [2]

Infiltrazione Ecoguidata
Fig. 1

Video 1

The second site where ultrasound finds its greatest utility is the shoulder (Fig. 2). Indeed, ultrasound-guided shoulder infiltrations allow the different peri-articular structures to be distinguished and infiltrated separately for maximum benefit. Among the structures that benefit most from the echoguided technique are the subacromial bursa (Fig.2) and the biceps long head tendon (CLB) (Video 2). [3]

Infiltrazione Ecoguidata
Fig. 2

Video 2

Bibliography
  1. Gilliland CA, Salazar LD, Borchers JR (2011) Ultrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review. Phys Sportsmed 39:121–131.
  2. Lynch TS, Oshlag BL, Bottiglieri TS, Desai NN (2019) Ultrasound-Guided Hip Injections. J Am Acad Orthop Surg 27:e451–e461.
  3. Aly A-R, Rajasekaran S, Ashworth N (2015) Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med 49:1042–1049.

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