Diagnostic Ultrasound & Ultrasound Guided Injection

Physiotherapy and Sports Injury Clinic based in E9, London

Diagnostic Ultrasound Imaging

The use of ultrasound in the management of a number of musculoskeletal pathologies is becoming increasingly popular. There are many reasons for this increasing popularity, including a lack of radiation making the technique more acceptable. In addition it is a non-invasive and relatively quick procedure when compared to MRI and also has the advantage of being able to be performed as part of a normal assessment.

The images below are of a calf muscle as it joins onto into the beginnings of the Achilles tendon at the back of the lower leg. The image to the left is of a normal calf and tendon. However the image to the right shows a significant tear of the muscle at this level. This information allows both an accurate diagnosis and correct level of rehabilitation to be implemented.

Unlike an MRI scan ultrasound scanning also occurs in 'real-time' often making it possible for the patient to demonstrate the exact movement which causes them discomfort.

The images below demonstrate scanning of the subscapularis tendon of the shoulder (part of the rotator cuff). The image to the left demonstrates the position of the transducer. The image to the right demonstrates what a normal tendon should look like.

Ultrasound may also be used to assess for inflammation and the process of 'neovascularity' which can often be associated with tendon pain and damage.

The image to the right is of an Achilles tendon. It demonstrates a significantly thickened tendon with 'neovascularity'.

Diagnostic Ultrasound & Ultrasound Guided Injection

A number of studies have demonstrated that even in if undertaken by specialists only a minority of injections performed for musculoskeletal pathologies are carried out accurately. In regards to the shoulder for example it has been shown that in the approximately only 29% of subacromial and 42% of intra-articular injections are accurately given without guidance. Given this it is not perhaps surprising that outcome appears to be significantly correlated with accuracy of injection.

The degree of accuracy of needle placement is of particular importance in the hip in order that nerves and blood vessels are avoided. A study assessing the accuracy of such a procedure demonstrated that hip joint injections given without guidance resulted in the needle piercing or contacting the femoral nerve in 27% of anterior injections. Clinicians using a lateral approach were never within 25mm of any neurovascular structure in any injection given however only 80% of such unguided injections managed to reach the joint cavity.

For this reason it is clear that injections performed under ultrasound imaging for musculoskeletal conditions are becoming more popular.

The image to the right demonstrates a guided injection into the tendon sheath of tibialis posterior (a tendon at the ankle). The needle can be seen being placed alongside the tendon in the foot. The image to the right demonstrates a technique called 'high volume' injection for a painful Achilles tendon.

For more information on the conditions we treat and services we offer, or to book an appointment please call 020 8510 5751 or email us at p.resteghini@nhs.net

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