Learning objectives
To illustrate the high-resolution ultrasound (US) appearance of the synovial recesses of interest for percutaneous joint procedures in the extremities;
To describe patient positioning,
scanning and needle approach techniques for each specific location.
Background
Percutaneous intra-articular procedures in the extremities mainly include aspiration,
injection for both diagnostic and therapeutic purposes,
and synovial biopsy.
The accuracy of these procedures is improved if the needle tip is visualized within the target.
US provides continuous needle monitoring and guidance throughout the procedure.
A crucial concept is that nearly each synovial joint in the extremities directly communicates with at least one articular recess that distends with joint effusion and is detectable at US.
An US-guided percutaneous procedure preferentially targets these recesses,
thus avoiding...
Imaging findings OR Procedure Details
Patient positioning,
transducer choice and needle selection depend on location and type of procedure.
Both in-plane and out-of-plane approaches can be used.
With the in-plane approach,
the needle is positioned under the long axis of the transducer,
thus enabling visualization of the entire needle at all times during the procedure.
With the out-of-plane approach,
the needle is positioned perpendicular to the transducer,
thus visualizing only a short segment of the needle when it passes through the US beam plane.
When accessing a joint for an...
Conclusion
US is valuable for guiding percutaneous joint procedures in the extremities.
Awareness of the synovial recess anatomy as well as knowledge of patient positioning,
scanning and needle approach techniques are required to accurately identify the target during the procedure.
References
Jacobson JA.
Fundamentals of Musculoskeletal Ultrasound.
Elsevier Health Sciences,
2012.
Sconfienza LM,
Serafini G,
Silvestri E.
Ultrasound-guided Musculoskeletal Procedures: The Upper Limb.
Springer Verlag,
2015
Sconfienza LM,
Orlandi D,
Silvestri E.
Ultrasound-guided Musculoskeletal Procedures: The Lower Limb.
Springer Verlag,
2015