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Sports Medicine & ShoulderSpecialist in Gilbert Arizona
Matthew L. Hansen, MD

Matthew L. Hansen, MD

Orthopedic surgeonBoard Certified in Orthopedic SurgeryBoard Certified in Sports Medicine

Ultrasound Guided Procedures

Ultrasound-guided procedures can be performed in clinic, and have a number of advantages. Structures are visualized in real-time, and a needle can be visualized throughout the encounter without the use of damaging radiation, or the need to attend a hospital or imaging facility. Ultrasound is used for both diagnostic and therapeutic procedures. While some procedures are not possible with ultrasound (including deep structures, the inside of some joints or patients with a large body habitus), more superficial structures are visualized very well. Ultrasound can be used for diagnosis of select injuries in patients who cannot tolerate other procedures, such as patients with a pacemaker or patients with anxiety or claustrophobia. Procedures include diagnostic and therapeutic injections of the hip and shoulder. When compared with blind injections, complication rates are significantly lower as a result of the constant visualization. In addition, ultrasound highlights structures such as nerves and blood vessels, which can then be avoided during a procedure.

Procedures:

Adhesive Capsulitis (Frozen Shoulder): Patients may experience loss of range of motion and pain associated with a frozen shoulder. (Please see further information under the “Shoulder Conditions” section of the web site.) This inflammatory process often responds well to a corticosteroid injection in the ball-and-socket joint, or glenohumeral joint, of the shoulder. The steroid targets the inflamed tissues, and calms the inflammation to allow a patient to tolerate physical therapy and home rehabilitation exercises.

The procedure is done with the patient lying on their side. Both the area to be injected and the ultrasound machine are prepared in a sterile fashion. The needle is inserted into the back of shoulder. Lidocaine is used to numb the skin, and a second needle may be used to enter the glenohumeral joint (the shoulder ball-and-socket joint). More lidocaine is used to numb the joint. The steroid is then injected. Most patients will notice improvement in their pain within minutes of the procedure, but no improvement in their motion. The steroid may take 2-5 days to cause a noticeable change.

Please see “Considerations Following Your Injection” below.

Ultrasound Guided ProceduresCalcific Tendonitis of the Shoulder: Calcium deposits can form in the rotator cuff, and become painful or limit motion of the shoulder. (Please see further information under the “Shoulder Conditions” section of the web site.) Treatment options include steroid injection, surgical removal, or ultrasound-guided breakup and/or removal of the calcium deposits.

The procedure is done with the patient lying on their back. Both the area to be injected and the ultrasound machine are prepared in a sterile fashion. The needle is inserted into the lateral side of shoulder. Lidocaine is used to numb the skin, and then a second needle is used to enter the calcium deposits in the rotator cuff. More lidocaine is used which serves to numb the rotator cuff. The needle is then used to break up the calcium deposits, and when possible, to aspirate (remove) the contents of the deposit. At the conclusion of the procedure, a steroid is injected to help calm inflammation and manage pain. There is often a period of increased pain after the local numbing effect subsides and before the steroid takes effect, typically 2-5 days after the injection. Therapy typically starts one week after the procedure.

Please see “Considerations Following Your Injection” below.

Hip Injection: Injections are frequently used as a diagnostic tool in the hip for patients experiencing pain from arthritis, labrum tears, femoral acetabular impingement, or other conditions of the hip. (Please see further information under the “Hip Conditions” section of the web site.) The injection helps your surgeon determine that the pain is truly coming from the hip, and not from other sources (i.e. hernia, gynecological problems, etc.). The procedure often provides pain relief for weeks to months in addition to the information gained for the surgeon.

The procedure is done with the patient lying on their back. Both the area to be injected and the ultrasound machine are prepared in a sterile fashion. The needle is inserted into the front of the hip. Lidocaine is used to numb the skin, and then a second needle is used to enter the hip joint. More lidocaine is used to numb the joint. The steroid is then injected. Most patients will notice improvement in their pain within minutes of the procedure.

Please see “Considerations Following Your Injection” below.

Considerations Following Your Injection:

**Please keep a pain journal of your symptoms for the first few days after the injection, so you can report them to your surgeon.** Most patients note soreness several hours after the procedure when the Lidocaine’s effects wear off. Avoid strenuous activity for 24 hours following the procedure. Pain is managed well with Ibuprofen, Tylenol and/or ice. The steroid often takes 3-5 days to take effect. Therapy can be started (if ordered) a minimum of 5 days after the procedure. Do not submerge the injection site (no baths, hot tubs or swimming pools – showering is OK) for 24 hours to prevent infection.

Complications are very rare following an ultrasound-guided injection. Possible side effects include, but are not limited to the following: infection (expanding redness around the injection site, purulent discharge, fevers, chills or night sweats), or allergic reactions (rash, difficulty breathing or swallowing, dizziness). If you notice any of these symptoms you should be seen immediately in clinic or in the emergency room.

Injection Consent

 

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AOSSM AAOS: American Academy of Orthopaedic Surgeons® / American Association of Orthopaedic Surgeons® ORS | Orthopaedic Research Society ARIZONA ORTHOPAEDIC SOCIETY OrthoArizona