Ultrasound-guided joint and soft tissue interventions

Minor procedures with an injection needle are frequently performed in orthopedic clinics. They may be of a diagnostic, diagnostic and therapeutic or purely therapeutic nature. Ultrasound guidance while inserting the needle allows for a safe medicine administration and evacuation of fluid contents. It improves the efficacy of such procedures by ensuring accurate needle insertion in the target site. Ultrasound-guided procedures reduce the duration of treatment (e.g. medicines reach the target site directly; all fluid collections are removed, even multilocular ones) and minimize pain (by the selection of optimal access sites omitting tendons, vessels and peripheral nerves). This paper presents the principles of performing ultrasound-guided interventions. A detailed description of such a technique is provided and the most commonly injected medicines as well as their adverse reactions and contraindications are discussed. Attention is also paid to image optimization and the role of procedure site selection with the exclusion of other pathologies in the puncture site (such as tumors, foreign bodies and vascular or nerve pathologies). What is more, the author also discusses the principles of needle length and thickness selection as well as the manners of its insertion in relation to the transducer. Moreover, the principles of aseptics that are mandatory during such interventions are also presented and the way to protect transducers from the effects of chemical disinfectants is discussed. Furthermore, the paper contains numerous photographs of performed interventions. It is addressed to clinical practitioners and its aim is to facilitate and improve the efficacy of the procedures which are commonly performed in orthopedics. Ultrasound guidance of joint and soft tissue interventions should become a gold standard in all orthopedic clinics.