Short Note on Ultrasound In Climbing Injuries

Summary

This video discusses advanced injection techniques for treating conditions like capsulitis and tendon injuries, focusing on ultrasound-guided procedures. The speaker emphasizes the importance of accurate needle placement to avoid complications, describing methods like the Spanish approach and their preferred use of ultrasound to visualize the joint space. They also highlight their experience with cortisone, PRP, and radiosurgery for chronic conditions, offering valuable insights into injection practices for musculoskeletal conditions. The speaker encourages further learning and invites participation in their upcoming courses.

Takeaways

• 😀 The needle technique for flexor tendon injections involves inserting the needle into the tendon sheath and allowing the patient to move their fingers to confirm the needle's correct position.
• 😀 A proper injection should be aimed at the tendon and bone without causing harm to the flexor tendon, using a method that allows for safe, precise targeting.
• 😀 Ultrasound is commonly used to ensure injections are placed correctly, particularly for chronic conditions like capsulitis.
• 😀 Cortisone, PRP (Platelet-Rich Plasma), and radioactive substances are employed in injections for chronic joint conditions after other treatments have been unsuccessful.
• 😀 Capsulitis, a chronic inflammation of the joint capsule, can be treated with injections into the joint space, typically after conservative treatments have failed.
• 😀 The Spanish method for joint injections involves passing the needle through the tendon into the palm space, while an alternative method uses ultrasound to precisely target the joint space.
• 😀 Ultrasound-guided injections offer greater accuracy in identifying the joint space and ensuring the correct placement of the needle during the procedure.
• 😀 Joint space is often smaller than it appears on an x-ray, and in some cases, torque is applied to open up the joint space for proper needle insertion.
• 😀 Fluoroscopy was once used to guide needle placement, but ultrasound has become the preferred tool due to its real-time visual guidance and higher accuracy.
• 😀 Ongoing learning and skill improvement are essential for medical professionals performing these types of injections, with available courses and literature offering valuable resources.

Q & A

What is the key goal when performing a tendon injection using the needle?

The key goal is to insert the needle safely into the flexor tendon without damaging it, ensuring that the needle tip is positioned correctly within the tendon to allow movement of the patient's finger, and then injecting the substance once the needle is in the right location.

Why is it important to ensure that the needle tip is in the correct location during a tendon injection?

It is important because the correct placement of the needle prevents harm to the tendon and surrounding structures. The needle must be positioned in the tendon, allowing the finger to move freely and confirming that the needle is in the correct area for injection.

What substances are typically injected in these procedures, and when are they used?

Common substances injected include corticosteroids (cortisone), Platelet-Rich Plasma (PRP), and occasionally radioactive substances like radiosu with thesis. These are generally used for chronic conditions like capsulitis, after conservative treatments have failed.

What is capsulitis, and how is it treated?

Capsulitis, or synovitis, is a chronic inflammation of the joint capsule's synovial lining. It is typically treated with injections of cortisone, PRP, or radioactive substances when conservative treatments like physical therapy do not provide relief.

How does the Spanish method for injection differ from the ultrasound-guided technique described?

The Spanish method involves injecting through the tendon to access the joint space directly, while the ultrasound-guided technique uses ultrasound to monitor needle placement accurately and sometimes adjusts the joint's position to open up the space for better access.

Why is ultrasound preferred over fluoroscopy for guiding injections?

Ultrasound is preferred because it provides real-time imaging and higher precision in needle placement. It also allows for easier visualization of the joint space and surrounding tissues, reducing the risk of complications.

What is the role of the ultrasound transducer's marker during the injection procedure?

The ultrasound transducer's marker helps the practitioner identify the correct joint space by indicating where the needle should be placed. It allows for accurate navigation to ensure the injection is made in the right area.

What challenges are involved when accessing the joint space for injections?

One challenge is that the joint space is often very small, which can make it difficult to accurately place the needle. Additionally, the joint space may need to be opened up by manipulating the joint, as cartilage can obscure the space.

How does the practitioner ensure that they are injecting the substance into the correct area of the joint?

The practitioner uses ultrasound to monitor the position of the needle and, if necessary, manipulates the joint to open up the space, making sure the needle is placed precisely within the joint for optimal treatment.

What is the educational significance of this injection technique, and how is it shared with others?

The injection technique, including ultrasound guidance, is taught through courses and educational materials. The speaker invites others to attend training courses and refers to books on climbing medicine, which include sections on ultrasound, highlighting the importance of continuous learning in medical practice.