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I'm a (long) retired EMT-II who has suffered from chronic bilateral shoulder pain for years. An MRI revealed a substantial left shoulder tear which over time resulted in a `frozen shoulder'. My range of motion was greatly reduced, and I was in constant pain, which affected my ability to sleep, and many other facets of my life. I started seeing Dr. Tang in 2010, and received several steroid injections, which provided temporary relief. In 2012, while skeptical, I (finally) agreed to try prolotherapy. After 3 or 4 treatments the pain in my left shoulder was reduced by about 75%, enough to allow me to take several weeks of physical therapy (including `joint mobilization' which unfroze my shoulder). I continue to do PT exercises at home. Today, a year later, my range of motion remains good, and my pain levels remain a fraction of what they used to be. My need for analgesics is far lower than before, as well. I'm very pleased at the results, and wanted to express my thanks. –Michael Coston EMT-II (Ret.)

Diagnostic Muscular Ultrasound

Ultrasound Offers Advantages in Musculoskeletal Disorders Diagnosis and Treatment

Recent advances in high-resolution ultrasound imaging present new opportunities for improving the care of patients with musculoskeletal injuries. Ultrasound uses sound waves to provide real-time, high-resolution images of tendons, ligaments, muscles, and nerves throughout the body.


Ultrasound as a Diagnostic Tool

Ultrasound is a readily available and cost-effective imaging technique that can help us evaluate tendons, muscles, ligaments, and nerves with a resolution that equals or surpasses MRI. Ultrasound can also be performed live, allowing a dynamic evaluation of ligaments and tendons, as well as guiding needles to target areas throughout the body. Finally, ultrasound does not use radiation and is therefore safe during pregnancy.

Ultrasound can be an effective tool for diagnosing problems in patients with difficult to evaluate conditions e.g. to determine whether a tendon tear is the source of the pain, the practitioner can use ultrasound to precisely inject anesthetic into the epitendon or epineural sheath to assess the patient's response. This diagnostic injection can help differentiate incidental from symptomatic structural abnormalities.

Ultrasound can also help diagnose the source of painful movement-related snaps and pops. By evaluating patients dynamically while they demonstrate their symptoms, practitioners can identify unstable tendons, snapping calcifications within tendons, and other sources of motion-induced pain.

Common applicatons of diagnostic musculoskeletal ultrasound include:

  • Identification of tendon or ligament tears, inflamed bursa, compressed nerves, cysts, and joint fluid.
  • Evaluation of painful pops and snaps
  • Diagnostic injections into joints, tendon sheaths, nerve sheath but not in the nerves.

Therapeutic Ultrasound-Guided Procedures

During ultrasound-guided injections or aspirations, practitioners can directly visualize the needle passing to the target, precisely deliver therapies to the affected tissue. Direct visualization ensures accurate injectate placement and offers a greater margin of safety. Smaller needles may also be used, improving patient comfort and potentially reducing risk.

Applications for ultrasound-guided injections include:

  • Needle placement into joints for aspiration or injection, particularly in patients with challenging anatomy, those on blood thinners, or those in whom a nonguided injection has failed.
  • Injection into tendon sheaths, nerve sheaths or bursae.
  • Aspiration and injection of ganglion cysts.
  • Diagnostic or therapeutic nerve blocks, including carpal tunnel syndrome.
  • Diagnostic or therapeutic Sacroiliac joint and facet injection
  • Percutaneous treatment of calcific tendonitis.

Epidural Steroid Injection

Fig: Epidural Steroid Injection










Fig: Transforaminal Injection










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