For information as it relates to preparing for your ultrasound and other FAQ’s, please refer to CMI’s Ultrasound – Diagnostic page.

What is therapeutic use of Ultrasound in musculoskeletal imaging?

Ultrasound is an imaging method that uses high-frequency sound waves to produce images of structures within the body. Therapeutic injections may be suggested to manage inflammatory and degenerative joint conditions when first-line therapies fail to provide adequate symptom relief.

Utilizing ultrasound technology allows for the precise placement of injected medicines into the joint space of specific areas of the body such as knees, shoulders and hips.

When medication is introduced through the needle the radiologist can see exactly where the medication is distributed to ensure that the local anaesthetic (numbing medications) or steroids (anti-inflammatory medication) have been directed to the right target. An ultrasound examination performed for assistance of a therapeutic procedure is termed an interventional ultrasound.

All diagnostic and interventional procedures are performed on a state of the art ultrasound machine with extremely high definition and excellent image processing capability. The CMI Ultrasound machine and rooms have been assessed and passed by the Diagnostic Accreditation Program (DAP) of the College of Physicians and Surgeons of BC, ensuring the highest standards of sterility and professionalism.

 

Disposable surgical drapes, sterile covers, gloves and needles are used for each intervention.

 

 

Who performs the diagnostic or interventional ultrasound procedures at CMI?

Radiologists are physicians specifically trained to perform and interpret radiology exams and ultrasound exams in particular. The radiologists at CMI performing these procedures are all staff radiologists at St. Paul’s Hospital in Vancouver who subspecialize in musculoskeletal radiology. The radiologist will perform and discuss the results of your exam at the time of your procedure and a more detailed written report will be produced and available to you and your referring physician(s) within 2-3 business days.

If the radiologist finds a treatable cause for your pain/ symptoms during the examination, you may request to proceed with an intervention to treat the problem.

What specific musculoskeletal interventions are performed at CMI?

All Ganglions and joint effusion aspiration and injections, diagnostic blocks and steroid injections, butulinum toxin and hyaluronic acid (symvisc, neovisc etc) injections.

Shoulder:

  • Hydrodilation for adhesive capsulitis / frozen shoulder,
  • Acromioclavicular joint (ACJ),
  • Glenohumeral joint
  • Long Head of biceps tendon sheath (LHB)
  • Subacromial subdeltoid bursa.

Perishoulder:

  • Sternoclavicular joint
  • Scapulothoracic

Elbow:

  • Common flexor and extensor origin (CFO & CEO)
  • Elbow joint
  • Perineural (usually ulnar nerve in cubital tunnel)

Wrist:

  • Distal radioulnar joint (DRUJ)
  • Wrist, radiocarpal joint, midcarpal joint, carpometacarpal (CMCJ)
  • MCPJ, PIPJ DIPJ
  • Flexor and extensor tendons, tenosynovitis, (ECU etc)
  • De Quervains tenosynovitis
  • proximal and distal crossover syndrome

Hand:

  • Carpometacarpal (CMCJ)
  • MCPJ, PIPJ DIPJ
  • Flexor and extensor tendons, tenosynovitis, (ECU etc)
  • De Quervains tenosynovitis

Hip:

  • Iliopsoas tendon and bursa
  • Hip joint
  • Tendon injections
  • Groin injections adductor tendon & rectus abdominus injections
  • Trochanteric bursa, gluteus medius and gluteus minimus
  • Proximal hamstring and rectus femoris tendon
  • Piriformis muscle

Knee:

  • Suprapatella pouch knee joint
  • Prepatella, & infrapatella bursa
  • Patella and quadriceps tendon procedures

Ankle:

  • Ankle & subtalar joint
  • Ankle tendons including achilles
  • Retrocalcaneal bursa
  • Plantar fascitis

Foot:

  • All joints (talonavicular (TNJ), navicular cuneiform, tarsometatarsal (TMTJ), Metatarsal pahalangeal joint (MTPJ), PIPJ and DIPJs
  • Mortons neuroma
  • Plantar fascitis
  • Foot tendons

Peripheral nerves:

  • Perineural steroid injections
  • Ganglion aspiration to decompress nerves

Spine:

  • Diagnostic imaging of the brachial plexus and neck.
  • Aspiration of neck cysts

What will I Experience During the Procedure?

A small needle is used to freeze the skin and tissues down to the intervention site. There is a brief stinging sensation which most people describe as mild discomfort. Very little symptoms after local anaesthetic is administered.

What will I Experience After the Procedure?

Numb in that area for the rest of the day.
Potential steroid flare (worsening of symptoms) the next day. Steroid effect should improve symptoms within 3-7 days.

Symptom Relief Timescale:

Effect of a steroid injection varies depending on location and patient. If the therapy works, symptom relief is usually on the order of several weeks to several months.

Can I Drive Home?

We strongly encourage patients to plan to have a designated driver following the procedure, as a numb joint may impair driving ability, and were you to be involved in an MVA, this is likely to create liability for you.

Can I Work?

On the first day of your therapy you should limit your activities with the body part involved in the injection as the anaesthetic can mask symptoms of overuse. After the first day the procedure should not result in any additional limitations to your work that did not exist prior to the procedure.

We do recommend doing activities that usually cause symptoms soon after the injection (when it is still numb) to see if it completely or partially resolves your usual symptoms, as this guides us in determining how significant findings seen on imaging are to you.