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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1001_Библиотеки_им_академика_М_И_Перельмана
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Diagnostic Musculoskeletal Ultrasound and
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Guided Injection: A Practical Guide
Peter Resteghini, PhD
Consultant Physiotherapist Sports and Musculoskeletal Medicine
Musculoskeletal Sonographer
Honorary Visiting Senior Clinical Fellow
Homerton University Hospital
London, UK
516 illustrations
Thieme
Stuttgart • New York • Delhi • Rio de Janeiro
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Library of Congress Cataloging-in-Publication Data
Names: Resteghini, Peter, author.
Title: Diagnostic musculoskeletal ultrasound and guided
injection : a practical guide / Peter Resteghini.
Description: Stuttgart ; New York : Thieme, [2018] |
Includes bibliographical references and index.
Identifiers: LCCN 2017029141 (print) |
LCCN 2017030929 (ebook) | ISBN 9783132203914 |
ISBN 9783132203815 | ISBN 9783132203914
(ebook)
Subjects: | MESH: Musculoskeletal Diseases–diagnostic
imaging | Ultrasonography–methods | Injections–
methods | Handbooks Classification: LCC RC925.7
(ebook) | LCC RC925.7 (print) | NLM WE 39 |
DDC 616.7/075–dc23
LC record available at https://lccn.loc.gov/2017029141
© 2018 by Georg Thieme Verlag KG
Thieme Publishers Stuttgart
Rüdigerstrasse 14, 70469 Stuttgart, Germany
+49 [0]711 8931 421, customerservice@thieme.de
Important Note: Medicine is an ever-changing science
undergoing continual development. Research and clinical
experience are continually expanding our knowledge, in
particular our knowledge of proper treatment and drug
therapy. Insofar as this book mentions any dosage or appli-
cation, readers may rest assured that the authors, editors,
and publishers have made every effort to ensure that such
references are in accordance with the state of knowledge
at the time of production of the book.
Nevertheless, this does not involve, imply, or express
any guarantee or responsibility on the part of the publishers with respect of any dosage instructions and forms of
application stated in the book. Every user is requested to
examine carefully the manufacturer’s leaflets accompa-
nying each drug and to check, if necessary in consultation
with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by
the manufacturer differ from the statements made in the
present book. Such examination is particularly important
with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every
form of application used is entirely at the user’s risk and
responsibility. The authors and publishers request every
user to report to the publishers any discrepancies or inaccuracies noticed.
Some of the product names, patents, and registered
designs referred to in this book are in fact registered trademarks or proprietary names, even though specific reference
to this fact is not always made in the text. Therefore, the
appearance of a name without a designation as proprietary
is not to be construed as a representation by the publisher
that it is in the public domain.
Thieme Publishers New York
333 Seventh Avenue, New York, NY 10001 USA
+1 800 782 3488, customerservice@thieme.com
Thieme Publishers Delhi
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Uttar Pradesh, India
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Cover design: Thieme Publishing Group
Typesetting by DiTech Process Solutions Pvt. Ltd., India
Printed in India by Replika Press Pvt. Ltd.
ISBN 978-3-13-220381-5
Also available as an e-book:
eISBN 978-3-13-220391-4
This book, including all parts thereof, is legally protected by
copyright. Any use, exploitation, or commercialization out-
side the narrow limits set by copyright legislation, without
the publisher’s consent, is illegal and liable to prosecution.
This applies in particular to photostat or mechanical reproduction, copying, or duplication of any kind, translating,
preparation of microfilms, and electronic data processing
and storage.
Contents
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Preface .......................................................... x
Introduction ..................................................... xi
Local Anesthetics and Corticosteroids ................................. xiii
1 Diagnostic Ultrasound and Guided Injection .................................. 1
1.1 Diagnostic Ultrasound and
Musculoskeletal Medicine ....... 2
1.1.1 Tendons ........................ 2
1.1.2 Joints ........................... 5
1.1.3 Bursae .......................... 6
1.1.4 Muscle .......................... 7
1.1.5 Nerve ........................... 9
2 The Shoulder: Diagnostic Imaging ............................................ 10
2.1 Diagnostic Imaging of the Shoulder:
Introduction .................... 10
2.1.1 Long Head of Biceps Tendon ....... 10
2.1.2 Subscapularis Tendon ............ 13
2.1.3 Dynamic Examination for Subcoracoid
Impingement .................... 14
2.1.4 Supraspinatus Tendon and
Subacromial Bursa (Including
Dynamic Imaging as Indicated) .... 15
2.1.5 Infraspinatus Tendon ............. 19
2.1.6 Suprascapular Notch and
Suprascapular Nerve ............. 20
2.1.7 The Acromioclavicular Joint ....... 20
2.1.8 Sternoclavicular Joint ............. 21
3 The Shoulder: Guided Injection Techniques ................................... 24
3.1 Glenohumeral Joint Injection —
Acute or Chronic Capsulitis:
‘The Frozen Shoulder’ ........... 24
3.1.1 Cause ........................... 24
3.1.2 Presentation ..................... 24
3.1.3 Equipment ...................... 24
3.1.4 Anatomical Considerations ........ 24
3.1.5 Procedure ....................... 24
3.1.6 The Injection .................... 24
3.1.7 Notes ........................... 25
3.2 Subacromial/Subdeltoid Bursal
Injection ....................... 25
3.2.1 Cause ........................... 25
3.2.2 Presentation ..................... 25
3.2.3 Equipment ...................... 25
3.2.4 Anatomical Considerations ........ 25
3.2.5 Procedure ....................... 25
3.2.6 The Injection .................... 25
3.2.7 Notes ........................... 25
3.3 Acromioclavicular Joint Injection . 27
3.3.1 Cause ........................... 27
3.3.2 Presentation ..................... 27
3.3.3 Equipment ...................... 27
3.3.4 Anatomical Considerations ........ 27
3.3.5 Procedure ....................... 27
3.3.6 The Injection .................... 27
3.3.7 Notes ........................... 27
3.4 Sternoclavicular Joint Injection .. 28
3.4.1 Cause ........................... 28
3.4.2 Presentation ..................... 28
3.4.3 Equipment ...................... 28
3.4.4 Anatomical Considerations ........ 28
3.4.5 Procedure ....................... 28
3.4.6 The Injection .................... 28
3.4.7 Notes ........................... 28
3.5 Biceps Tendon Sheath Injection .. 29
3.5.1 Cause ........................... 29
3.5.2 Presentation ..................... 29
3.5.3 Equipment ...................... 29
3.5.4 Anatomical Considerations ........ 29
3.5.5 Procedure ....................... 29
3.5.6 The Injection .................... 29
3.5.7 Notes ........................... 29
3.6 Suprascapular Nerve Block ...... 30
3.6.1 Cause ........................... 30
3.6.2 Presentation ..................... 30
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3.6.3 Equipment ...................... 30
3.6.4 Anatomical Considerations ........ 30
3.6.5 Procedure ....................... 30
3.6.6 The Injection .................... 30
3.6.7 Notes ........................... 31
4 The Elbow: Diagnostic Imaging ............................................... 32
4.1 Diagnostic Imaging of the Elbow:
Introduction .................... 32
4.1.1 Anterior ........................ 32
4.1.2 Distal Biceps Tendon ............. 35
4.1.3 Lateral .......................... 37
4.1.4 Medial .......................... 38
4.1.5 Posterior ........................ 38
5 The Elbow: Guided Injection Techniques ...................................... 43
5.1 Elbow Joint Injection ............ 43
5.1.1 Cause ........................... 43
5.1.2 Presentation ..................... 43
5.1.3 Equipment ...................... 43
5.1.4 Anatomical Considerations ........ 43
5.1.5 Procedure ....................... 43
5.1.6 The Injection .................... 43
5.1.7 Notes ........................... 43
5.2 Common Extensor Tendon
Injection — Tennis Elbow ........ 44
5.2.1 Cause ........................... 44
5.2.2 Presentation ..................... 44
5.2.3 Equipment ...................... 44
5.2.4 Anatomical Considerations ........ 44
5.2.5 Procedure ....................... 44
5.2.6 The Injection .................... 45
5.2.7 Notes ........................... 45
5.3 Common Flexor Tendon Injection —
‘Golfer’s Elbow’ ................. 45
5.3.1 Cause ........................... 45
5.3.2 Presentation ..................... 45
5.3.3 Equipment ...................... 45
5.3.4 Anatomical Considerations ........ 45
5.3.5 Procedure ....................... 45
5.3.6 The Injection .................... 46
5.3.7 Notes ........................... 46
5.4 Radiobicipital Bursa/Biceps
Insertional Tendinopathy
Injection ......................... 46
5.4.1 Cause ........................... 46
5.4.2 Presentation ..................... 46
5.4.3 Equipment ...................... 46
5.4.4 Anatomical Considerations ........ 46
5.4.5 Procedure ....................... 47
5.4.6 The Injection .................... 47
5.4.7 Notes ........................... 47
5.5 Olecranon Bursa Injection . . . . . . . 47
5.5.1 Cause ........................... 47
5.5.2 Presentation ..................... 47
5.5.3 Equipment ...................... 47
5.5.4 Anatomical Considerations ........ 48
5.5.5 Procedure ....................... 48
5.5.6 The Injection .................... 48
5.5.7 Notes ........................... 48
6 The Wrist and Hand: Diagnostic Imaging ..................................... 49
6.1 Diagnostic Imaging of the Wrist
and Hand: Introduction ......... 49
6.1.1 Wrist Joint — Volar ............... 49
7 The Wrist and Hand: Guided Injection Techniques ............................ 67
7.1 Wrist Joint Injection —
Radiocarpal Joint ............... 67
7.1.1 Cause ........................... 67
7.1.2 Presentation ..................... 67
7.1.3 Equipment ...................... 67
7.1.4 Anatomical Considerations ........ 67
7.1.5 Procedure ....................... 67
7.1.6 The Injection .................... 67
7.1.7 Notes ........................... 67
7.2 Carpometacarpal Joint of the
Thumb Injection ................ 68
7.2.1 Cause ........................... 68
7.2.2 Presentation ..................... 68
vi
6.1.2 Wrist Joint — Dorsal: ............. 53
6.1.3 Fingers and Thumb ............... 60
7.2.3 Equipment ...................... 68
7.2.4 Anatomical Considerations ........ 68
7.2.5 Procedure ....................... 68
7.2.6 The Injection .................... 69
7.2.7 Notes ........................... 69
7.3 First Dorsal Compartment
Injection — de Quervain’s
Tenosynovitis .................... 69
7.3.1 Cause ........................... 69
7.3.2 Presentation ..................... 69
7.3.3 Equipment ...................... 69
7.3.4 Anatomical Considerations ........ 69
7.3.5 Procedure ....................... 70
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7.3.6 The Injection .................... 70
7.3.7 Notes ........................... 70
7.4 A1 Pulley Injection —
Trigger Finger or Thumb ......... 70
7.4.1 Cause ........................... 70
7.4.2 Presentation ..................... 70
7.4.3 Equipment ...................... 70
7.4.4 Anatomical Considerations ........ 71
7.4.5 Procedure ....................... 71
7.4.6 The Injection .................... 71
7.4.7 Notes ........................... 72
7.5 Ganglion Cyst: Guided Aspiration
72
7.5.1 Cause ........................... 72
7.5.2 Presentation ..................... 72
7.5.3 Equipment ...................... 72
7.5.4 Anatomical Considerations ........ 72
7.5.5 Procedure ....................... 72
7.5.6 Guided Aspiration ................ 72
7.6 Carpal Tunnel Syndrome:
Guided Injection ................ 73
7.6.1 Cause ........................... 73
7.6.2 Presentation ..................... 73
7.6.3 Equipment ...................... 73
7.6.4 Anatomical Considerations ........ 73
7.6.5 Procedure ....................... 73
7.6.6 The Injection .................... 73
7.6.7 Notes ........................... 74
8 The Hip: Diagnostic Imaging .................................................. 75
8.1 Diagnostic Imaging of the Hip:
Introduction .................... 75
8.1.1 Anterior ........................ 75
8.1.2 Medial .......................... 80
8.1.3 Lateral .......................... 82
8.1.4 Posterior ........................ 84
8.1.5 Symphysis Pubis ................. 87
9 The Hip: Guided Injection Techniques ......................................... 88
9.1 Hip Joint Injection .............. 88
9.1.1 Cause ........................... 88
9.1.2 Presentation ..................... 88
9.1.3 Equipment ...................... 88
9.1.4 Anatomical Considerations ........ 88
9.1.5 Procedure ....................... 88
9.1.6 The Injection .................... 89
9.1.7 Notes ........................... 89
9.2 Psoas Bursa Injection ............ 89
9.2.1 Cause ........................... 89
9.2.2 Presentation ..................... 89
9.2.3 Equipment ...................... 89
9.2.4 Anatomical Considerations ........ 89
9.2.5 Procedure ....................... 89
9.2.6 The Injection .................... 90
9.2.7 Notes ........................... 90
9.3 Ischial Bursa/Hamstring
Tendon Origin Injection .......... 90
9.3.1 Cause ........................... 90
9.3.2 Presentation ..................... 90
9.3.3 Equipment ...................... 91
9.3.4 Anatomical Considerations ........ 91
9.3.5 Procedure ....................... 91
9.3.6 The Injection .................... 91
9.3.7 Notes ........................... 91
9.4 Greater Trochanter Injection ..... 91
9.4.1 Cause ........................... 91
9.4.2 Presentation ..................... 92
9.4.3 Equipment ...................... 92
9.4.4 Anatomical Considerations ........ 92
9.4.5 Procedure ....................... 92
9.4.6 The Injection .................... 92
9.4.7 Notes ........................... 92
10 The Knee: Diagnostic Imaging ................................................. 93
10.1 Diagnostic Imaging of the Knee:
Introduction .................... 93
10.1.1 Anterior ........................ 93
10.1.2 Medial .......................... 101
10.1.3 Lateral .......................... 104
10.1.4 Posterior ........................ 107
11 The Knee: Guided Injection Techniques ....................................... 111
11.1 Knee Joint Aspiration/Injection ... 111
11.1.1 Cause ........................... 111
11.1.2 Presentation ..................... 111
11.1.3 Equipment ...................... 111
11.1.4 Anatomical Considerations ........ 111
11.1.5 Procedure ....................... 111
11.1.6 The Aspiration/Injection .......... 111
11.1.7 Notes ........................... 112
11.2 Semimembranosus Bursa/Baker’s
Cyst Aspiration/Injection ......... 112
11.2.1 Cause ........................... 112
11.2.2 Presentation ..................... 112
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11.2.3 Equipment ...................... 112
11.2.4 Anatomical Considerations ........ 112
11.2.5 Procedure ....................... 112
11.2.6 The Aspiration/Injection .......... 112
11.2.7 Notes ........................... 112
11.3 Distal Iliotibial Band/Bursa
Injection ......................... 113
11.3.1 Cause ........................... 113
11.3.2 Presentation ..................... 113
11.3.3 Equipment ...................... 113
11.3.4 Anatomical Considerations ........ 113
11.3.5 Procedure ....................... 113
11.3.6 The Injection .................... 113
11.3.7 Notes ........................... 113
11.4 Pes Anserine Bursa/Tendon
Injection ......................... 114
11.4.1 Cause ........................... 114
11.4.2 Presentation ..................... 114
11.4.3 Equipment ...................... 114
11.4.4 Anatomical Considerations ........ 114
11.4.5 Procedure ....................... 114
11.4.6 The Injection .................... 114
11.4.7 Notes ........................... 115
11.5 Medial Collateral Ligament
Injection ......................... 115
11.5.1 Cause ........................... 115
11.5.2 Presentation ..................... 115
11.5.3 Equipment ...................... 115
11.5.4 Anatomical Considerations ........ 115
11.5.5 Procedure ....................... 115
11.5.6 Medial Collateral Ligament Injection 115
11.5.7 Notes ........................... 115
11.6 Deep and Superficial Infrapatellar
Bursa Injection ................... 116
11.6.1 Cause ........................... 116
11.6.2 Presentation ..................... 116
11.6.3 Equipment ...................... 116
11.6.4 Anatomical Considerations ........ 116
11.6.5 Procedure ....................... 116
11.6.6 The Injection .................... 117
11.6.7 A. Deep Infrapatellar Bursa ........ 117
11.6.8 B. Superficial Infrapatellar Bursa ... 117
11.6.9 Notes ........................... 117
11.7 Popliteus Tendon Sheath Injection 117
11.7.1 Cause ........................... 117
11.7.2 Presentation ..................... 117
11.7.3 Equipment ...................... 117
11.7.4 Anatomical Considerations ........ 118
11.7.5 Procedure ....................... 118
11.7.6 The Injection .................... 118
11.7.7 Notes ........................... 118
11.8 Proximal Tibiofibular Joint
Injection .......................... 118
11.8.1 Cause ........................... 118
11.8.2 Presentation ..................... 118
11.8.3 Equipment ...................... 118
11.8.4 Anatomical Considerations ........ 119
11.8.5 Procedure ....................... 119
11.8.6 The Injection .................... 119
11.8.7 Notes ........................... 119
11.9 Patellar Tendon — Fenestration and
Injection of Autologous Blood ... 119
11.9.1 Cause ........................... 119
11.9.2 Presentation ..................... 119
11.9.3 Equipment ...................... 119
11.9.4 Anatomical Considerations ........ 120
11.9.5 Procedure ....................... 120
11.9.6 Fenestration and Injection of
Autologous Blood ................ 120
11.9.7 Notes ........................... 120
11.10 Patellar Tendon — High Volume
Guided Injection ................. 120
11.10.1 Cause ........................... 120
11.10.2 Presentation ..................... 120
11.10.3 Equipment ...................... 120
11.10.4 Anatomical Considerations ........ 121
11.10.5 Procedure ....................... 121
11.10.6 High-Volume Saline Injection ...... 121
11.10.7 Notes ........................... 122
12 The Ankle and Foot: Diagnostic Imaging ...................................... 123
12.1 Diagnostic Imaging of the Ankle and
Foot: Introduction ............... 123
12.1.1 Anterior ........................ 123
12.1.2 Medial .......................... 128
12.1.3 Lateral .......................... 136
13 The Ankle and Foot: Guided Injection Techniques ............................ 157
13.1 Ankle Joint (Talocrural Joint)
Injection ......................... 157
13.1.1 Cause............................ 157
13.1.2 Presentation...................... 157
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12.1.4 Posterior ........................ 139
12.1.5 Inferior ......................... 148
12.1.6 Interdigital . . . . . . . . . . . . . . . . . . . . . . 150
12.1.7 Digital .......................... 153
13.1.3 Equipment ....................... 157
13.1.4 Anatomical Considerations......... 157
13.1.5 Procedure ........................ 157
13.1.6 The Injection ..................... 157
13.1.7 Notes............................ 158
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