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Pain Management Protocol

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Ultrasound Guidance

Ultrasound is a common imaging technique that employs high frequency sound waves to create images of the organs and other internal structures of the body. These images provide the doctor valuable information which assists in diagnosis and treatment of a wide range of tendon, muscle and joint disorders affecting the body. It is also an excellent tool for guiding the placement of needles for both diagnostic as well as therapeutic purposes.  Injection of a pain medication in combination with a local anesthetic directly to the site of injury helps relieve pain. Ultrasound-guided injection provides improved accuracy for injection site location.

Advantages

The advantages of ultrasound imaging compared to other imaging techniques includes the following:

  • No patient exposure to ionizing radiation
  • Able to assess tendons, ligaments and muscles under high resolution
  • Provides direct visualization of the area being treated
  • Ensures accurate placement of the needle to targeted areas

Indications

The indications for diagnostic ultrasound imaging technique include the following:

  • Diagnose conditions such as tendon/ligament tears, inflamed bursa, compressed nerves, joint fluid and cysts
  • Assess painful pops and snaps that occur during movement
  • Deliver diagnostic injections to specific targets including joints and tendon sheaths or around nerves
  • Help guide needle placement during needle aspirations or injections for patients with challenging anatomical variations or people taking blood-thinning medications
  • Aspiration of a ganglion cyst
  • Injection into a tendon sheath or a bursa
  • Administer a nerve block (diagnostic or therapeutic)
  • Guide needles in percutaneous therapy for the treatment of calcific tendonitis

Procedure

During an ultrasound guided injection, you will be asked to lie or sit down on a table depending on the injection location. A clear water based conducting gel is applied to your skin to assist the transmission of sound waves. Your doctor moves a hand-held probe, called a transducer, over the target area. The doctor then inserts the needle into the skin under ultrasound guidance to the specified location. The transducer emits sound waves and detects the rebound echoes from the tissue. Images are created from these sound waves which are viewed on the video display screen attached to the scanner.

Risks

Ultrasound guided injection is a relatively safe and painless procedure. Some of the associated complications include bleeding at the site of insertion, and injury to adjacent structures. You can resume your normal activities immediately after the procedure.

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