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Neurovascular structures to avoid during musculoskeletal ultrasound-guided intervention in the extremities

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Abstract

Ultrasound is a useful modality for guiding injections and other procedures in the extremities. Its portability and the ability to adjust the probe and needle in real time, as well as lack of radiation exposure make it preferable for many routine procedures. However, ultrasound is highly operator dependent and a firm understanding of regional anatomy is important, including neurovascular structures that are in close proximity during many of these procedures. Knowledge of the characteristic location and appearance of neurovascular structures in the extremities allows safe needle advancement and prevention of iatrogenic complications.

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References

  1. Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 2nd Ed. Philadelphia, PA, PA: Elsevier; 2018. Ch. 9, Interventional Techniques. pp 407–10.

  2. Chang K-V, Mezian K, Naňka O, Wu W-T, Lin C-P, Özçakar L. Ultrasound-guided interventions for painful shoulder: from anatomy to evidence. J Pain Res. 2018;11:2311–22.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gerber C, Schneeberger AG, Vinh TS. The arterial vascularization of the humeral head: An anatomical study. J Bone Joint Surg Am. 1990;72(10):1486–94.

    Article  CAS  PubMed  Google Scholar 

  4. Hufeland M, Hamed G, Kubo H, et al. Blood supply in the bicipital groove: A histological analysis. Orthop Rev (Pavia). 2019;11(1):8106.

    Article  PubMed  Google Scholar 

  5. Mattie R, Wong J, McCormick Z, Yu S, Saltychev M, Laimi K. Percutaneous needle tenotomy for the treatment of lateral epicondylitis: A systematic review of the literature. PM R. 2017;9(6):603–11.

    Article  PubMed  Google Scholar 

  6. Chalian M, Nacey NC, Rawat U, et al. Ultrasound-guided percutaneous needle tenotomy using Tenex system for refractory lateral epicondylitis; short and long-term effectiveness and contributing factors. Skeletal Radiol. 2021;50(10):2049–57.

    Article  PubMed  Google Scholar 

  7. Zadeh FS, Shafiei M, Hosseini N, Alipour E, Cheung H, Chalian M. The effectiveness of percutaneous ultrasound-guided needle tenotomy compared to alternative treatments for chronic tendinopathy: A systematic review. Skeletal Radiol. 2023;52(5):875–88.

    Article  Google Scholar 

  8. Barker SL, Bell SN, Connell D, Coghlan JA. Ultrasound-guided platelet-rich plasma injection for distal biceps tendinopathy. Shoulder Elbow. 2015;7(2):110–4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Van der Vis J, Janssen SJ, Bleys RLA, Eygendaal D, van den Bekerom MPJ. Distal biceps tendon injection. Clin Shoulder Elb. 2021;24(2):93–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Clay NR, Clement DA. The treatment of dorsal wrist ganglia by radical excision. J Hand Surg Br. 1988;13(2):187–91.

    Article  CAS  PubMed  Google Scholar 

  11. Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg Am. 1976;1(3):228–35.

    Article  CAS  PubMed  Google Scholar 

  12. Wright TW, Cooney WP, Ilstrup DM. Anterior wrist ganglion. J Hand Surg Am. 1994;19(6):954–8.

    Article  CAS  PubMed  Google Scholar 

  13. Greendyke SD, Wilson M, Shepler TR. Anterior wrist ganglia from the scaphotrapezial joint. J Hand Surg Am. 1992;17(3):487–90.

    Article  CAS  PubMed  Google Scholar 

  14. Kutsikovich J, Merrell G. Accuracy of injection into the first dorsal compartment: A cadaveric ultrasound study. J Hand Surg Am. 2018;43(8):777.e1-777.e5.

    Article  PubMed  Google Scholar 

  15. Mahakkanukrauh P, Mahakkanukrauh C. Incidence of a septum in the first dorsal compartment and its effects on therapy of de Quervain’s disease. Clin Anat. 2000;13(3):195–8.

    Article  CAS  PubMed  Google Scholar 

  16. Bas H, Kleinert JM. Anatomic variations in sensory innervation of the hand and digits. J Hand Surg Am. 1999;24(6):1171–84.

    Article  CAS  PubMed  Google Scholar 

  17. Stappaerts KH, Van Hees J, Van den Broeck EA. Peripheral cutaneous nerve distribution to the fingers. Physiother Res Int. 1996;1(1):41–9.

    Article  CAS  PubMed  Google Scholar 

  18. Park JA, Lee SH, Hwang SJ, Koh KS, Song WC. Anatomic, histologic, and ultrasound analyses of the dorsum of the hand for volumetric rejuvenation. J Plast Reconstr Aesthet Surg. 2021;74(7):1615–20.

    Article  PubMed  Google Scholar 

  19. Zhang M, Pessina M, Higgs J, Kissin E. A vascular obstacle in ultrasound-Guided hip joint injection. J Med Ultrasound. 2018;26(2):77–80.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Weintraub MT, Barrack TN, Burnett RA 3rd, Serino J 3rd, Bhanot SS, Della Valle CJ. Ultrasound-guided iliopsoas bursal injections for management of iliopsoas bursitis after total hip arthroplasty. J Arthroplasty. 2022; S0883–5403(22)01090–7. Online ahead of print.

  21. Kim DH, Yoon DM, Yoon KB. Ultrasound-guided quadratus femoris muscle injection in patients with lower buttock pain: Novel ultrasound-guided approach and clinical effectiveness. Pain Physician. 2016;19(6):E863–70.

    PubMed  Google Scholar 

  22. Wilson MD, Keene JS. Treatment of ischiofemoral impingement: results of diagnostic injections and arthroscopic resection of the lesser trochanter. J Hip Preserv Surg. 2016;3(2):146–53.

    Article  PubMed  Google Scholar 

  23. Michel F, Decavel P, Toussirot E, et al. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56(5):371–83.

    Article  CAS  PubMed  Google Scholar 

  24. Santamato A, Micello MF, Valeno G, et al. Ultrasound-guided injection of botulinum toxin type A for piriformis muscle syndrome: A case report and review of the literature. Toxins (Basel). 2015;7(8):3045–56.

    Article  CAS  Google Scholar 

  25. Elsawy AGS, Ameer AH, Gazar YA, et al. Efficacy of ultrasound-guided injection of botulinum toxin, ozone, and lidocaine in piriformis syndrome. Healthcare (Basel). 2022;11(1):95.

    Article  PubMed  Google Scholar 

  26. Fusco P, Di Carlo S, Scimia P, Degan G, Petrucci E, Marinangeli F. Ultrasound-guided dry needling treatment of myofascial trigger points for piriformis syndrome management: A case series. J Chiropr Med. 2018;17(3):198–200.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Varenika V, Lutz AM, Beaulieu CF, Bucknor MD. Detection and prevalence of variant sciatic nerve anatomy in relation to the piriformis muscle on MRI. Skeletal Radiol. 2017;46(6):751–7.

  28. Telischak NA, Wu JS, Eisenberg RL. Cysts and cystic-appearing lesions of the knee: A pictorial essay. Indian J Radiol Imaging. 2014;24(2):182–91.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Geannette C, Warren RF, Miller TT. Ultrasound-guided aspiration of anterior cruciate ligament mucinous cysts in the posterior intercondylar notch: Technique and short-term outcomes. J Clin Ultrasound. 2021;49(3):194–8.

    Article  PubMed  Google Scholar 

  30. Mehdizade A, Adler RS. Sonographically guided flexor hallucis longus tendon sheath injection. J Ultrasound Med. 2007;26(2):233–7.

    Article  PubMed  Google Scholar 

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Correspondence to Jenifer Pitman.

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Pitman, J., Endo, Y. Neurovascular structures to avoid during musculoskeletal ultrasound-guided intervention in the extremities. Skeletal Radiol 53, 1–17 (2024). https://doi.org/10.1007/s00256-023-04372-x

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  • DOI: https://doi.org/10.1007/s00256-023-04372-x

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