Which Procedure is Right for me? 

​

This is a shared decision between you and your physician. Medical treatment for any issue falls on a continuum, from conservative (e.g. exercise) to invasive (e.g. surgery). Ultrasound-guided interventional procedures fall somewhere in the middle.

 

It is the job of the physician to ensure that you have explored all conservative options first, before deciding on an interventional procedure.

​

The level of evidence behind any procedure varies depending on the reason for it and the intended body structure. Again, it is the job of the physician to ensure that you understand each of your options, before deciding on an interventional procedure. 

​

Procedures Available

​

• Glucocorticosteroid injection (steroid/cortisone)

• Hyaluronic acid injection (HA injection)

• Platelet-rich plasma injection (PRP injection)

• Dry needle fenestration (needle tenotomy)

• High concentration dextrose injection (prolotherapy)

• Joint fluid aspiration

• Needle aspiration of calcium deposits (barbotage/lavage)

• Nerve hydrodissection

• Hydrodilatation (hydrodistension)

• Local anesthetic injection of trigger points

​

The below is a general guide.

​

​

WHERE is the pain? 

​

Head

• Suboccipital nerve

​

Shoulder

• Suprascapular nerve

• Acromioclavicular joint (AC joint)

• Glenohumeral joint (true shoulder joint)

• Long head biceps brachii tendon (bicipital tendinosis)

• Subacromial subdeltoid bursa (impingement syndrome)

• Rotator cuff 

​​

Elbow

• Medial epicondyle (golfer’s elbow)

• Lateral epicondyle(tennis elbow)

• Ulnar nerve

• Posterior interosseus nerve

• Olecranon bursa

​​

Wrist

• Carpal metacarpal joint (CMC joint)

• Distal radial ulnar joint (DRUJ)

• Scaphotrapezial trapezoid joint (STTJ)

• First extensor compartment (De Quervain’s tenosynovitis)

• Median nerve (carpal tunnel syndrome)

• Ganglia 

​​

Hand

• Finger flexor tendons (trigger finger)

​​

Low back

• Sacroiliac joint

• Piriformis (Piriformis syndrome)

​​

Presently, we do not offer any neuroaxial procedures, such as epidural or facet joint injections.

​​

Hip

• Femoroacetabular joint (true hip joint)

• Greater trochanteric region 

• Lateral cutaneous nerve of the thigh (“meralgia paresthetica”)

• Iliopsoas bursa

​​

Knee

• Patellofemoral joint (Runner's knee)

• Tibiofemoral joint (true knee joint)

• Pes anserine bursa

• Iliotibial band (IT band syndrome)

• Popliteal cyst (Baker’s cyst)

​​

Ankle

• Tibiotalar joint (true ankle joint)

• Talocalcaneal joint (subtalar joint)

• Lateral collateral ligament of ankle joint (lateral ankle sprain)

• Medial collateral ligament of ankle joint (deltoid ligament)

• Achilles tendon

• Tibial nerve (tarsal tunnel syndrome)

​​

Foot

• Plantar fascia

• First metatarsal phalangeal joint

• First metatarsal phalangeal ligament

• Intermetatarsal neuroma (Morton’s neuroma)

​​

Muscle

• Most structures can be accessed without an ultrasound

• Deeper structures can benefit from image guidance e.g. Rhomboids as they lie deep near lung pleura, Quadratus Lumborum