It is a medical technique established in the treatment of calcium tendinopathy, namely calcification of the shoulder rotator cuff, safe, often avoiding surgical procedures and contributing to the earlier recovery of the normal daily activity of the patient.

 

This is an outpatient procedure, with local anesthesia only, which uses ultrasound to guide a fine needle through which saline lavage and aspiration of the calcifications deposited inside the tendons of the rotator hood are performed, thus avoiding exposure to ionizing radiation.

 

With ultrasound control, an experienced operator can direct and real-time visualization of heterotopic calcification, with access to lavage or fragmentation, according to the evolutionary state of calcium tendinopathy, with minimal tendon injury and avoiding the lesion of the tendon structures , articular and ligamentary satellites.

 

Ultrasound allows at the same time, the identification of other associated pathologies, such as bursitis or tendinous ruptures.

 

The technique of barking (of needling) and lavage of calcifications, together with infiltration of the echogenic bursa, improve clinical and imaging results in 1 year in patients with calcium tendinopathy of the rotator cuff.

 

With this technique there is a probability of 60-70% of complete or significant improvement of the symptoms and return to the activity.

 

Sometimes, two treatments may be needed, at intervals of 6 weeks. About 1/3 of patients may not respond to treatment, and may require surgery.

 

 

The echo-guided joint injection allows a greater precision and control of the exact location in which we intend to infiltrate the drug. It also makes a previous evaluation of the articular pathology, with the exclusion of potential associated complications, and also allowing comparison with the contralateral side.

 

Ultrasound documents the positioning of the needle in real time, drastically reducing the possibility of injury to surrounding structures, such as tendons and ligaments, as well as the risk of vascular lesions, such as bruising or possible pseudo arterial aneurysm formations.

 

If the steroid is not injected correctly into the joint or tendinous sheath, there is a possibility of tendon rupture and cytoske- toato-necrosis of adipose tissues.

 

This technique also allows aspiration of intra-articular contents, lumen of bursae, or tendinous sheaths, with delivery of the material for analysis, namely microbiology.

 

The technique to be performed depends on the experience of the physician, the joint in question and the underlying or associated pathology. Here, too, there are benefits of ultrasound associated with puncture, since it allows adaptation to the specific joint and its particularities, namely joint deformities present in some chronic patients.

The performance of echocardiographic synovial biopsy is a minimally invasive technique for synovial tissue collection, being safe and well tolerated by patients with rare complications.

 

It avoids the costly costs of the biopsy performed in the operative block, reducing the patient's morbidity, being a technique that can be performed in an outpatient clinic.

 

Synovial biopsies can allow histological examinations of RNA among others, identifying tissue lesions and monitoring early stages of rheumatoid arthritis or other joint pathologies.

Morton's neuromas are the most frequent orthopedic pathologies at the foot level. They are a cause of pain in the anterior plantar region (metatarsalgias) and result of thickening of the interdigital nerves by repeated traumatisms and areas of hyperpressure. They are often associated with halux valgus (commonly referred to as bunion). Discharge of the metatarsal head with special orthoses or insoles and infiltrations often prevent the need for surgery for the excision of Morton's neuroma.

 

The echogenic infiltration technique of Morton's nevromas allows the confirmation of the correct site to infiltrate, which is reflected in the improvement of clinical outcomes. 

 

It allows to evaluate and to identify in real time the existence of other comorbidities, with possibility of immediate treatment. It also prevents accidental infiltration of neighboring structures and injury of adjacent ligament / tendon structures.

 

Due to the clinical success, often achieved by these minimally invasive techniques, performed in an outpatient clinic, some surgeries are sometimes avoided, with the costs and risks inherent to the surgical procedure.