provides basic knowledge of ultrasound guided interventions and used injectants Hosted by : smile makers Sponsored by hyalomed

1. NTUH TUH

2. Basics of Ultrasound Guided Interventions
For Management of
Musculoskeletal, Neuromuscular and Spine Pain

4. Who Why How
Common
musculoskeletal
problems
Injectants
COVID19- a new
challenge

5. • Rheumatologists
• Physiatrists
• Pain Physicians
• Radiologists
• Neurologists & Neurosurgeons
• Orthopedic surgeons
• Physiotherapists

6. 1- Accurate placement of the injectate
2- Avoids collateral injury of the neurovascular
structures
Allam AE, Khalil AAF, Eltawab BA, Wu WT, Chang KV. Ultrasound-Guided Intervention for Treatment of Trigeminal Neuralgia:
An Updated Review of Anatomy and Techniques. Pain Res Manag. 2018;2018:5480728. Published 2018 Apr 2.
doi:10.1155/2018/5480728

9. Needle visualization

16. Scan before you inject

25. Common MSK , NMS problems
Tendinopathy
Achilles, CET, RC, PT
Osteoarthritis
Neuropathy
Entrapment, Diabetic and
nerve injuries
Ligament
pathology
PF, MCL, CFL, ATFL, ACL
Muscle
Others
FZ

26. Injectants

27. • CS
• DW
• PRP
• LPDGF
• Placental extract
• Hyaluronic acid
• Botulinum toxin

28. Corticosteroids

30. Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic
Musculoskeletal Pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139‐159. Published 2016 Jul 7.
doi:10.4137/CMAMD.S39160
Dextrose prolotherapy

33. 1. TRPV1 (Transient receptor potential vanilloid type1)
modulation ?
↓ Substance P
↓ Calcitonin gene related peptide 
↓ neurogenic inflammation.
2. Hyper-polarization of C-fibers  ↓ Firing rate ?
3. Potential analgesic effect?
Wu YT et al. Ann Neurol.2018
Lam SKH et al. Biomed Res Int. 2017

34. 4. Energy supply to the malnourished nerve ?
5. Mechanical dissection?
6. Placebo?
Wu YT et al. Ann Neurol.2018
Lam SKH et al. Biomed Res Int. 2017

35. PRP

38. LPDGF

39. Placental extract

42. Hyaluronic acid

48. Botulinum toxin
TARGETS many neuropeptides
==> decreases pain
==> decreases peripheral sensitization and reduces
in turn central sensitization
==> reduces neurogenic inflammation ==> anti
inflammatory
Allam AE, Galluccio F. Ultrasound guided intra-articular botulinum toxin injection for treatment of the
osteoarthritic knee pain; expert opinion. Jr.med.res. 2020; 3(1):25.

49. Allam AE, Galluccio F. Ultrasound guided intra-articular botulinum toxin injection for treatment of the
osteoarthritic knee pain; expert opinion. Jr.med.res. 2020; 3(1):25.

54. Common spine pain syndromes
Erector spinae
Thoraco
-lumbar
myofascial pain
Cervical
myofascial pain
Ligament
pathology
SS, IS, NL
DSN
SCN
Radicular

60. Interscapular
&DSN
Chang KV, Lin CP, Lin CS, Wu WT, Karmakar
MK, Özçakar L. Sonographic tracking of trunk
nerves: essential for ultrasound-guided pain
management and research. J Pain Res.
2017;10:79‐88. Published 2017 Jan 4.
doi:10.2147/JPR.S123828

61. SCN

68. "May the Force be with you"