Part 2 book “Atlas of pain medicine procedures” has contents: Sphenopalatine ganglion block, occipital nerve blocks, transforaminal epidural steroid injection, sacroiliac joint injections, percutaneous sacroplasty, percutaneous facet fusion, provocative discogram, intradiscal electrothermal therapy, and other contents. | SECTION V MUSCULOSKELETAL INJECTIONS CHAPTER 50 Fluoroscopy and Ultrasound-Guided Joint Injections Jennifer Solomon, Christine Roque-Dang, and James Wyss IMAGE-GUIDED PERIPHERAL JOINT INJECTION INDICATIONS The most common clinical indication for an image-guided interventional procedure is pain in the targeted anatomic location, which has either failed other conservative treatments or as an adjunctive treatment. The primary advantage of image-guided interventional procedures over blind injections includes needle placement confirmation and the ability to view the targeted area and relevant anatomy. Corticosteroid injections are frequently used as conservative treatments in the management of various conditions, including osteoarthritis, tendonitis, bursitis, and impingement conditions. Injectate mixtures typically comprise a local anesthetic and a corticosteroid (triamcinolone or methylprednisolone). In addition, patients at higher risk for developing nonsteroidal anti-inflammatory drug (NSAID)–induced renal dysfunction or gastric and duodenal ulcers are candidates for intra-articular steroid injections to avoid the potential systemic effects that occur with oral anti-inflammatory medications. However, the detrimental effects of repeated steroid injections on soft tissue structures like articular cartilage and tendons have not yet been determined. The advantages of ultrasound-guided percutaneous interventional procedures are as follows: • Real-time assessment • Guidance, and continuous needle visualization • Lack of radiation exposure • Technological portability • Relatively low cost • Improved accessibility Fluoroscopic guidance also allows real-time needle visualization and the acquisition of imaging frames throughout the injection course. The visualization occurs at different C-arm angles. The primary disadvantage of fluoroscopy is radiation exposure to both the patient and physician. BASIC CONCERNS AND CONTRAINDICATIONS With therapeutic interventions, the
