Ultrasonic and Fluoroscopic Guidance
For many years, physicians have relied on their examination skills alone to provide injections for musculoskeletal pain. Many physicians acquire great skill in doing so. However, the complexity and precision required for the best outcomes often requires the use of advanced technology to "steer" the injection. Ultrasonic and fluoroscopic guidance have made procedures more safe, more comfortable, and more beneficial.
Ultrasound waves allow the physician to see the different layers in the body, such as tendons, nerves, ligaments, and joints. This allows for precise diagnosis of inflamed and damaged tissues, and also allows the physician to avoid direct nerve and blood vessel contact while guiding the needle to the target precisely for treatment. Ultrasound provides a "live" view of the needle and of the muscles, blood vessels, tendons, and other moving tissues. Ultrasound itself has no significant side-effects used in this manner, but has other limitations. It cannot be used to easily see behind hard bony structures, for instance. Ultrasound allows complex procedures to be performed safely. Carpal Tunnel Syndrome can now be treated with a needle through the skin using ultrasound to release the constrictions around the nerve in a process called "hydro-dissection", and also to loosen the ligament covering the tunnel, in less than 30 minutes with good potential for success and minimal discomfort.
X-Ray Fluoroscopy also is used for diagnosis and precision targeting of structures. The modern "C-Arm" provides a high-resolution image of bony structures allowing for placement of a needle into the spine and joints. Use of "contrast" allows the physician to determine whether the medication will reach the desired target, and avoid nearby structures. The images can be snapshots, or can be video "live" images, to view in real-time the bony structures, the needle placement, and the flow patterns of contrast.
X-Ray is a form of ionizing radiation that needs to be used judiciously. Current C-Arm Fluoroscopy machines use low-dose settings and high-sensitivity detectors to minimize the risks of X-Ray radiation. A careful radiology technician and experienced physician will work together as a team to minimize your exposure.
