USS Interventions

This session included presentations on: Consent for USS intervention; Drugs commonly used in radiology; Upper limb interventions; Knee interventions; Foot and ankle interventions; Groin/pelvis interventions; Complications of interventions and how to avoid them; and Is there a role for fluoroscopic interventions in CT/MRI?

Complications from injections are rare but can be significant (particularly regarding the risk of infection if performed less than 3 months before surgery) and the law now requires that a clinician must take ‘reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment’. Additionally, the impact of any potential risk has to be considered for the patient as an individual. Another area of potential confusion exists when patients are referred between specialities. Be clear about which doctor is responsible for the management of the patient and the confirmation of informed consent is the responsibility of the person carrying out the procedure. Drugs commonly used in musculoskeltal interventions include local anaesthetics, steroids, hyaluronic acid, alcohol, prolotherapy-dextrose and platelet-rich plasma (PTP). Additional agents include botox, used for muscle spasms and to block neural impulses, and mesenchymal stem cells as a new treatment for damaged cartilage and the prevention of OA. The use of injections at various anatomical sites, including the upper limn, knee, foot and ankle, and groin/pelvis, were discussed. A thorough understanding of the anatomy of the region is needed as well as good knowledge of the machine involved. Complications can involve pain, bleeding, infection, nerve damage, compartment syndrome, tendon rupture among others. Contrast agents injected into joints under image guidance can be used in MRI arthrograms for aiding diagnoses/management in the context of multiligamentous injuries and instability.