Sonosurgery (interventional ultrasound) refers to a wide range of percutaneous procedures performed under ultrasound guidance. The most common procedures include aspiration of fluid from the joint cavity or bursa, as well as administration of the drug into the joint, tendon sheaths, or other soft tissues. Under ultrasound guidance, a tumor biopsy is also performed or foreign bodies are removed. Monitoring the needle on the ultrasound monitor allows for precise execution of a given procedure and increases the safety of the procedure.
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What does the ultrasound-guided procedure look like?
The puncture procedure or drug administration under ultrasound guidance is a completely safe, minimally invasive procedure. The patient leaves the facility on the same day that the sonosurgery is performed.
The general course of the procedure under ultrasound control:
- The patient should always give his consent in writing to perform the procedure,
- Before inserting the needle, a standard ultrasound examination of the musculoskeletal system is performed to locate the lesion and select the surgical access,
- The patient is placed in a comfortable position for him and the doctor,
- The doctor thoroughly disinfects the injection site and the ultrasound head, and may put a special cover on the head,
- The doctor inserts the needle under ultrasound control - two techniques are used for this purpose:
- Indirect - ultrasound is used only for the exact location of the injection site and depth,
- Direct - allows you to locate the needle within the tissues in real time.
- After the procedure, the doctor puts a small bandage on the injection site.
- After the procedure, regardless of the type of procedure performed, the patient should not overload the treated area for 2-3 days. If a fever occurs during this period and the pain at the injection site worsens, you should immediately consult the doctor performing the procedure.
Types of procedures performed under ultrasound control
Joint puncture
Puncture involves inserting a needle into the joint cavity in order to:
Draining excess fluid to reduce pressure in the joint and relieve pain, e.g. knee puncture - drawing water from the knee,
Collecting a sample of synovial fluid for laboratory tests. Normal synovial fluid is sticky and light yellow in color. In the course of various pathological conditions, abnormal physical and chemical changes in the synovial fluid can be determined:
Joint inflammation - a watery, less viscous fluid
Degenerative changes - slightly reduced viscosity,
Past trauma, coagulation disorders - presence of blood in the fluid,
Intra-articular fractures - the presence of blood and drops of fat.
The collected synovial fluid is tested for the presence of substances that abnormally accumulate in the joints in the course of various diseases, e.g. gout or chondrocalcinosis.
Drainage of fluid reservoirs in soft tissues
A frequent procedure performed in the area of soft tissues is puncture and removal of fluid from the cyst. For example, a pathological Baker's cyst located in the popliteal fossa may form within the knee joint. A Baker's cyst is best decolourised as part of an ultrasound-guided puncture procedure. Some massive soft tissue injuries can lead to large hematomas - these lesions may not always self-absorb and require drainage. The decompression of the hematoma makes it possible to accelerate the healing of soft tissues.
Injection with administration of the drug into a joint or soft tissues
The purpose of administering the drug under ultrasound guidance is to precisely inject a specific substance into the affected area. Examples of injections within the musculoskeletal system are:
Hyaluronic acid injections, e.g. into the knee
Plasma treatment - intra-articular injection,
Plasma injection of tendons with concentrated plates.
Local injection of steroids (steroid blockade)
Steroid injection into a joint or soft tissue cavity is a method of treating persistent pain that is not relieved by other available medical measures. The injected drug, e.g., Diprophos, is a mixture of anesthetic drug and a steroid with potent anti-inflammatory properties. The proper effect of the steroid drug begins on the 2-3rd day after injection and lasts usually for a period of 3-4 weeks.
The most common sites for steroid administration are:
Synovial bursa,
Synovial sheath,
Pond cavity,
Nerve, e.g. Morton's neuroma of the forefoot
Accurate control of the needle position when administering the steroid to pathologically changed tissue is very important. Accidental administration of the steroid into the subcutaneous tissue or tendon may cause necrosis and reduce the mechanical strength of the tissue.
Read more about treating pain with a steroid blockade.
Steroid injection - shooting thumb
Tendon injection
Tumor biopsy
Ultrasound can also be used as an imaging tool for biopsy of soft tissue tumors, as well as bone tissue tumors with soft tissue infiltration. Ultrasound helps you choose the place from which to collect the tissue sample. Doppler examination allows the selection of safe access bypassing the vascular structures and reducing the risk of hemorrhage in the event of damage to the richly vascularized part of the tumor. Percutaneous biopsies of tumors should be performed in specialized centers in close cooperation of surgeons-oncologists and radiologists.
Removal of foreign bodies
Ultrasound allows the visualization of superficially placed foreign bodies in fabrics, e.g. filings, metal or glass fragments. Thanks to the ultrasound examination, the surgeon can make an incision of an appropriate size without the risk of excessive damage to the surrounding soft tissues.
Tenodesis, stitching a tendon, stitching a torn Achilles tendon
Intraoperative ultrasound allows for minimizing surgical access to the minimum - often up to 1-2 cm instead of 6-10. This promotes faster recovery, reduces the risk of scarring, adhesions, and longer wound healing.
Examples of procedures performed under ultrasound control:
Biceps tenodesis (proximal attachment pinch of the head of the long biceps muscle of the shoulder) in the intercubular groove
Shooting finger surgery (cutting A1 drawstring)
Rinsing of calcifications from the rotator cuff tendon
Knee puncture
Frequently asked questions about sonosurgery:
The plasma administration procedure is preceded by a standard ultrasound examination in order to precisely locate the tendon areas within which we want to accelerate the healing and repair processes. After preparing the plasma obtained from the patient's blood, the doctor uses an ultrasound to mark the injection site. If necessary, he observes the position of the needle in real time so as to inject the plasma exactly into the changed site of the tendon. A small patch is put on the skin after the injection.
At the time of the injection, you may feel slight discomfort as the needle is inserted and the medicine is infused into the joint. A slight feeling of discomfort should disappear after 2 days after the injection in the knee.
Real-time monitoring of the needle position on the ultrasound monitor allows for precise execution of a given procedure and increases the safety of the procedure. A given drug can be administered exactly to the affected area, which maximizes the effects of treatment.
