Silva Flávio Duarte, Zorzenoni Fernando, da Silva Lucas Nakasone Matos, Dos Reis Teixeira Neto Afranio, Gonzalez Marco Tulio, Filho Alípio Gomes Ormond, Guimarães Júlio Brandão
Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil.
Skeletal Radiol. 2023 May;52(5):979-990. doi: 10.1007/s00256-022-04174-7. Epub 2022 Sep 2.
Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers. Upper limb injections commonly use corticosteroids and anesthetics with different reported short- and long-term results depending on the tendon treated; better results are obtained in the treatment of tenosynovitis (sliding tendons such as trigger finger and De Quervain's tenosynovitis). Shoulder and elbow tendinopathies (anchor tendons) may also benefit from injections containing irritants or healing stimulants such as dextrose (prolotherapy) and platelet-rich plasma or by the stimulation of healing via tendon perforations (fenestration). The hyaluronic acid injection has also been used in the treatment of both tenosynovitis and tendinopathies. For tendons passing through osteofibrous tunnels, an additional release may be performed, and the techniques are discussed in this review. Therefore, this article provides practicing musculoskeletal radiologists and trainees with a comprehensive review of tendon injection musculoskeletal image-guided procedures.
影像引导下的肌腱手术旨在通过控制炎症和刺激愈合来减轻疼痛并增强功能。超声是首选的引导方式，因为它具有高分辨率，能实时显示肌腱解剖结构和针头定位。该技术包括适当的患者体位摆放，其因目标肌腱不同而有所变化，以及无菌且恰当的铺巾。对于大多数手术，我们更倾向于“平面内”入路，这种方法能显示针头在穿过不同组织层时的全貌。上肢注射通常使用皮质类固醇和麻醉剂，根据所治疗的肌腱不同，其短期和长期效果报道各异；在治疗腱鞘炎（如扳机指和桡骨茎突狭窄性腱鞘炎等滑动肌腱）时能取得更好的效果。肩部和肘部肌腱病（附着点肌腱）也可能从含有刺激物或愈合刺激剂（如葡萄糖（注射增殖疗法）和富血小板血浆）的注射中获益，或通过肌腱穿孔（开窗术）刺激愈合。透明质酸注射也已用于腱鞘炎和肌腱病的治疗。对于穿过骨纤维隧道的肌腱，可能需要进行额外的松解，本文将对这些技术进行讨论。因此，本文为执业肌肉骨骼放射科医生和实习生提供了关于肌肉骨骼影像引导下肌腱注射手术的全面综述。
