Diagnostic ultrasound ( PDFDrive )

CHAPTER 25 Musculoskeletal Interventions 907
A
B
C
D
FIG. 25.17 Ultrasound-Guided Greater Trochanteric Bursal Injection. A 53-year-old woman with right lateral hip pain. (A) Axial T2-weighted
fat-suppressed image depicts the greater trochanter (GT) and abductor tendon complex (T). The image is oriented similar to the manner in which
it would be viewed during an injection with the patient in a lateral decubitus position. A trace amount of T2-bright luid (arrow) is present in the
bursa. (B) A 22-gauge spinal needle (arrow) is positioned near the posterior margin of the greater trochanter, supericial to the gluteus medius
tendon and deep to the gluteus maximus. A test injection with local anesthetic helps ensure appropriate needle placement, which is followed by
injection of the therapeutic mixture. (C) Short-axis postinjection image at the greater trochanter shows anterior extension of the greater trochanteric
bursa (B) at the level of the anterior facet. (D) Postinjection short-axis image centered more posteriorly over the lateral and posterior facets depicts
the posterior extension of the bursa (B) abutting the posterior facet of the greater trochanter, also referred to as the “bare area” of the greater
trochanter. I usually inject a large volume (10 mL).
the needle toward the posterior facet of the greater trochanter
in the case of a trochanteric bursal injection, or adjacent to the
margin of the hamstring origin if a peritendinous injection is
requested.
BURSAL, GANGLION CYST, AND
PARALABRAL INJECTIONS
Distended bursae around tendinous insertions provide anatomic
localization for therapeutic agents. Injection of these areas is
oten requested for the patient with localized bursitis and
abnormality of the adjacent tendon. Examples include the retrocalcaneal,
iliopsoas, greater trochanteric, and ischial bursae
(Fig. 25.19). Alternatively, the presence of a bursitis, distended
synovial cyst, or ganglion cyst may cause mechanical impingement
of adjacent tendons. he decompression of these cysts with
subsequent administration of a therapeutic agent may alleviate
these symptoms 32 (Fig. 25.20). Ganglion cysts typically contain
clear gelatinous material, most oten occurring in the hand, wrist,
foot, and ankle. Not infrequently they may come in close proximity
to neurovascular structures and may extend along nerves as
perineural ganglia. his occurs most oten in the knee, at the