An Ultrasound MSK Primer for the IR: Expanding Your Practice with Small Joint Injections

• Discuss how employing ultrasound guided small joint injections can expand one's practice and improve patient care


• Review sonographic appearance/anatomy of small joints of the pelvis, upper extremities, and lower extremities


• Share clinical pearls and provocative movements to maximize procedural efficiency

Literature around pain management often focuses on large joints, however, chronic pain from axial and extremity small joints may play a large role in many Americans’ quality of life and/or dependence on opioids for pain control. For example, it has been estimated that the SI joints account for 30-38% of cases of lower back pain^1,2. A 2020 article from Pain Therapy reported that hand pain has about a 10% prevalence in men and 20% prevalence in women, carrying  significant costs to the healthcare system³.

Interventional radiologists can intervene on chronic small joint pain through ultrasound-guided joint injections. Sonographic joint injections not only play an important role in conservative pain management, but they also avoid radiation and may improve overall workflows by freeing up fluoroscopy rooms. While many IRs are familiar with fluoroscopic approaches to joint injections, some may be less familiar with sonographic approaches, especially for small joints.

Clinical Findings/Procedure Details: This ultrasound MSK primer for the IR will distill our practice’s wide experiences with ultrasound-guided small joint injections to provide a succinct overview of small joint injection techniques, including the true ankle and subtalar joints, wrists, hands, SI joints, and the elbow. We will review not only basics of joint sonography, but we will share intra-procedural images demonstrating sonographic patterns of successful intra-articular injections, as well as provocative maneuvers for different joints that can improve efficiency and accuracy of articular access.

Conclusion and/or Teaching Points: By briefly demonstrating these basic concepts, we will equip our audience with the confidence and foundational knowledge to ultimately expand their practice to provide minimally invasive palliation of joint pain while avoiding unnecessary radiation.