Atlas of Ultrasound Guided Musculoskeletal Injections

164 Pages·2014·19.2 MB·English

by  Jonathan S. Kirschner MD

Musculoskeletal Medicine
David A. Spinner
Jonathan S. Kirschner
Joseph E. Herrera Editors
Atlas of
Ultrasound Guided
Musculoskeletal
Injections
Musculoskeletal Medicine
Series Editors
Grant Cooper (cid:129) Joseph E. Herrera
For further volumes:
http://www.springer.com/series/7656

David A. Spinner (cid:129) J onathan S. Kirschner
Joseph E. Herrera
Editors
Atlas of Ultrasound Guided
Musculoskeletal Injections
Editors
David A. Spinner, DO, RMSK Joseph E. Herrera, DO, FAAPMR
Department of Anesthesiology - Pain Medicine Interventional Spine and Sports Medicine Division
Beth Israel Deaconess Medical Center Department of Rehabilitation Medicine
Arnold Pain Management Center Icahn School of Medicine at Mount Sinai
Harvard Medical School New York, NY
Brookline, MA USA
USA
Jonathan S. Kirschner, MD, FAAPMR, RMSK
Interventional Spine and Sports Medicine Division
Department of Rehabilitation Medicine
Icahn School of Medicine at Mount Sinai
New York, NY
USA
Series Editors
Grant Cooper, MD
Princeton Spine and Joint Center
Princeton, NJ
USA
Joseph E. Herrera, DO, FAAPMR
Icahn School of Medicine at Mount Sinai
New York, NY
USA
ISBN 978-1-4614-8935-1 ISBN 978-1-4614-8936-8 (eBook)
DOI 10.1007/978-1-4614-8936-8
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2013954547
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Grant me an opportunity to improve and extend my training, since there is no
limit to knowledge. Help me to correct and supplement my educational
defects as the scope of science and its horizon widen day by day.
Moses ben Maimon (Maimonides)
Mishneh Torah. IV, 19

Dedicated to my wife, Jessica, and daughter, Shirley, who spent nights and
weekends without me so that I could bring this book to completion.
To my sister, Randi, and mother, Ricki, for a lifetime of setting the bar high
and leading by example.
And to my father, Charles, who had an unequivocal belief in me to succeed.
When I scored a 93 on a test, he asked what happened to the other 7 points,
ensuring whatever the score on a test, I understood the material for it would
make a difference. No matter the cost or family adversity, my education would
never be sacrifi ced. He believed that one day I would help people in their
suffering. I hope this helps.
David A. Spinner, DO, RMSK
To those who I have learned so much from, my parents, Bruce and Gwenn;
my sisters, Greta and Kaye; my brother, Eli; my wonderful friends; my
mentors; and my students.
Jonathan S. Kirschner, MD, FAAPMR, RMSK
This book is dedicated to my wife, Sandra, and children, Alex, Mikhayla, and
Andrew, for their love and encouragement. To my parents, Eduardo and Rosario,
and my sister, Sacha, for their sacrifi ce and unconditional support.
Joseph E. Herrera, DO, FAAPMR

Foreword
I am very fortunate to have had the opportunity to write the foreword for this excellent piece
of work, Atlas of Ultrasound Guided Musculoskeletal Injections, inspired and created by Drs.
Spinner, Kirschner, and Herrera.
The use of ultrasound to diagnose and treat musculoskeletal conditions is an evolving and
incredible medical skill. We now have the ability to go beyond palpation and physical exami-
nation maneuvers and truly visualize neuromusculoskeletal structures and their spatial rela-
tionships and dynamic interactions. We can do focused visual evaluations seeing structures
and specifi c tissue planes and dynamically visualize obvious and subtle defects.
Structures such as nerves and tendon sheathes can now be clearly visualized while we direct
our treatments more precisely adjacent to them while avoiding injecting within their substance.
Equally, if not more importantly, we can visualize vascular and other structures we want to
avoid. This leads to improved, safer, and more comfortable treatments.
Ultrasound is also an evolving supplemental tool in the interventional spine fi eld. For the
last several decades, our spinal treatments have improved in effi cacy and safety due to fl uoro-
scopic techniques. They have improved even further with contrast installation and more
recently with digital subtraction usage. I anticipate that these spinal ultrasound techniques will
not replace, but s upplement , fl uoroscopy in the evolving spinal intervention treatment fi eld. As
the ultrasound technology and resolution improve, we will get improved visualization of the
nerves we want to treat and the vessels we want to avoid, along with the landmarks we know
from fl uoroscopically performed spinal procedures.
This Atlas is an enormous and distinctive contribution to the evolving ultrasound fi eld. It
comprises e ssential musculoskeletal ultrasound topics important to physiatrists, sports medi-
cine physicians, orthopedists, rheumatologists, and others devoted to the treatment of muscu-
loskeletal disorders. The Atlas is unique since it also presents evolving understanding of spinal
ultrasound options and controversial subjects including ultrasound-guided spasticity, myofas-
cial pain syndrome, and biologic treatments.
This Atlas will be sure to have a profound impact on the education of musculoskeletal spe-
cialists, residents, and fellows. This Atlas is a representation of the commitment Drs. Spinner,
Kirschner, and Herrera have as passionate teachers and educators. They have gone to great
length and detail to present a plethora of appropriate m usculoskeletal references and evidence-
based medicine relevant to each procedure.
This Atlas is truly a work of art based on what now would seem simple premises. This is a
succinct visual reference with fi gures, pictures, and diagrams to facilitate an easy understand-
ing of the core concepts on patient presentation, relevant anatomy, and sonoanatomy. Common
colors, symbols, and photographs are closely incorporated throughout the book to underscore
a clear, consistent visual presentation. There is emphasis on safety and avoiding relevant struc-
tures while performing these ultrasound-guided procedures. This approach makes some very
complex procedures easier, more effi cient, and safer to perform.
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