Musculoskeletal Medicine Atlas of Ultrasound Guided Musculoskeletal Injections David A. Spinner Jonathan S. Kirschner Joseph E. Herrera Editors Musculoskeletal Medicine Series Editors Grant Cooper \u2022 Joseph E. Herrera For further volumes: http://www.springer.com/series/7656 David A. Spinner \u2022 Jonathan S. Kirschner Joseph E. Herrera Editors Atlas of Ultrasound Guided Musculoskeletal Injections Editors David A. Spinner, DO, RMSK Department of Anesthesiology - Pain Medicine Beth Israel Deaconess Medical Center Arnold Pain Management Center Harvard Medical School Brookline, MA 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 Joseph E. Herrera, DO, FAAPMR Interventional Spine and Sports Medicine Division Department of Rehabilitation Medicine 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 © Springer Science+Business Media, LLC 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) 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 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 ix 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 supplement , 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 essential 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 musculoskeletal 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.