In 2022, the Asia Pacific Journal of Pain has become the offi cial journal of the Taiwan Pain Society which disseminates the scientific research about pain across Asian countries [1]. Considering the mounting role of ultrasound (US) imaging as an excellent tool to “guide” the interventional procedures in pain medicine, we are glad to present to the offi cial journal of the Taiwan Pain Society the sonographic protocols of the EURO-MUSCULUS/USPRM [2,3]. Indeed, on behalf of the European Musculoskeletal Ultrasound Study Group/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine, static/ dynamic US scanning protocols have been prepared to share a common language among several medical specialties as regards US-guided interventions for several painful disorders of the neuromusculoskeletal system.

Starting from the basic protocols for the six main joints [4-9], their pediatric version [10], dynamic scanning protocols [11,12], sonographic approaches to specifi c painful musculoskeletal conditions [13] as well as interventional guides for common clinical conditions [14-19] have also been added to progressively enrich the “sonographic menu”. Accordingly, this paper intends to draw the attention of the journal’s readers to these already established, practical, and standardized sonographic protocols/approaches as useful references to “guide” their interventional procedures in daily clinical practice.

Importantly, we remind our colleagues that US imaging should be considered as not only the imaging tool to “see” the needle but also the natural extension of the physical examination to correctly plan the procedure. Therefore, US examination can help the physicians answer the questions like “should I perform the intervention or not ?,” “which pain generator(s) should I target ?,” “is it a safe procedure or which approach is the easier/safer ?,” or “what should I inject ?.” [20]

In this sense, among the countless potentialities of US examinations in the daily practice of pain physicians, we would like to highlight some of them. First of all, we emphasize the accuracy in detecting the anatomical/histological target of the interventional procedure, which can highly vary from a myofascial trigger point to a focal injury of a tendon. Indeed, some historical defi nitions like “subacromial injection” or “periscapular needling” are now widely replaced by a detailed terminology in pain medicine (e.g., intralesional injection of a full-thickness tear of the supraspinatus tendon or US-guided needling of a myofascial trigger point within the levator scapulae muscle [Figure 1]). In other words, US imaging is also defi ning a new “vocabulary” among the pain specialists which allows to disseminate the scientifi c research about pain management owing to the possibility of reproducing different interventions. Second, we would strongly underline that physical and US examination can be promptly coupled to better define the diagnosis in the outpatient setting to avoid other expensive and often unnecessary second-level radiological exams which lead to delay in the management. For instance, in the presence of clinical findings compatible with painful subacromial impingement, sonographic evaluation can be easily performed to “directly observe” the bursal nodule in between the rotator cuff and the coracoacromial ligament because of the local frictions (Figure 1). Therefore, the physician is not confused and does not inevitably decide to perform old and nonspecific techniques (e.g., “tripple shoulder injection”).

Last but not least, US examination can be considered a really useful tool in terms of differential diagnosis to identify the “atypical” pain generators. For instance, subcutaneous synovial structures or capsular/ ligamentous elements stabilizing the joints should be fully scrutinized especially in patients with challenging and “mysterious” clinical scenarios (Figure 1).

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