Brief Communications
Ultrasound Imaging and Guidance for Musculoskeletal Interventions: “Cross-Talk” Between EURO-MUSCULUS/ USPRM and Pain Physicians
Volume 32,Issue 1,Pages 16-18
Vincenzo Ricci1 , Ke-Vin Chang2 , Levent Özçakar3

1 Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy

2Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan

3Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey

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Outline


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).

Conflict of Interest

None.


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References
1

Chang KV.

Mission, vision, and ambition for Asia Pacific Journal of Pain.

Asia Pacific J Pain. 2022;2022:1-8. [Pub- lished online ahead of print] doi:10.29760/APJP.202202/ PP.0002

CrossRef

2

Özçakar L, Kara M, Wang TG, De Muynck M.

EURO-MUSCULUS/USPRM basic scanning protocols: a practical guide for physiatrists.

Eur J Phys Rehabil Med. 2015;51(4):477-478.

PDF

3

Özçakar L, Ricci V, Mezian K, Pirri C.

A new and dedicat- ed video gallery: EURO-MUSCULUS/USPRM protocols for dynamic ultrasound examination of the joints.

Am J Phys Med Rehabil. 2022;101(3):201-202. doi:10.1097/ PHM.0000000000001956

CrossRef

4

Özçakar L, Kara M, Chang KV, et al.

EURO-MUSCULUS/USPRM. Basic scanning protocols for shoulder.

Eur J Phys Rehabil Med. 2015;51(4):491-496.

PDF

5

Özçakar L, Kara M, Chang KV, et al.

EURO-MUSCULUS/USPRM. Basic scanning protocols for elbow.

Eur J Phys Rehabil Med. 2015;51(4):485-489.

PDF

6

Özçakar L, Kara M, Chang KV, et al.

EURO-MUSCULUS/USPRM. Basic scanning protocols for wrist and hand.

Eur J Phys Rehabil Med. 2015;51(4):479-484.

PDF

7

Özçakar L, Kara M, Chang KV, et al.

EURO-MUSCU- LUS/USPRM. Basic scanning protocols for hip.

Eur J Phys Rehabil Med. 2015;51(5):635-640.

CrossRef

8

Özçakar L, Kara M, Chang KV, et al.

EURO-MUSCULUS/USPRM. Basic scanning protocols for knee.

Eur J Phys Rehabil Med. 2015;51(5):641-646.

CrossRef

9

Özçakar L, Kara M, Chang KV, et al.

EURO-MUSCU- LUS/USPRM. Basic scanning protocols for ankle and foot.

Eur J Phys Rehabil Med. 2015;51(5):647-653.

PDF

10

Chang KV, Şahin Onat Ş, Lee CW, Kara M, Hung CY, Özçakar L.

EURO-MUSCULUS/USPRM basic scanning protocols revisited in children.

Eur J Phys Rehabil Med. 2016;52(6):887-901.

CrossRef

11

Ricci V, Chang KV, Güvener O, et al.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Shoulder

Am J Phys Med Rehabil. 2022;101(3):e29-e36. doi:10.1097/PHM.0000000000001833

CrossRef

12

Ricci V, Güvener O, Chang KV, et al.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Elbow

Am J Phys Med Rehabil. 2021. [Published online ahead of print] doi:10.1097/PHM.0000000000001915

CrossRef

13

Ricci V, Ricci C, Gervasoni F, Cocco G, Andreoli A, Özça- kar L.

From Histo-anatomy to Sonography in Myofascial Pain Syndrome: EURO-MUSCULUS/USPRM Approach.

Am J Phys Med Rehabil. 2022. [Published online ahead of print] doi:10.1097/PHM.0000000000001975

CrossRef

14

Kara M, Kaymak B, Ulaşli AM, et al.

Sonographic guide for botulinum toxin injections of the upper limb: EURO- MUSCULUS/USPRM spasticity approach.

Eur J Phys Rehabil Med. 2018;54(3):469-485. doi:10.23736/S1973- 9087.17.04664-0

PDF

15

Kaymak B, Kara M, Tok F, et al.

Sonographic guide for botulinum toxin injections of the lower limb: EURO- MUSCULUS/USPRM spasticity approach.

Sonographic guide for botulinum toxin injections of the lower limb: EURO- MUSCULUS/USPRM spasticity approach.

Article PDF

16

Kaymak B, Kara M, Gürçay E, Özçakar L.

Sonographic guide for botulinum toxin injections of the neck muscles in cervical dystonia

Phys Med Rehabil Clin N Am. 2018;29(1):105-123. doi:10.1016/j.pmr.2017.08.009

CrossRef

17

Chang KV, Kara M, Su DC, et al.

Sonoanatomy of the spine: a comprehensive scanning protocol from cervi- cal to sacral region.

Med Ultrason. 2019;21(4):474-482. doi:10.11152/mu-2034

CrossRef

18

Chang KV, Wu WT, Özçakar L.

Ultrasound-guided interventions of the cervical spine and nerves

Phys Med Rehabil Clin N Am. 2018;29(1):93-103. doi:10.1016/ j.pmr.2017.08.008

CrossRef

19

Chang KV, Lin CP, Lin CS, Wu WT, Karmakar MK, Özça- kar L.

Sonographic tracking of trunk nerves: essential for ultrasound-guided pain management and research

J Pain Res. 2017;10:79-88. doi:10.2147/JPR.S123828

CrossRef

20

Sekizkardeş M, Aydin G, Özçakar L.

Ultrasound-Guided Shoulder Injection or Ultrasound Guides the Shoulder Injection?: Standard Versus State-of-the-Art.

Am J Phys Med Rehabil. 2018;97(5):e46. doi:10.1097/ PHM.0000000000000900

CrossRef