Spinal Injections.

Spinal pain is a common complaint and cause of disability in the United States, affecting most individuals at some point in their lives. The complex anatomy of the spine leads to multiple potential and coexisting etiologies for pain, and the differentiation of these sources can present a diagnostic challenge. Image-guided spinal injections can provide both diagnostic information identifying pain location as well as prolonged therapeutic relief as an alternative to medical management. Anesthetic and corticosteroid medications can be administered within the epidural space through transforaminal or interlaminar approaches, blocking various sensory nerves, or directly within the facet joints. Proceduralists must be aware of associated patient considerations, techniques, and potential complications to perform the procedures safely. We discuss image-guided spinal injection techniques, based on best practices and our experiences.

Ultrasound-Guided Musculoskeletal Injections.

Musculoskeletal injections serve a variety of diagnostic and therapeutic purposes, with ultrasonography (US) guidance having many advantages: no ionizing radiation, real-time guidance, high spatial resolution, excellent soft tissue contrast, and the ability to identify and avoid critical structures. Sonography can be cost effective and afford flexibility in resource-constrained settings. This article describes US-guided musculoskeletal injections relevant to many radiology practices and provides experience-based suggestions. Structures covered include multiple joints (shoulder, hip), bursae (iliopsoas, subacromial-subdeltoid, greater trochanteric), peripheral nerves (sciatic, radial), and tendon sheaths (posterior tibial, peroneal, flexor hallucis longus, Achilles, long head of the biceps). Trigger point and similar targeted steroid injections, as well as calcific tendinopathy barbotage, are also described.

Adamantinoma of the Ulnar Shaft Reconstructed With a Vascularized Free Fibula.

We describe a 36-year-old man with a long-standing diagnosis of ulnar fibrous dysplasia with associated fracture of the ulna. He presented with a growing and increasingly tender forearm mass and was diagnosed with adamantinoma of the ulna, for which he underwent wide resection of the ulnar diaphysis followed by reconstruction with a vascularized fibula autograft. This case serves to emphasize the importance of performing a stepwise workup for the diagnosis of osseous neoplasms even in cases with long-standing diagnoses. [Orthopedics. 2024;47(2):e102-e105.].

Asymptomatic Intracardiac Cement Embolism Following Kyphoplasty.

Cement extravasation can occur during vertebral body augmentation such as kyphoplasty and vertebroplasty with diverse presentation and resultant treatment. The cement can embolize through venous vasculature to the thorax where it poses a potential threat to the cardiovascular and pulmonary systems. A thorough risk-benefit analysis should be conducted to select the appropriate treatment course. We present an asymptomatic case of cement extravasation to the heart and lungs during kyphoplasty.

Osseous Pathology on Wrist Magnetic Resonance Imaging.

Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.

Shoulder MR Imaging Versus Ultrasound: How to Choose.

Imaging evaluation of the shoulder is performed using multiple modalities, including ultrasound (US) and MR imaging. Clinicians often wonder which modality to use to work up their patients with shoulder pain. Although MR imaging has remained the workhorse of shoulder imaging, US has increased in popularity among academic and private institutions. Both modalities offer similar diagnostic information in regards to rotator cuff pathology and other soft tissues, although they differ in their technique, indications, and interpretation. A thorough understanding of these differences is imperative to appropriately use these modalities in clinical practice, including the unique interventional opportunities available with US.