Ultrasound-guided musculoskeletal interventional procedures around the shoulder
Authors:   Department of Radiology, Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Italy, Tortora Silvia , Messina Carmelo ,   IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, Gitto Salvatore ,   Department of Biomedical Science for Health, University of Milan, Italy, Chianca Vito ,   Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonese (EOC), Lugano, Switzerland,   Diagnostica per Immagini, Ospedale Evangelico Betania, Italy, Serpi Francesca ,   Department of Radiology, Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Italy, Gambino Angelo ,   IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, Pedone Luigi ,   IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, Carrafiello Gianpaolo ,   Unità Operativa di Radiologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy,   Department of Health Sciences, University of Milan, Italy, Sconfienza Luca Maria ,   IRCCS Istituto Ortopedico Galeazzi, Milano, Italy,   Department of Biomedical Science for Health, University of Milan, Italy, Albano Domenico ,   IRCCS Istituto Ortopedico Galeazzi, Milano, Italy,   Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Italy
Published: June 2021

Ultrasound is a fast, accessible, reliable, and radiation-free imaging modality routinely used to assess the soft tissues around the shoulder. It enables to identify a wide range of pathological conditions. Furthermore, most ultrasound-guided musculoskeletal interventional procedures around the shoulder produce better results in terms of accuracy and clinical efficacy than those performed in a blinded fashion. Indeed, intra-articular and peri-articular interventional procedures can be easily performed under continuous ultrasound monitoring to ensure the correct position of the needle and to deliver the medication to a specific target. Several technical approaches and medications can be used to treat different causes of painful shoulder. Intra-articular injections are applied to treat acromioclavicular osteoarthritis as well as glenohumeral joint osteoarthritis and adhesive capsulitis. Subacromialsubdeltoid bursitis, either presenting as a primary inflammatory condition or secondary to rotator cuff disorders, can be easily approached using ultrasound guidance to aspirate synovial effusion and to inject medications. Ultrasound-guided percutaneous irrigation is a well-established technique increasingly applied to treat patients with rotator cuff calcific tendinopathy. Also, degenerative rotator cuff tendinopathy can be conservatively treated by image-guided interventions, specifically with needling under ultrasound guidance that can be associated with injections of platelet-rich plasma. Lastly, periarticular peripheral nerve block can be quickly and safely performed under ultrasound guidance, particularly in conditions involving the suprascapular nerve in the setting of pre-operative analgesia or pain treatment in glenohumeral osteoarthritis and adhesive capsulitis. In this article, the most common ultrasound-guided procedures around the shoulder have been reviewed to discuss indications and techniques.