Ultrasound-guided therapy intrigues skeletal society

A British research team is applying a new twist to an old technique for treating ankle injuries in high-performance athletes. The procedure involves use of ultrasound to guide steroid and anesthetic injections and was originally described in the literature a decade ago for treating ankle impingement in ballet dancers.

The approach piqued the interest of attendees at the 2006 International Skeletal Society meeting in Vancouver, where a paper on it was presented.

"We don't do it at our institution, but it looks like a wonderful technique," said Dr. Thomas L. Pope Jr., a professor of radiology and orthopedics at the Medical University of South Carolina, during a special focus session on sports medicine.

At the meeting, Dr. Philip Robinson, a consultant musculoskeletal radiologist at St. James University Hospital in Leeds, U.K., described how his team uses ultrasound guidance to inject anesthetics and steroids in professional soccer players with posterior ankle impingement. Early reports show the minimally invasive treatment could help players recover mobility and return to training and active competition sooner than with conventional treatment (AJR 2006;187[1]:W53-58).

In addition to the technical aspects of guidance with ultrasound, participants' questions revolved around when to use steroids with anesthetics and when to use anesthetics alone. Recent studies have linked the use of steroids with serious musculoskeletal disorders, including tendon rupture and rare neuropathies. Learning when to use which, or both, is a matter of gaining experience, Robinson said.

"When I got to practice, I was very concerned about using steroids, certainly around the main weight-bearing tendons," Robinson said.

Although the risk of causing damage is minimal, Leeds physicians avoid steroid use involving weight-bearing tendons, Robinson said. Most interventionalists need to keep an eye instead on applying the treatment only after the correct diagnosis is made, preferably with MRI, to keep the drugs from concealing more serious underlying conditions.

Several physician attendees showed interest in the technique's potential application for chronic tendinopathies in older patients. Robinson does not use the technique in this population. These patients generally have severely ill tendons, which often split or are hanging on by only a few threads. Administering steroids could help their symptoms for a while but won't cure the underlying problem. He usually sends these patients to an orthopedic surgeon first.