Diagnostic and Therapeutic Procedures
In addition to diagnostic imaging evaluation, the musculoskeletal imaging section at Mount Sinai Health System performs a number of diagnostic and therapeutic procedures for a variety of orthopaedic and rheumatologic disorders.
Many structures in the musculoskeletal system are capable of producing pain: joints (arthritis), tendons (tendonitis), inflamed bursa (bursitis), and nerves. Inflammation of these structures can result in debilitating pain and limited range of motion. Mount Sinai's musculoskeletal radiologists specialize in treating these painful conditions. We use multiple imaging techniques (x-ray, CT scan, and ultrasound) to inject medications into joints, tendons, and bursa in order to reduce pain, increase range of motion, and help you return to activity faster.
Fluoroscopic images from an arthrogram. The left image shows the placement of the needle in the hip; the right image shows the same hip after the injection of contrast (the dark band) and local anesthesia and steroid (not visualized).
MRI images of the hip demonstrate a tear of the labrum (left-most image) with a painful, fluid filled cyst (white arrow) extending from tear along the front of the acetabulum (hip socket) on the right-sided images.
The patient was referred for an ultrasound guided cyst aspiration and injection. Ultrasound images show the presence the dark cyst next to the hip joint (white arrow, left image). Using ultrasound guidance, the cyst was punctured with a needle (dashed arrows, middle image) with resolution of the cyst (right image). The cyst was injected with steroids and local anesthesia with relief of pain.
Calcific Tendinitis Injection and Lavage
Calcific tendinitis is caused by the deposition of calcium in and around tendons and joints. While it can occur anywhere, calcific tendinitis is most frequently seen around the shoulder and hip. The deposition of calcium within the tendons can cause extreme discomfort and decreased range of motion due to inflammation of the tendon and bursa producing acutely painful tendinitis and bursitis.
Ultrasound-guided intervention is very effective in the treatment of calcific tendinitis. After the calcific deposits are localized under ultrasound, the shoulder is numbed with local anesthesia. The calcium in the tendon is then injected with anesthesia and punctured repeatedly with a needle under ultrasound. This dissolves the calcium in and around the tendon. After the calcium is dissolved, the tendon and bursa are injected with a steroid to reduce inflammation and promote healing.
X-ray of the shoulder showing a cloudy structure near the rotator cuff compatible with calcific tendinitis.
Ultrasound image prior to lavage shows the calcium within the tendon (white circle).
X-ray of the same shoulder weeks later, showing resolution of the calcium within the tendon.
Morton's Neuroma Injection
Morton's neuroma is a benign lesion that occurs in the feet, usually between the toes. It most commonly occurs between the third and fourth toe and can cause a sharp, burning pain. Morton's neuromas are the result of scarring around the small nerves between your toes. If conservative measures fail (changing footwear, using arch supports) these lesions can be treated without surgery. Using ultrasound and local anesthesia, a small needle can be inserted into the neuroma (between the toes) and injected with a combination of local anesthesia and steroid. The injected medication reduces the pain and inflammation around the nerve causing the neuroma, which usually resolves. If this is unsuccessful, using the same procedure, the neuroma can be injected with alcohol to kill the surrounding inflammatory tissue.
Ultrasound between the first and second toes shows the Morton’s neuroma. The second image shows needle placement in the neuroma (arrow) prior to the injection of steroid and local anesthesia (not shown).
Bone and Soft Tissue Biopsy
Mount Sinai's musculoskeletal radiologists specialize in bone and soft tissue biopsy. We use the latest equipment and technology to perform bone biopsies safely and effectively with no overnight hospital stay. With a combination of light sedation and local anesthesia, bone biopsies are performed using guidance with a CT scan. Soft tissue biopsies can be performed with ultrasound or CT guidance techniques.
Two images from a biopsy of the tibia (below the knee) showing the placement of needle (left) and biopsy of the bone (right).
Image from a second biopsy of the sacrum demonstrating accurate needle placement.
Radiofrequency Ablation of Osteoid Osteoma
Osteoid osteoma is a benign bone tumor found mostly in young adults. It is most frequently diagnosed on CT scan or MRI when patients present with extremity pain. In some cases the pain is more frequent or severe at night and is relieved by aspirin and related anti-inflammatory medications such as ibuprofen. Although these benign tumors can be removed surgically, they can be difficult to localize in the operating room and sometimes require a prolonged hospital stay.
Radiofrequency ablation is a technique whereby the tumor is accessed by CT scan then heated with a special catheter. The intense heat is localized to the immediate area in order to kill the tumor and prevent the further release of inflammatory chemicals that cause pain. Radiofrequency ablation has over a 90 percent cure rate of osteoid osteomas and is a safe and effective technique that frequently requires no overnight hospital stay. Radiofrequency and other ablative techniques can also be used to palliate metastatic lesions in bone to reduce pain and prevent potential fracture.
CT images of a radiofrequency ablation of an osteoid osteoma. On the first image, the osteoid osteoma is present within the femur; the external line of dots represents a localization grid on the patient’s skin. The second image shows the placement of a standard bone biopsy needle just outside the lesion. On the final image, the ablation catheter is placed through the bone biopsy needle for successful ablation.
Mount Sinai Radiology Associates
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Klingenstein Pavilion, MC Level
New York, NY 10029 Map