Description
Objectives:
Treating supraspinatus tendinopathy and patellar tendinopathy presents challenges for healthcare professionals. This study aims to assess the precision of needle interventions in these conditions, comparing ultrasound-guided and blind approaches.
Methods:
Two cadaveric studies were conducted, involving injections under ultrasound guidance or blindly, with randomization of specimens and practitioners. For supraspinatus tendinopathy, 20 fresh cadaveric shoulders and 30 experienced musculoskeletal ultrasound practitioners performed 4 ultrasound-guided and 4 unguided punctures each, totaling 240 punctures analyzed in 3 anatomical cuts. For patellar tendinopathy, 26 knees from fresh cadavers were used, and 26 experienced practitioners conducted 6 ultrasound-guided and 6 blind punctures each, resulting in 312 injections analyzed across 2 anatomical cuts. A 1cc infiltration of colored natural latex was performed to mark the site infiltration. Ultrasound examination was done with a 5-16MHz linear array transducer in longitudinal and transversal view in a real-time imaging mode in a standardized mode. The main response variable was analyzed, this being the average distance to the point of the tendon to be treated (bullet point) in the different anatomical cuts, categorizing this mean as precision. Other statistical analyses were done: Kolmogorov-Smirnov test for normality of each study and a descriptive analysis of the data, a box diagram of the mean distance to the center of the tendon and the table with the basic descriptive statistics. The Wilcoxon test was done to check whether there were differences in the distances to the center of the tendon between the punctures, ultrasound-guided and unguided. The Chi-Square independence test was carried out to check whether there were differences in the puncture precision distribution based on whether it was ultrasound-guided or not.
Results:
Significant differences (p<0.0001) in the distance from the target point were observed in both studies. For supraspinatus tendinopathy, unguided punctures were on average 10mm farther from the target than ultrasound-guided punctures, with ultrasound-guided punctures achieving 95% precision and unguided punctures only 12.5% precision. In patellar tendinopathy, the unguided injections were also performed on average 10mm away from the target point compared to ultrasound-guided injections, with ultrasound-guided injections achieving an accuracy of 74.36% and unguided injections only 11.54% accuracy (p < 0.0001).
