Non-Spine MSK Interventions

This issue of Seminars in Musculoskeletal Radiology highlights the wide spectrum of minimally invasive musculoskeletal interventions. An entire issue would be needed for spine interventions ranging from epidurals to vertebroplasty, so such procedures pertaining to the spine are not discussed here . We are excited to share with our readers the myriad of interesting and innovative procedures that are currently performed in practice as we experience tremendous growth in our thriving specialty of musculoskeletal radiology.

As musculoskeletal imaging tools and techniques continue to expand, we are experiencing a concomitant growth in our minimally invasive procedure armamentarium. Procedural innovations are in part due to our patients' needs and our desire, both radiologists and referring clinicians, to deliver high-quality care with less morbidity, recovery time, and cost. To this end, we are pleased to present 10 articles written by experts from various institutions that span the globe from Europe to North America.

The first group of articles discusses different applications in treating certain tendon diseases. The first article by Véronique Freire and colleagues from the University of Montreal discusses the ubiquitous applications of corticosteroid injection but also details the careful consideration required when treating our patients. Carmelo Messina and Luca Sconfienza from the University of Milan then report on the role of ultrasound-guided calcific tendinosis lavage of the rotator cuff including indications, practical considerations, and technique. The next two articles compare and contrast a current hot topic in the orthopedic, sports medicine, and radiology literature regarding the percutaneous treatment of tendinosis. Jon Jacobson from the University of Michigan nicely details in his article the rationale, indications, technique, and common uses of percutaneous tenotomy, and my article from the University of Wisconsin discusses the often debated use of platelet-rich plasma treatment for tendinosis.

The next group of articles discusses unique and innovative approaches to the minimally invasive treatment of carpal tunnel syndrome, trigger finger, and the various uses of botulinum toxin. Gajan Rajeswaran and colleagues from Chelsea & Westminster Hospital in London discuss ultrasound-guided approaches to fenestrate the flexor retinaculum to treat carpal tunnel syndrome and the A1 pulley in patients with trigger finger. Ivan Godoy et al from Massachusetts General Hospital offer a comprehensive review of the clinical applications of botulinum toxin injections ranging from neurogenic thoracic outlet syndrome to epicondylitis. They also discuss state of the science regarding botulinum toxin injections for musculoskeletal disorders including mechanism of action and botulinum toxin formulations.

Musculoskeletal imaging and interventions have recently expanded to include peripheral nerve lesions. In this issue, we are fortunate to include two articles from experts who treat peripheral nerve lesions in their respective practices. The first article in this group is by Alberto Tagliafico et al from the University of Genoa and covers common peripheral nerve procedures including the more advanced injections involving the ilioinguinal, genitofemoral, and pudendal nerves. The second article is by Sahlya Djebbar and colleagues from New York University Langone Medical Center and details their experience with cryoablation of peripheral nerves, in particular the treatment of Morton neuroma.

The final set of articles concentrates on image-guided ablation procedures of bone tumors. Image-guided bone biopsy has been well studied and described in the literature. Most, if not all, radiology groups are adept with bone biopsies. Thus we did not include this familiar topic in this issue. Pain palliation procedures, however, are growing in musculoskeletal radiology practices. Anderanik Tomasian et al from the Mallinckrodt Institute of Radiology discuss ablation procedures of painful bone tumors ranging from treatment algorithms to its emerging use for local tumor control. Radiofrequency ablation for treatment of osteoid osteoma is now the treatment standard, replacing surgery in most cases. We are fortunate to have Ambrose Huang from Massachusetts General Hospital share his vast experience in his article outlining strategies to treat osteoid osteomas that are in difficult-to-reach locations.

We hope this issue provides practicing radiologists and trainees with a comprehensive review of non-spine current and new innovative musculoskeletal image-guided procedures. Our authors have provided their expertise in providing the most accurate and up-to-date information regarding each topic. As guest editor for this edition I would like to thank all the authors for their time and expertise in helping create a wonderful compilation of related procedural topics that showcase our specialty of musculoskeletal imaging and intervention. I would also like to thank both Lawrence White and Laura Bancroft who provided their vision and invaluable advice to make yet another issue a success.