Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature

Figure 3 Percutaneous tenotomy or dry-needling can be performed under ultrasound-guidance to provide ideal visualization of the needle. Use of the short-axis plane should be to localize neighboring structures and visualize complete disruption of the tendon fibers. Use of the long-axis plane should be to confirm complete disruption of the tendon from anterior to posterior. However, the actual procedure should be performed within the short-axis plane as maintaining the needle in long-axis is difficult and unreliable to prevent neighboring structure damage. Confirmation of the structure as tendon fibers should rely on noting anisotropy which is characteristic of tendons. Short arrow indicates needle tip. Long arrows indicate Achilles tendon sheath. Stars indicate Achilles tendon fibers in long-axis plane.