I think once the $200 for using the US machine fee goes down or becomes bundled, it will end the brief torrid love affair with the device.
It will be useful for complicated knees, but never for spine. I played with one recently and was looking at my median nerve 3mm under the skin. I realized it would be impossible to miss using textbook technique for CTS injection. In the recent study in PMR Journal, US was useful for inexperienced injectionists, but once they learned technique- 100% of residents and attendings had intra-articular placement blind. This proves that the US is a good training tool, but may not be needed in clinical practice. I think we will find lots of useful procedures for US, but they will dissipate once reimbursement goes bye-bye.
Steve,
I have to respectfully disagree with you on this one. US may provide an important role in spine care in the future too. While fluoro currently remains the gold standard, US may be used in cases where fluoro is contraindicated or just not feasible, such as in pregnant patients or where access to fluoro is not possible. Admittedly, they're not nearly as easy to learn to do as other US procedures, and it pays to have a strong foundation and lots of prior US experience before attempting (See:
http://www.springerlink.com/content/j763436lqk094032/fulltext.pdf). You need to use a transducer with a lower frequency, at the expense of higher resolution, which only makes it more difficult. Here's a fairly recent article for more on the subject:
http://journals.lww.com/anesthesiol...px?utm_source=twitterfeed&utm_medium=facebook
Several months ago, I had a 95 year old patient come to see me with scoliosis and severe spinal stenosis. Poor woman was in so much pain she couldn't even get up on the fluoro table despite all our best efforts, and wouldn't have been able to lie prone even had she been able to get on the table. I had her sit up as best she could, and performed US-guided facet blocks. Worked quite well. Can't say 100%, but with a spine like hers I wasn't expecting complete resolution. She did well enough though, that the next time she came in she was able to undergo fluoro-guided injections without much difficulty. (Btw, although this was probably one of the more difficult and time consuming procedures I've had to do in a while, I basically got reimbursed nothing, as the procedure code is still experimental. Knowing this before performing the injections, I looked at it as my good deed for the day.)
It is also my belief that any invasive thoracic procedure warrants US use so as to avoid pneumothorax. Can't tell you how many stories I've heard about pneumos occurring from simple trigger point injections. (It's like the 6-degrees of complications: Even if you don't know someone directly who's had this complication, you can get there within 6 degrees or less.)
My experience has been all too similar to drusso's. Patients have had several injections by other practicioners without guidance to little avail. Done by me under US, it's a whole different story. Placebo? Don't know. But I do know that I'm sticking with what works.
