Ultrasound Certification for intra-articular injections and fluid collection assessment

[jessed]

I work in orthopaedics and am looking to become certified (if possible) using ultrasound for intra-articular injections and fluid collection assessment around total joints. Anyone have an idea where to start looking? Thank you.

Jesse Doll PA-C

[ventana]

hum, did not know they were doing this, not sure where the real benefit is.....

 

having worked in IR and Chronic pain I have no knowledge of anyone doing this..

[primadonna22274]

Can't answer the question but as a longtime PA and now med student in my final clinical year I am frankly AMAZED at how US-guided everything has quickly become "standard of care". Stuff I've tapped blindly for years--shoulders, knees, elbows--with simple knowledge of anatomy and palpation is now "off limits" without sono. Simple I&D abscesses?! Come on....

I'm convinced this is a billing issue more than a true patient care issue. I can see using sono for central lines, PICC, thoracentesis/paracentesis...but simple arthroscopic taps seems ridiculous to me.

Of course I can hardly do ANYTHING procedurally as a med student and that's more perplexing to me altogether. I had much more latitude as a PA student 15 years ago (but that's a story for another thread)..,.

[EMEDPA]

agree with primma. u/s guidance for joints is probably not needed unless you are looking at tiny effusions. I too still tap joints without u/s.

I think it is about billing. throw an u/s over a simple abscess and stick a needle in and the cost is degrees of magnitude larger. thoracentesis I can see using u/s. I still do paracentesis without u/s. if someone needs 6L of fluid taken off their belly it isn't that hard to figure out where to stick the needle.

[Just Steve]

http://www.togct.com/downloads/TOG_Articles/ortho-ob-dss-ultrasound-in-ortho.pdf

 

I hear a lot about the assumed vs. true accuracy of joint injections.  We use US guidance quite a bit.. almost exclusively, in my current practice for steroid injections.  Yes, the reimbursement rate is nice however what is also nice is being able show proof that the injection was delivered to the appropriate structure instead of using "best guess".  

 

The enclosed link is to a collection of data comparing guided vs non guided injections performed by skilled experts.  If I was going to let someone drive a needle into my joint and pump me full of steroid, I sure would appreciate them using an US to help ensure they were in the right spot.