Cause, clinical and ultrasound findings

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  Inflammatory arthritis, chronic injury or overuse may cause inflammation/microtearing of the tendon.

  
  
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  Pain and swelling are present at the affected area.

  
  
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  Hypoechoic areas and clefts with or without neovascularity and calcifications in the tendon.

  
  
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  Irregularity of the cortex of the bone is in keeping with enthesopathy at the site of tendon insertion.

Equipment and drugs

Anatomy

Locate the tendon according to the site.

Anatomy

Locate the tendon according to the site.

Technique

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  Put the patient in the lying or sitting position according to the site of injection and using aseptic technique.

  
  
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  The abnormal area is identified by ultrasound, and the needle is introduced parallel to the probe (for best visualization); lidocaine is injected subcutaneously and on top of the tendon for anaesthesia.

  
  
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  Wait for a few minutes for the anaesthetic to take effect.

  
  
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  The needle is then inserted several times into the abnormal tendon area (dry needling). This can be followed by injection of a steroid and local anaesthetic adjacent to the tendon.

  
  
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  The needle is retracted, and skin pressure is applied.