Fall 2015 (Volume 25, Number 3)

Teach the Teachers Course: Ultrasound-guided Joint Injections

By Maria Bagovich, MD, FRCPC, RhMSUS

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Greetings, CRA members. We would like to update you about a recent Canadian Rheumatology Ultrasound Society (CRUS) advanced learning opportunity undertaken at the University of Florida’s College of Medicine on March 13-14, 2015. This two-day interventional musculo-skeletal (MSK) ultrasound (US) course was led by local expert Dr. Gurjit Kaeley at the Jackson-ville Simulation Centre. Funding was graciously provided by an educational grant from Janssen Canada. The course was exclusive to CRUS members, and included Dr. Diane Wilson, Dr. Abe Chaiton, Dr. Maggie Larché, and myself.

The CRUS team practicing US-guided injections.

Despite facing airline drama and flight cancellations, our CRUS group persevered and arrived in time to a wet but warm Jacksonville, Florida. Our purpose was to learn US-guided injection techniques from the injection master, Dr. Kaeley. After a brief didactic session on the principles of visualizing key anatomic landmarks and injection techniques, we went to the simulation centre, a converted operating suite equipped with injection materials, portable Sonosite US machines and cadaver specimens. Specimens were set up for shoulder, hand and wrist, and elbow injections throughout the day. In a 2:1 ratio of attendee to specimen, we were able to practice US-guided injections in real-time on sections of cadaver until the anatomy and technique was mastered. I have a newfound appreciation for the concept of the “stand-off gel pad” and needle visualization through the various tissue planes. It is remarkable the detail that can be seen with US, even on cadaveric specimens! On the second day, we covered the hip, knee, ankle, foot and a few other special regions including the sacroiliac (SI) joint and, thanks to Dr. Wilson, the suprascapular nerve block.

Dr. Kaeley provided a fantastic learning environment enriched with classical music and masterful feedback. Our trips to and from the hotel in the Honda Pilot “fun wagon” was memorable. We also experienced Jacksonville hospitality at the Crowne Plaza Steakhouse, receiving a personal escort from a local motivational speaker for our evening stroll across the riverfront walkway. All in all, it was a successful trip with a great opportunity for small-group learning and hands-on experience with US-guided injections.

Furthermore, we are excited about the growth of MSK US in rheumatology practice and would love to have you join our CRUS family! Luckily, you have many training opportunities in Canada. The next CRUS Basic Course will be September 19-20, 2015 in Hamilton, Ontario. Details regarding registration can be found at www.crus-surc.ca. Sign up early to ensure your spot! The next Intermediate Course will be held in association with the CRA conference in Lake Louise, Alberta, in February 2016. In 2017, the Intermediate Level CRUS course will be in Montreal in association with the annual CRA meeting. The course will be dedicated to US-guided procedures. Enrollment will be limited so please register early! Stay tuned for more details. If you still have questions, please direct them to info@ecrus.ca.

Maria Bagovich, MD, FRCPC, RhMSUS
Adjunct Lecturer,
University of Toronto
Rheumatologist,
North York General
Toronto, Ontario