Table 5

Procedural

TermDefinition
Needle/device terminology
In-plane55 Needle/device aligned with the long axis of the transducer
Out-of-plane55 Needle/device aligned perpendicular to the long axis of the transducer
Jiggling55 Rapid, low-amplitude movement of the needle/device in the plane of insertion to facilitate needle visualisation
Rotation55 Rotating the needle will result in the bevel alternately facing up and down, thus enabling identification of the needle tip.
Stylet movement55 Small movements of a stylet in and out of the tip of the needle to improve needle tip visualisation; the stylet should not be modified to allow it to advance beyond the needle tip when using this technique for visualisation.
Procedure technique descriptions
Aponeurotomy56 57 Cutting an aponeurosis, either completely or incompletely, using a needle, scalpel or other device.
AspirationThe act of removing fluid, calcification or other crystalline material, blood, pus or other substance from the body typically using a needle and syringe, catheter or another device
Barbotage58 Repeated injection and aspiration of fluid to break up and remove calcification, usually within a tendon
Brisement59–61 The injection of fluid into the space between a tendon and its paratenon or sheath; brisement has also been used to refer to injection of saline or other fluid into a joint to break down adhesions (eg, in treatment of adhesive capsulitis).
Debridement62 63 The removal of necrotic, degenerative or infected tissue from a region or given tissue of the body.
Dry needling64 A procedure, generally used as part of manual physical therapy, where a small gauge needle is inserted into a muscle or other soft tissue structure to treat myofascial pain
Fasciotomy65 66 Cutting fascia, either completely or incompletely, using a needle, scalpel or other device
Fenestration64 The act of repetitive puncture of a soft tissue structure with a needle or other device
Fragmentation67 The use of a needle or other device to break up calcified and/or bony tissue
Hydrodissection68–70 Technique by which saline or other sterile fluid is injected to separate tissues or tissue planes from each other
InjectionThe act of delivering a fluid or other substance into the body, typically using a needle and syringe, catheter or another device.
Lavage71 Washing out using saline or other sterile solution; irrigation is an acceptable alternate term.
Neurolysis69 70 72–74 There are distinct definitions of neurolysis. An appropriate modifier is recommended to clearly describe the procedure performed.
 Chemical neurolysisThe application of chemical agents to a nerve in order to cause temporary or permanent degeneration of targeted nerve fibres.
 HydroneurolysisThe injection of saline or other sterile fluid to free nerves from surrounding tissue/adhesion; the term ‘nerve hydrodissection’ is an acceptable alternate term.
 Surgical neurolysisThe surgical freeing of nerves from surrounding tissue/adhesion
 Physical neurolysisThe application of physical energy (eg, heat or cold) to a nerve in order to cause temporary or permanent degeneration of the targeted nerve fibres
Plantar fasciotomy75 76 Cutting the plantar fascia, either completely or incompletely, using a needle, scalpel or other device.
Tendon scraping77 78 The process of abrading the surface of a tendon or paratenon with a needle, scalpel, or other device, with the goal of separating the tendon from neovessels, neonerves and/or adjacent soft tissues.
Tenotomy62 79–82 Cutting tendon tissue, either completely or incompletely, using a needle, scalpel or other device
Trigger finger release83 84 Cutting the pulley and associated tendon sheath responsible for the stenosis using a needle, scalpel or other device
Terms to avoid
Minimally invasive, ultraminimally invasive and microinvasiveThese are relative and imprecise terms without formal definitions. Therefore, their use is not recommended. The exact procedure should be described including technique and tool(s) used.
Needling85 This is an inconsistent term that has been used to describe a range of procedures from dry needling of myofascial trigger points to tenotomy or fasciotomy procedures. The use of a more precise term is recommended. ‘Needling’ should only be used in conjunction with ‘dry needling’ as previously defined.
Peppering85 This term has been used to describe a type of fenestration procedure (often involving a tendon) alone or in conjunction with an injection. The use of more precise terms such as ‘tenotomy’, ‘fasciotomy’ or ‘fenestration’ is recommended.
PercutaneousThis term refers to a procedure performed through the skin. Due to lack of specificity associated with this term, its use in isolation is not recommended. Rather, the exact procedural technique should be described including tool(s) used and approach.