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Musculoskeletal Radiology

Under the direction of J. Herman Kan, MD, our pediatric musculoskeletal radiology services are tailored specifically to the needs, age and size of our pediatric patients and are optimized to assess sports injuries, growing bones, muscles, tendons and ligaments. We provide subspecialty pediatric musculoskeletal radiology care inclusive of diagnostic (Radiography, CT, MRI, US, EOS spine imaging) and interventional (image guided joint and tendon sheath injections, arthrography, joint aspirations, and US guided ganglion cyst fenestration) procedures.

In 2019, over 328 advanced imaging studies and procedures per month were performed.

Schedule

  • Main Campus (Medical Center)
    MSK Injection Clinic on Wednesdays and Thursdays
    MSK Ultrasound Clinic on Wednesdays
     
  • West Campus (Katy)
    MSK Injection Clinic on Thursdays and Fridays
    MSK Ultrasound Clinic on Fridays
     
  • Woodlands Campus
    MSK Injection Clinic on Mondays and Tuesdays
    MSK Ultrasound Clinic on Mondays

MSK Injection Clinic

The MSK injection clinic is subspecialty care provided by pediatric musculoskeletal subspecialty trained radiologists. The MSK clinic is staffed by a pediatric focused care team composed of pediatric musculoskeletal radiologists, nurses, technologists, child life specialists, and anesthesiologists. As a rule of thumb, we perform all our procedures without sedation when the child is 10 years and older using various distraction devices and strategies with parent participation. Sometimes, light sedation and anxiolytic supplementation will be provided in children if necessary and as requested by your doctor. All procedures are performed under sterile technique in a dedicated procedure room.

In general, children younger than 10 years are performed with light sedation or anesthesia.

To order a study, please have your provider order through EPIC if they are a TCH provider. If they are an external provider, please have your provider complete the attached PDF form then email to mskradiology@texaschildrens.org. If the procedure you are interested is not listed below or you have additional questions about the procedure, please email mskradiology@texaschildrens.org, and someone will respond back to you within 1 business day.

Services provided:

Therapeutic anesthetic/steroid injections: US, x-ray, or CT guided needle placements are performed followed by anesthetic/steroid injections for joints, tendon sheaths, or bursa for sports medicine, cerebral palsy, rheumatologic or physiatry patients. Ropivicaine and Kenalog are our preferred agents.

Therapeutic steroid injections for juvenile idiopathic arthritis:  US or x-ray guided steroid injections are performed only by referral from a rheumatologist. For injections of the hand, wrist, foot, or ankle, a limited non-contrast MRI will be performed beforehand to road map and identify joints and tendons that may be inflamed and require directed therapy. Our recommended medication dose sheet is listed below.

Diagnostic anesthetic/steroid injections: A diagnostic injection is performed to determine if a specific anatomic area is the site that is causing pain or discomfort. Pre- injection, post-injection, and 2-3 day follow-up pain scores are also generated and a radiology nurse will call you after the procedure. US, x-ray, or CT guided needle placements are performed followed by anesthetic/steroid injections for joints, tendon sheaths, or bursa for sports medicine, cerebral palsy, rheumatologic or physiatry patients. Ropivicaine and Kenalog are our preferred agents.

Arthrography prior to MRI: US or x-ray administration of diluted gadolinium is performed prior to MRI.

US guided ganglion cyst fenestration: Symptomatic ganglion cysts of the hand, wrist, ankle, or foot may be treated by non-sedated ganglion cyst fenestration with a small needle. This study is performed under ultrasound and is an alternative to surgical resection of symptomatic ganglion cysts. We will always perform a diagnostic US first to confirm the diagnosis of a ganglion cyst and rule out underlying mass or alternative diagnosis. There is a regimented aftercare procedure that needs to be followed requiring 4 weeks of non-athletic activity.

US guided PRP (platelet rich plasma) injection and US guided dry needling: PRP and dry needling of ligament, tendon, and muscle injuries is an alternative therapy and should only be considered if all non-operative options have been exhausted and your physician is now considering surgery to treat your injury. For PRP injections, a blood draw will performed and platelets will be extracted from your child’s blood, then injected to the injured body part under sterile conditions. Prior to your PRP injection, please do not take any non-steroidal medication 1 week before or 1 week after the procedure.  

Therapeutic hyaluronic acid synthetic joint injections (only in patients 18 years and older): US or x-ray needle placement into your painful osteoarthritic joint is performed with injection of a synthetic hyaluronic acid derivative. Because the hyaluronic acid is viscous, a slightly larger needle is necessary to deliver the medication into your joint.

Fact Sheets


Other information:

For Physicians: