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Effect of ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:545-561. [PMID: 35635576 DOI: 10.1007/s00402-022-04437-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS), the commonest neuropathy of the upper limb, can be managed with different therapeutic approaches. Local corticosteroid injection has been adopted widely in clinical practice, as it showed great efficacy in treating CTS. However, the best injection technique continues to be a subject of controversy. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) corticosteroid injection on the clinical and electrophysiological outcomes in patients with CTS. METHODS We performed a systematic literature search in Medline, Embase, and CENTRAL, from which we included randomized controlled trials (RCTs) that compared US-guided and LM-based corticosteroid injection in treating individuals with CTS. We evaluated the following outcomes: Boston carpal tunnel questionnaire functional status scale (BCTQ-FSS) and symptom severity scale (BCTQ-SSS), and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcome. RESULTS A total of 8 RCTs that enrolled 500 wrists were deemed eligible. US-guided injection showed a significantly better BCTQ-FSS (SMD = -0.22, 95% CI -0.39 to -0.04), BCTQ-SSS (SMD = -0.77, 95% CI -1.22 to -0.31), and adverse event rate (RR = 0.32, 95% CI 0.21 to 0.49) compared to LM-based injection. CONCLUSION This meta-analysis showed the superiority of US-guided corticosteroid injection over LM-guided corticosteroid injection in enhancing functional status, improving symptom severity, and reducing the adverse event rate in individuals with CTS.
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2
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Gorelik N, Darwish Y, Walter WR, Burke CJ, Sarpel D, Chong J, Adler RS. Incidence of infectious complications following ultrasound-guided percutaneous musculoskeletal interventions with the use of an uncovered transducer footprint. Eur Radiol 2022; 32:6759-6768. [PMID: 35579710 DOI: 10.1007/s00330-022-08849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the incidence of infectious complications following ultrasound-guided musculoskeletal interventions performed with a disinfected uncovered ultrasound transducer footprint. METHODS Electronic medical records of all patients who underwent an ultrasound-guided musculoskeletal procedure (including injection, calcific lavage, or ganglion cyst aspiration) performed by any of the 14 interventional musculoskeletal radiologists at our institution between January 2013 and December 2018 were retrospectively reviewed to identify procedure site infections. Biopsies and joint aspirations were excluded. The procedures were performed using a disinfected uncovered transducer footprint. First, an automated chart review identified cases with (1) positive answers to the nurse's post-procedure call, (2) an International Classification of Diseases (ICD) diagnostic code related to a musculoskeletal infection, or (3) an antibiotic prescription within 30 days post-procedure. Then, these cases were manually reviewed for evidence of procedure site infection. RESULTS In total, 6511 procedures were included. The automated chart review identified 3 procedures (2 patients) in which post-procedural fever was reported during the nurse's post-procedure call, 33 procedures (28 patients) with an ICD code for a musculoskeletal infection, and 220 procedures (216 patients) with an antibiotic prescription within 30 post-procedural days. The manual chart review of these patients revealed no cases of confirmed infection and 1 case (0.015%) of possible site infection. CONCLUSIONS The incidence of infectious complications after an ultrasound-guided musculoskeletal procedure performed with an uncovered transducer footprint is extremely low. This information allows radiologists to counsel their patients more precisely when obtaining informed consent. KEY POINTS • Infectious complications after ultrasound-guided musculoskeletal procedures performed with a disinfected uncovered transducer footprint are extremely rare.
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Affiliation(s)
- Natalia Gorelik
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Blvd., Montreal, Quebec, H4A 3J1, Canada. .,Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA.
| | - Yousef Darwish
- , New York City, NY, USA.,Information Technology Department, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - William R Walter
- Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
| | - Christopher J Burke
- Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
| | - Dost Sarpel
- Division of Infectious Disease, Milford Regional Medical Center, 14 Prospect St, Milford, MA, 01757, USA
| | - Jaron Chong
- Department of Radiology, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd E, C1-609, London, Ontario, N6A 5W9, Canada
| | - Ronald S Adler
- Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
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3
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Klontzas ME, Koltsakis E, Kakkos GA, Karantanas AH. Ultrasound-guided treatment of Morton's neuroma. J Ultrason 2021; 21:e134-e138. [PMID: 34258038 PMCID: PMC8264811 DOI: 10.15557/jou.2021.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
Morton’s neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular degeneration, and deregulation of sympathetic innervation. Patients usually present with burning or sharp metatarsalgia at the dorsal or plantar aspect of the foot. The management of Morton’s neuroma starts with conservative measures, usually with limited efficacy, including orthotics and anti-inflammatory medication. When conservative treatment fails, a series of minimally invasive ultrasound-guided procedures can be employed as second-line treatments prior to surgery. Such procedures include infiltration of the area with a corticosteroid and local anesthetic, chemical neurolysis with alcohol or radiofrequency thermal neurolysis. Ultrasound aids in the accurate diagnosis of Morton’s neuroma and guides the aforementioned treatment, so that significant and potentially long-lasting pain reduction can be achieved. In cases of initial treatment failure, the procedure can be repeated, usually leading to the complete remission of symptoms. Current data shows that minimally invasive treatments can significantly reduce the need for subsequent surgery in patients with persistent Morton’s neuroma unresponsive to conservative measures. The purpose of this review is to present current data on the application of ultrasound for the diagnosis and treatment of Morton’s neuroma, with emphasis on the outcomes of ultrasound-guided treatments.
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Affiliation(s)
- Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece.,Advanced Hybrid Imaging Systems, Institute of Computer Science, FORTH, Crete, Greece.,Department of Radiology, School of Medicine, University of Crete, Greece
| | - Emmanouil Koltsakis
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - George A Kakkos
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece.,Advanced Hybrid Imaging Systems, Institute of Computer Science, FORTH, Crete, Greece.,Department of Radiology, School of Medicine, University of Crete, Greece
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4
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Kakkos GA, Klontzas ME, Koltsakis E, Karantanas AH. US-guided high-volume injection for Achilles tendinopathy. J Ultrason 2021; 21:e127-e133. [PMID: 34258037 PMCID: PMC8264817 DOI: 10.15557/jou.2021.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
Achilles tendinopathy is a common overuse condition affecting the adult population. The incidence is on the rise because of greater participation of people in recreational or competitive sporting activities. Chronic Achilles tendinopathy occurs most commonly in the tendon’s mid-portion, and it is challenging to manage, leading to significant patient morbidity. Despite conservative management many patients still require surgical intervention. The mechanism underlying pain is not entirely understood; however, high-resolution color Doppler ultrasound has shown that neovascularisation could be involved. Minimally-invasive treatments for chronic Achilles tendinopathy may prevent the need for surgery when conservative methods have failed. Ultrasound provides an option to guide therapeutic interventions accurately, so that treatment is delivered to the desired site of pathology. High-volume image-guided injection is a relatively new technique where a high volume of liquid is injected between the anterior aspect of the Achilles tendon and the Kager’s fat pad, used to strip away the neovascularity and disrupt the nerve ingrowth seen in chronic cases of Achilles tendinopathy. High-volume image-guided injection has shown promising results in terms of reducing pain and improving function in patients where conservative measures have failed. This review aims to describe the fundamental technical factors, and investigate the efficacy of high-volume image-guided injection with reference to the available literature.
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Affiliation(s)
- George A Kakkos
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece.,Advanced Hybrid Imaging Systems, Institute of Computer Science, FORTH, Crete, Greece.,Department of Radiology, School of Medicine, University of Crete, Greece
| | - Emmanouil Koltsakis
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece.,Advanced Hybrid Imaging Systems, Institute of Computer Science, FORTH, Crete, Greece.,Department of Radiology, School of Medicine, University of Crete, Greece
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Romero-Morales C, Bravo-Aguilar M, Abuín-Porras V, Almazán-Polo J, Calvo-Lobo C, Martínez-Jiménez EM, López-López D, Navarro-Flores E. Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Dis Mon 2021; 67:101210. [PMID: 34099238 DOI: 10.1016/j.disamonth.2021.101210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - María Bravo-Aguilar
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Eva María Martínez-Jiménez
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | - Emmanuel Navarro-Flores
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain.
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Ayekoloye CI, Nwangwu O. Ultrasound-Guided Versus Anatomic Landmark-Guided Steroid Injection of the Subacromial Bursa in the Management of Subacromial Impingement: A Systematic Review of Randomised Control Studies. Indian J Orthop 2020; 54:10-19. [PMID: 32952904 PMCID: PMC7474019 DOI: 10.1007/s43465-020-00148-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/21/2020] [Indexed: 02/04/2023]
Abstract
This study is a systematic review of prospective randomised control studies comparing ultrasound-guided steroid injection of the subacromial space with anatomic landmark-guided injection in the treatment of subacromial impingement to determine if there is any difference in pain relief and functional outcome. Mesh terms and free-text words search of electronic databases, reference list of identified studies and grey literature was performed using the PICO format. All identified papers were sifted sequentially by title, abstract and review of full text articles. Four papers qualified and were included in the review and analysis. The total number of patients in the studies was 234 patients with 117 patients randomised to each of landmark-guided and ultrasound-guided injection groups. There was no statistically significant difference in VAS pain scores (P = 0.67), SDQ scores (P = 0.43), SPADI disability score (P = 0.17) and functional outcomes scores (P = 0.09) at 4 to 6 weeks when USS-guided subacromial steroid injection was compared with landmark-guided injection. SPADI pain scores (P = 0.02) demonstrates significant reduction in favour of landmark-guided injection. There was low to moderate risk of bias. In conclusion, ultrasound-guided subacromial steroid injection does not offer any statistically significant clinical improvement over landmark-guided injection in adults with subacromial impingement.
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Affiliation(s)
- Charles I. Ayekoloye
- Department of Orthopaedics, Oaklands Hospital, 19 Lancaster Road, Salford, M6 8AQ UK
| | - Osondu Nwangwu
- Department of Orthopaedics, Luton & Dunstable Hospital, Bedfordshire, UK
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Bockbrader MA, Thompson RD, Way DP, Colachis SC, Siddiqui IJ, Luz J, Borg-Stein J, OʼConnor K, Kohler MJ, Bahner DP. Toward a Consensus for Musculoskeletal Ultrasonography Education in Physical Medicine and Rehabilitation: A National Poll of Residency Directors. Am J Phys Med Rehabil 2019; 98:715-724. [PMID: 31318753 PMCID: PMC6635046 DOI: 10.1097/phm.0000000000001195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The aims of the study were to evaluate integration of musculoskeletal ultrasonography education in physical medicine and rehabilitation training programs in 2014-2015, when the American Academy of Physical Medicine & Rehabilitation and Accreditation Council for Graduate Medical Education Residency Review Committee both recognized it as a fundamental component of physiatric practice, to identify common musculoskeletal ultrasonography components of physical medicine and rehabilitation residency curricula, and to identify common barriers to integration. DESIGN Survey of 78 Accreditation Council for Graduate Medical Education-accredited physical medicine and rehabilitation residency programs was conducted. RESULTS The 2015 survey response rate was more than 50%, and respondents were representative of programs across the United States. Most programs (80%) reported teaching musculoskeletal ultrasonography, whereas a minority (20%) required mastery of ultrasonography skills for graduation. Ultrasonography curricula varied, although most programs agreed that the scope of resident training in physical medicine and rehabilitation should include diagnostic and interventional musculoskeletal ultrasonography, especially for key joints (shoulder, elbow, knee, wrist, hip, and ankle) and nerves (median, ulnar, fibular, tibial, radial, and sciatic). Barriers to teaching included insufficient expertise of instructors, poor access to equipment, and lack of a structured curriculum. CONCLUSIONS Musculoskeletal ultrasonography has become a required component of physical medicine and rehabilitation residency training. Based on survey responses and expert recommendations, we propose a structure for musculoskeletal ultrasonography curricular standards and milestones for trainee competency.
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Affiliation(s)
- Marcia A Bockbrader
- From the Department of Physical Medicine & Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio (MAB, RDT, SCC); Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (DPW, DPB); Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (IJS, JL, JB-S, KO); Regenerative Orthopedics and Sports Medicine (ROSM), Washington, DC (IJS); Department of Orthopedics, Tufts University School of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts (JL); and Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (MJK)
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Strakowski JA, Visco CJ. Diagnostic and therapeutic musculoskeletal ultrasound applications of the shoulder. Muscle Nerve 2019; 60:1-6. [PMID: 31054148 DOI: 10.1002/mus.26505] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 11/10/2022]
Abstract
High frequency ultrasound is a valuable tool for assessing soft tissue injuries about the shoulder. It has advantages over other imaging modalities including relatively low cost, portability, and dynamic real-time visualization. It has a high sensitivity for identifying tendon degeneration, bursitis, and rotator cuff tears. Ultrasound is also an excellent modality for diagnostic and therapeutic needle-guided procedures. A detailed knowledge of shoulder anatomy and transducer positioning is required for obtaining adequate diagnostic value from ultrasound. This Monograph is designed to help develop scanning protocols for optimizing image acquisition for musculoskeletal assessment of the shoulder. Muscle Nerve, 2019.
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Affiliation(s)
- Jeffrey A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA.,OhioHealth Riverside Methodist Hospital, 3555 Olentangy River Road, Columbus, 43214, Ohio, USA.,The McConnell Spine, Sport, and Joint Center, Columbus, Ohio, USA
| | - Christopher J Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Ultrasound-Guided Versus Landmark-Guided Local Corticosteroid Injection for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2017; 99:766-775. [PMID: 28943161 DOI: 10.1016/j.apmr.2017.08.484] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review the literature and assess the comparative effectiveness of ultrasound-guided versus landmark-guided local corticosteroid injections in patients with carpal tunnel syndrome (CTS). DATA SOURCES Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Embase (Ovid), and Web of Science (from inception to February 1, 2017). STUDY SELECTION Randomized controlled trials (RCTs) comparing ultrasound-guided injection with landmark-guided injection in patients with CTS were included. DATA EXTRACTION Two authors independently screened abstracts and full texts. The outcomes of interest were Symptom Severity Scale (SSS) and Functional Status Scale (FSS) scores of the Boston Carpal Tunnel Questionnaire and 4 electrodiagnostic parameters, including compound muscle action potential (CMAP), sensory nerve action potential (SNAP), distal motor latency (DML), and distal sensory latency (DSL). DATA SYNTHESIS Overall, 569 abstracts were retrieved and checked for eligibility; finally, 3 RCTs were included (181 injected hands). Pooled analysis showed that ultrasound-guided injection was more effective in SSS improvement (mean difference [MD], -.46; 95% confidence interval [CI], -.59 to -.32; P<.00001), whereas no significant difference was observed between the 2 methods in terms of the FSS (MD, -.25; 95% CI, -.56 to .05; P=.10). There were also no statistically significant differences in improvements of CMAP (MD, 1.54; 95% CI, 0.01 to 3.07; P=.05), SNAP (MD, -0.02; 95% CI, -6.27 to 6.23; P>.99), DML (MD, .05; 95% CI, -.30 to .39; P=.80), or DSL (MD, .00; 95% CI, -.65 to .65; P>.99). CONCLUSIONS This review suggested that ultrasound-guided injection was more effective than landmark-guided injection in symptom severity improvement in patients with CTS; however, no significant differences were observed in functional status or electrodiagnostic improvements between the 2 methods.
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10
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Kim GW, Kang C, Oh YB, Ko MH, Seo JH, Lee D. Ultrasonographic Imaging and Anti-inflammatory Therapy of Muscle and Tendon Injuries Using Polymer Nanoparticles. Theranostics 2017; 7:2463-2476. [PMID: 28744328 PMCID: PMC5525750 DOI: 10.7150/thno.18922] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/17/2017] [Indexed: 12/23/2022] Open
Abstract
Ultrasonography is a reliable diagnostic modality for muscle and tendon injuries, but it has been challenging to find right diagnosis of minor musculoskeletal injuries by conventional ultrasonographic imaging. A large amount of hydrogen peroxide (H2O2) are known to be generated during tissue damages such as mechanical injury and therefore H2O2 holds great potential as a diagnostic and therapeutic marker for mechanical injuries in the musculoskeletal system. We previously developed poly(vanillyl alcohol-co-oxalate) (PVAX), which rapidly scavenges H2O2 and exerts antioxidant and anti-inflammatory activity in H2O2-associated diseases. Based on the notion that PVAX nanoparticles generate CO2 bubbles through H2O2-triggered hydrolysis, we postulated that PVAX nanoparticles could serve as ultrasonographic contrast agents and therapeutic agents for musculoskeletal injuries associated with overproduction of H2O2. In the agarose gel phantom study, PVAX nanoparticles continuously generated CO2 bubbles to enhance ultrasonographic echogenicity significantly. Contusion injury significantly elevated the level of H2O2 in skeletal muscles and Achilles tendons. Upon intramuscular injection, PVAX nanoparticles significantly elevated the ultrasound contrast and suppressed inflammation and apoptosis in the contusion injury of musculoskeletal systems. We anticipate that PVAX nanoparticles hold great translational potential as theranostic agents for musculoskeletal injuries.
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Affiliation(s)
- Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Changsun Kang
- Department of BIN Convergence Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
| | - Young-Bin Oh
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Dongwon Lee
- Department of BIN Convergence Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
- Department of Polymer•Nano Science and Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
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12
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Martel Villagrán J, Bueno Horcajadas Á, Agrela Rojas E. Intervencionismo en musculoesquelético. Ecografía y tac. RADIOLOGIA 2016; 58 Suppl 2:45-57. [DOI: 10.1016/j.rx.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/09/2016] [Accepted: 03/19/2016] [Indexed: 01/23/2023]
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13
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Schickendantz M, King D. Nonoperative Management (Including Ultrasound-Guided Injections) of Proximal Biceps Disorders. Clin Sports Med 2016; 35:57-73. [DOI: 10.1016/j.csm.2015.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Wilson DJ, Scully WF, Rawlings JM. Evolving Role of Ultrasound in Therapeutic Injections of the Upper Extremity. Orthopedics 2015; 38:e1017-24. [PMID: 26558666 DOI: 10.3928/01477447-20151020-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/23/2015] [Indexed: 02/03/2023]
Abstract
Ultrasound machines are creating more refined pictures and becoming more user-friendly and readily accessible. As a result, ultrasound is being increasingly used for therapeutic purposes. One example involves the use of ultrasound guidance in musculoskeletal interventional procedures, such as joint injections, tendon sheath injections, and peripheral nerve blocks. Technical considerations and therapeutic results have been described for multiple locations about the upper extremities, with varying levels of success. The implementation of ultrasound-guided injections in the orthopedist's clinic has therapeutic, financial, and provider role implications. Given these potential benefits, orthopedic providers, both in practice and residency, would benefit from increased exposure and education in ultrasound use. Ultrasound provides the benefit of real-time, dynamic imaging without the radiation exposure of fluoroscopy, and ultrasound-guided injections can be performed in the office, as opposed to the operating room, which is frequently required when using fluoroscopy. A basic knowledge of the principles and terms used in ultrasound is required. With these simple principles, a practitioner can review techniques for specific areas of the musculoskeletal system and begin using ultrasound to guide injections. Many locations for diagnostic and/or therapeutic injections in the upper extremities have improved accuracy and benefit with the use of ultrasound vs blind techniques, although a few have not been shown to have a significant difference in the literature. The educational and professional implications can be significant, but these potential benefits need to be carefully weighed against costs by each orthopedic practice.
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15
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Kay JC, Higgs JB, Battafarano DF. Utility of musculoskeletal ultrasound in a Department of Defense rheumatology practice: a four-year retrospective experience. Arthritis Care Res (Hoboken) 2013; 66:14-8. [PMID: 23982974 DOI: 10.1002/acr.22127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 08/13/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyze the utility of musculoskeletal ultrasound (MSUS) in a rheumatology department and characterize relevant clinical trends. METHODS Electronic medical records of all patients (n = 503) requiring MSUS in our department from January 2007 to December 2011 were reviewed. Rheumatologists performed MSUS using MyLab 25 or MyLab 70 systems. Clinical data were collected, including age, sex, symptoms, joint(s) examined, MSUS findings, procedures, further radiologic studies, and additional specialty consults. Results were tabulated from 717 total MSUS encounters and each was categorized as a completed encounter or an incomplete encounter. All magnetic resonance imaging (MRI) reports that followed MSUS were examined for concurrence. Cumulative numbers of MSUS examinations and MRIs were totaled. The Medicare global national average cost for MRIs and potential savings were calculated. RESULTS A total of 789 joint sites were examined by MSUS. There were 84 US-guided procedures. Overall, 158 specialty consults were generated. After MSUS, 55 additional radiologic studies were ordered. There were 613 (85.5%) primary completed MSUS encounters and 104 cases (14.5%) requiring further imaging studies or an orthopedic consultation. There was an increased use of MSUS and a concurrent decreased use of MRI in our department over 4 consecutive years. We calculated the total potential savings from our rheumatology service to the Department of Defense as approximately $27,937.80 to $38,047.20 over 4 years. CONCLUSION MSUS has a positive impact in a rheumatology practice. MSUS augments the clinical examination, influences diagnosis and management, decreases reliance on other imaging modalities, and reduces health care costs.
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Affiliation(s)
- Johnson C Kay
- San Antonio Military Medical Center, Fort Sam Houston, Texas
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Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-012-0003-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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