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Weimer AM, Weimer JM, Berthold S, Stein S, Müller L, Buggenhagen H, Balser G, Stankov K, Sgroi M, Schmidmaier G, Kloeckner R, Schamberger C. Shoulder and Knee Arthroscopy Access Point: Prospective Comparison of Sonographic and Palpatory Detection - Which Method is Better for Novices? Ultrasound Int Open 2024; 10:a22710098. [PMID: 38812890 PMCID: PMC11135419 DOI: 10.1055/a-2271-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/03/2024] [Indexed: 05/31/2024] Open
Abstract
Purpose Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints. Materials and Methods The study included trainee doctors (n=68) attending workshops (lasting approx. 90 minutes). In these workshops a teaching video initially demonstrated the PalpMethod and SonoMethod of AP identification. An experienced operator first marked the access portals on the test subject with a UV pen (determined ideal point [DIP]). Adhesive film was then affixed to the puncture regions. Subsequently participants marked on shoulders and knees first the point determined by palpation, then the point determined by sonography. Analysis involved DIP visualization with a UV lamp and employed a coordinate system around the central DIP. In addition, participants completed an evaluation before and after the workshop. Results The analysis included 324 measurements (n=163 shoulders and n= 161 knees). The majority of participants had not previously attended any courses on manual examination (87.9%) or musculoskeletal ultrasound (93.9%). Overall, the markings participants made on the shoulder using the SonoMethod were significantly closer to the DIP than those made by the PalpMethod (Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001). On the knee, however, the markings made by the PalpMethod were significantly closer to the DIP overall (Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm; p<0.001). Conclusion The results show that the SonoMethod produces more accurate markings on the shoulder, while the PalpMethod is superior for the knee.
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Affiliation(s)
- Andreas Michael Weimer
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Johannes M. Weimer
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Svenja Berthold
- Department for Orthopaedics and Trauma Surgery,
University Medical Centre Mannheim, Mannheim, Germany
| | - Stephan Stein
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology,
University Medical Center of the Johannes Gutenberg University Mainz, Mainz,
Germany
| | - Holger Buggenhagen
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gerd Balser
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kay Stankov
- Corporate Finance, Technical University of Darmstadt,
Darmstadt, Germany
| | - Mirco Sgroi
- Department of Orthopaedic Surgery, Ulm University
Medical Center, Ulm, Germany
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Roman Kloeckner
- Institute of Interventional Radiology, University
Medical Center Schleswig Holstein Campus Lübeck, Lübeck, Germany
| | - Christian Schamberger
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
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García N, Droppelmann G, Oliver N, Jorquera C, Rosales J. Nonsurgical Management of Shoulder Pain in Rotator Cuff Tears: Ultrasound-Guided Biceps Tenotomy Combined With Corticosteroid Injection. Arthrosc Tech 2024; 13:102847. [PMID: 38435258 PMCID: PMC10907900 DOI: 10.1016/j.eats.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/21/2023] [Indexed: 03/05/2024] Open
Abstract
Traditionally, the management of rotator cuff tears in elderly individuals has involved surgical intervention, specifically biceps tenotomy. However, surgical procedures come with inherent medical risks and significant financial costs. As an alternative, ultrasound-guided biceps tenotomy combined with corticosteroid has emerged as a highly effective, well-tolerated, and cost-efficient option. This article aims to describe the procedural technique of nonsurgical management using ultrasound-guided biceps tenotomy combined with corticosteroid injection.
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Affiliation(s)
| | - Guillermo Droppelmann
- Research Center on Medicine, Exercise, Sport and Health, MEDS Clinic, Santiago, Chile
- Principles and Practice of Clinical Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, U.S.A
| | - Nicolás Oliver
- Department of Orthopaedics, MEDS Clinic, Santiago, Chile
| | - Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago, Chile
| | - Julio Rosales
- Department of Radiology, MEDS Clinic, Santiago, Chile
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Du Y, Wang Z, Zhang T, Liang Y. Diagnostic Implications of Ultrasound Evaluation in Patients With Shoulder Impingement Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:273-280. [PMID: 37846610 DOI: 10.1002/jum.16357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of musculoskeletal ultrasound measurements of subacromial bursa (SAB) thickness, supraspinatus tendon (SUP) thickness, acromiohumeral distance (AHD), and SUP-to-AHD ratio (AHD%) in patients with shoulder impingement syndrome (SIS). METHODS This was a prospective cross-sectional observational study. Thirty patients with SIS (60 shoulders) admitted between January 2019 and January 2020 were enrolled. The SUP thickness, SAB thickness, AHD, and AHD% (calculated as AHD% = [(SUP / AHD) × 100%]) were measured in 60 shoulders using musculoskeletal ultrasound. RESULTS The affected shoulder displayed thicker SUP and SAB (t = 7.838), narrower AHD (t = 2.324), and larger AHD% (t = 6.875) than the unaffected shoulder (P < .05). The SUP thickness showed a linear positive correlation with AHD (r = .503) and AHD% (r = .792) in the affected shoulder (P < .05). On receiver operating characteristic analysis, AHD*AHD% showed the best diagnostic performance in both measurements (area under the curve: 0.877). CONCLUSION This study revealed that SIS symptoms may be related to a larger AHD% with SUP thickening. As diagnostic criteria, the cut-off values of AHD% (65.6%) and AHD*AHD% (0.504) have good sensitivity and specificity and can help improve the differential diagnosis of patients with SIS.
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Affiliation(s)
- Yiting Du
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhengtao Wang
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Tao Zhang
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Ying Liang
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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Chen S, Zhang J, Fei Y, Cui X, Shen L, Huang Y. Proposal of a Route Map for Cervical Spinal Ultrasonography: A Simple and Clear Learning Tool for Beginners. Pain Ther 2023; 12:1293-1305. [PMID: 37517030 PMCID: PMC10444723 DOI: 10.1007/s40122-023-00545-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
Spinal ultrasonography has increasingly been used to image axial structures from the cervical to sacral region in recent years. In this work, we propose a comprehensive, systematic cervical scanning protocol that we refined as a route map, especially for beginners, to facilitate teaching, learning, diagnosis, and treatment in clinical pain practice. As a simple and clear tool to demonstrate the scanning protocol, the route map is delineated with rectangles, lines, and arrows. The rectangles represent the positions of the transducer, the arrows indicate route directions, and the lines show the routes of transducer movement. In this article, we describe cervical spinal ultrasonography to illustrate the route map interpretation, scanning protocol and target anatomical structures in detail. We believe that this comprehensive, clear, systematic, and portable route map will be beneficial for inexperienced pain clinicians and ultrasound beginners.
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Affiliation(s)
- Si Chen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jiao Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yuda Fei
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xulei Cui
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
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Barber J, Lodo F, Nugent-Head A, Zeng X. Comparative Techniques of Acupuncture and Dry Needling Intersecting with Trigger Point Physiology and Diagnostics: A Cross-Discipline Narrative Review. Med Acupunct 2023; 35:220-229. [PMID: 37900872 PMCID: PMC10606949 DOI: 10.1089/acu.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background Pain management is a great burden on society; therefore, cost-effective and nonaddictive treatments for pain are urgently required. Needling of painful spots has been applied in acupuncture along with dry needling Methods A narrative review of the literature on TrP physiology, its associated diagnostics, and the techniques of DN and acupuncture was performed. Results Diagnostic imagery may benefit the study and treatment of TrPs using needling. Acupuncture and DN techniques are similar in their applications. However, the warm needling technique is established in acupuncture but not in dry needling. Additionally, translational difficulties have inhibited crossdiscipline learning. Conclusions Historical evidence suggests a need to examine the use of heat in needling further. Additional research should be conducted on TrP categories to determine if a relationship with the needling technique can be established. Furthermore, interdisciplinary communication would benefit both modalities.
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Affiliation(s)
- Jordan Barber
- AOMA Graduate School of Integrative Medicine, Austin, TX, USA
| | - Fabio Lodo
- So Wen School of Acupuncture, Milan, Italy
| | | | - Xia Zeng
- AOMA Graduate School of Integrative Medicine, Austin, TX, USA
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