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Pujalte G, Hudspeth LJ, Troyer WD, Shapiro SA. Ultrasound-guided injection of the long head of the biceps tendon sheath with concomitant subacromial bursa injection through the same needlestick. Clin Anat 2023; 36:400-405. [PMID: 36210353 DOI: 10.1002/ca.23961] [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: 06/20/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022]
Abstract
Sonography and specific shoulder positions allow for injections into both the long head of the biceps tendon sheath (LHBTS) and the subacromial space (SS) with one needlestick. We validated this technique using cadavers. An experienced proceduralist injected latex solution into 12 unembalmed cadaveric shoulders, aiming for the LHBTS and SS, using an ultrasound-guided injection technique that employs a single-needle entry point. An experienced surgeon dissected each specimen and graded latex location as: (1) completely accurate (in both the SS and LHBTS); (2) partially accurate (in either the SS or LHBTS); (3) accurate with overflow (in both locations, but also elsewhere); (4) partially accurate with overflow (in either location, but also somewhere else); or (5) completely inaccurate (no latex in either location). All 12 ultrasound-guided injections using the technique accurately placed latex into both LHBTS and SS (100% accuracy). Latex was also found in adjacent regions after two (17%) injections: one within the shoulder joint and one within the deltoid musculature. This newly described technique allows highly accurate access to the LHBTS and SS with single-needle entry. This technique could become a favored alternative to subjecting patients to two needlesticks and preparing separate injections to address often concomitant pathologies.
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Affiliation(s)
- George Pujalte
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Division of Sports Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Loren J Hudspeth
- Orthopedic Surgery, Piedmont Atlanta Hospital, Macon, Georgia, USA
| | - Wesley D Troyer
- Division of Sports Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA
| | - Shane A Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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2
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Papalexis N, Ponti F, Rinaldi R, Peta G, Bruno R, Miceli M, Battaglia M, Marinelli A, Spinnato P. Ultrasound-Guided Treatments for the Painful Shoulder. Curr Med Imaging 2021; 18:693-700. [PMID: 34872482 DOI: 10.2174/1573405617666211206112752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/30/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022]
Abstract
Shoulder pain is an extremely common condition. The painful shoulder may be the result of a wide spectrum of underlying pathological conditions, including calcific tendinopathy of the rotator cuff, subacromial-subdeltoid bursitis, acromioclavicular or glenohumeral arthritis, tenosynovitis of the long biceps tendon, rotator cuff lesions, and many other less common conditions. Ultrasound imaging is an effective tool for the diagnosis and also for the image guidance of treatment of the majority of these conditions. Several ultrasound-guided procedures are effective for pain relief, such as percutaneous irrigation, intra-bursal or intra-articular drugs injection, fluid aspiration, neural block. This review article aims to summarize and discuss the most common treatment possibilities with ultrasound guidance for the painful shoulder.
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Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Raffaella Rinaldi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Riccardo Bruno
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Milva Battaglia
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | | | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
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El Naggar TEDM, Maaty AIE, Mohamed AE. Effectiveness of radial extracorporeal shock-wave therapy versus ultrasound-guided low-dose intra-articular steroid injection in improving shoulder pain, function, and range of motion in diabetic patients with shoulder adhesive capsulitis. J Shoulder Elbow Surg 2020; 29:1300-1309. [PMID: 32553435 DOI: 10.1016/j.jse.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023]
Abstract
UNLABELLED To compare the efficacy of radial extracorporeal shock-wave therapy (rESWT) vs. an ultrasound-guided low-dose intra-articular steroid injection in pain reduction and functional improvement in diabetic patients with shoulder adhesive capsulitis (AC). METHODS This was a 2-parallel-group, active-control, assessor-blinded, randomized trial. We randomized 103 diabetic patients with shoulder AC to receive either 4 sessions of rESWT, 1 week apart (rESWT group, n = 52), or a single ultrasound-guided low-dose intra-articular steroid injection of 20 mg of triamcinolone acetonide (steroid group, n = 51). The primary outcome measure was functional improvement evaluated by the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) score. Secondary outcome measures were pain evaluated by the visual analog scale score and shoulder range of motion (ROM). An assessor who was blinded to treatment assignment assessed both groups at baseline and at 4, 8, and 12 weeks thereafter. RESULTS By 12 weeks, both groups demonstrated a significant reduction in the qDASH score and pain severity, as well as improvement in ROM. However, significantly improved function (qDASH score, 40.4 ± 12.9 vs. 50.5 ± 13.3; P < .001) and shoulder pain reduction (visual analog scale score, 1.6 ± 1.2 vs. 2.8 ± 1.7; P < .001) were found in the rESWT group vs. the steroid group. Similar improvement in shoulder ROM was observed in both groups. CONCLUSION At short-term follow-up, rESWT was superior to a low-dose intra-articular steroid injection in improving function and pain in diabetic patients with shoulder AC. Therefore, rESWT might be considered a safe alternative to steroid injections in diabetic patients with shoulder AC.
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Affiliation(s)
| | - Ahmed Ibrahim Elsayed Maaty
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Aly Elsayed Mohamed
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
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4
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Cushman DM, Christiansen J, Kirk M, Clements ND, Cunningham S, Teramoto M, McCormick ZL. Image guidance used for large joint and bursa injections; a survey study. PHYSICIAN SPORTSMED 2020; 48:208-214. [PMID: 31560251 DOI: 10.1080/00913847.2019.1674122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To determine the current rates of use of available image guidance modalities for large joint and bursal injections, in addition to their relationships to physician demographics.Methods: An electronic survey was sent to 3,400 members of the American Medical Society for Sports Medicine (AMSSM), examining types of guidance used for each large joint and bursal injection.Results: A total of 674 sports medicine physicians responded to the survey. Intra-articular hip and glenohumeral joint injections were more commonly performed with ultrasound guidance, while palpation-guidance was more common with all other injections. Physicians who specialized in Physical Medicine & Rehabilitation (PM&R) were more likely to use ultrasound for trochanteric bursa (p = 0.007, OR = 4.16 [1.46-11.8]), while internal medicine-, pediatrics-, and family medicine-trained physicians were more likely to use palpation guidance for at least one joint (p < 0.05). Physicians with fewer years of experience were more likely to use ultrasound for glenohumeral joint injections (p ≤ 0.002 for all age groups with less than 20 years of experience, ORs ranging from 6.3 to 9.2).Conclusion: Palpation-guidance is the most common technique used for large joint and bursal injections, other than for glenohumeral and hip joint injections. PM&R-trained physicians and those with less experience tend to use ultrasound more frequently.
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Affiliation(s)
- Daniel M Cushman
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Jacob Christiansen
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Melissa Kirk
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Nathan D Clements
- Department of Physical Medicine & Rehabilitation, University of Texas Health Science Center, San Antonio, TX, USA
| | - Shellie Cunningham
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Masaru Teramoto
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Zachary L McCormick
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
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5
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Ultrasound Visualization of Torsional Anatomic Changes From External Rotation of the Anterior Shoulder. J Comput Assist Tomogr 2019; 43:519-523. [DOI: 10.1097/rct.0000000000000861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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6
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Chang KV, Mezian K, Naňka O, Wu WT, Lin CP, Özçakar L. Ultrasound-guided interventions for painful shoulder: from anatomy to evidence. J Pain Res 2018; 11:2311-2322. [PMID: 30349357 PMCID: PMC6188188 DOI: 10.2147/jpr.s169434] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Shoulder pain is a common musculoskeletal disorder of variable etiology, ranging from rotator cuff pathology to peripheral nerve entrapment. Advances in ultrasound (US) technology have allowed static and dynamic evaluation of shoulder problems and most importantly, offer real-time, radiation-free guidance for interventions. The present review aims to describe shoulder anatomy in detail using information from cadaveric models and to illustrate US-guided techniques using clearly labeled figures and videos. The review will also present evidence of specific US-guided therapies for shoulder pain by summarizing landmark studies, systematic reviews, and meta-analyses. The following shoulder structures will be covered: 1) the biceps long head tendon, 2) the acromioclavicular joint, 3) the subacromial-subdeltoid bursa, 4) the glenohumeral joint, 5) the suprascapular nerve, and 6) the axillary nerve.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan,
- Department of Physical Medicine and Rehabilitation, National Taiwan University, College of Medicine, Taipei, Taiwan,
| | - Kamal Mezian
- Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Ondřej Naňka
- Institute of Anatomy, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan,
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan,
- Department of Anesthesiology, National Taiwan University, College of Medicine, Taipei, Taiwan,
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Forero M, Rajarathinam M, Adhikary SD, Chin KJ. Erector spinae plane block for the management of chronic shoulder pain: a case report. Can J Anaesth 2018; 65:288-293. [PMID: 29134518 DOI: 10.1007/s12630-017-1010-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/02/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The erector spinae plane (ESP) block has been described in the successful management of both thoracic and abdominal pain. Since the erector spinae muscle extends to the cervical spine, the ESP block may be potentially useful in painful conditions of the shoulder girdle. CLINICAL FEATURES We performed a series of ESP blocks at the T2/T3 level in an elderly male patient with chronic shoulder pain. Immediate and profound analgesia with improved range of motion was consistently observed following the block. There was detectable sensory block in the congruent cervico-thoracic dermatomes with no motor block. Computed tomography imaging showed the spread of radiocontrast up to the C3 level in the vicinity of the neural foramina. Clinical analgesia generally outlasted the expected duration of conduction blockade and significantly contributed to overall improvement in the patient's symptoms. CONCLUSIONS The ESP block may be a promising alternative to other interventional procedures in the management of chronic shoulder pain and deserves further study.
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Affiliation(s)
- Mauricio Forero
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | | | - Sanjib Das Adhikary
- Department of Anesthesia, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Ki Jinn Chin
- Department of Anesthesia, University of Toronto, Toronto Western Hospital, McL 2-405, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
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8
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Roberts SL, Stout A, Loh EY, Swain N, Dreyfuss P, Agur AM. Anatomical Comparison of Radiofrequency Ablation Techniques for Sacroiliac Joint Pain. PAIN MEDICINE 2018; 19:1924-1943. [DOI: 10.1093/pm/pnx329] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shannon L Roberts
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Eldon Y Loh
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
| | | | - Paul Dreyfuss
- EvergreenHealth, Kirkland, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Anne M Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Krill MK, Rosas S, Kwon K, Dakkak A, Nwachukwu BU, McCormick F. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. PHYSICIAN SPORTSMED 2018; 46:98-104. [PMID: 29210329 PMCID: PMC6396285 DOI: 10.1080/00913847.2018.1413920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The clinical examination of the shoulder joint is an undervalued diagnostic tool for evaluating acromioclavicular (AC) joint pathology. Applying evidence-based clinical tests enables providers to make an accurate diagnosis and minimize costly imaging procedures and potential delays in care. The purpose of this study was to create a decision tree analysis enabling simple and accurate diagnosis of AC joint pathology. METHODS A systematic review of the Medline, Ovid and Cochrane Review databases was performed to identify level one and two diagnostic studies evaluating clinical tests for AC joint pathology. Individual test characteristics were combined in series and in parallel to improve sensitivities and specificities. A secondary analysis utilized subjective pre-test probabilities to create a clinical decision tree algorithm with post-test probabilities. RESULTS The optimal special test combination to screen and confirm AC joint pathology combined Paxinos sign and O'Brien's Test, with a specificity of 95.8% when performed in series; whereas, Paxinos sign and Hawkins-Kennedy Test demonstrated a sensitivity of 93.7% when performed in parallel. Paxinos sign and O'Brien's Test demonstrated the greatest positive likelihood ratio (2.71); whereas, Paxinos sign and Hawkins-Kennedy Test reported the lowest negative likelihood ratio (0.35). CONCLUSION No combination of special tests performed in series or in parallel creates more than a small impact on post-test probabilities to screen or confirm AC joint pathology. Paxinos sign and O'Brien's Test is the only special test combination that has a small and sometimes important impact when used both in series and in parallel. Physical examination testing is not beneficial for diagnosis of AC joint pathology when pretest probability is unequivocal. In these instances, it is of benefit to proceed with procedural tests to evaluate AC joint pathology. Ultrasound-guided corticosteroid injections are diagnostic and therapeutic. An ultrasound-guided AC joint corticosteroid injection may be an appropriate new standard for treatment and surgical decision-making. LEVEL OF EVIDENCE II - Systematic Review.
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Affiliation(s)
- Michael K Krill
- a Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA
- b Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Samuel Rosas
- c Baptist Health, Department of Orthopedic Surgery , Wake Forest University , Winston-Salem , NC , USA
| | - KiHyun Kwon
- d Florida International University Herbert Wertheim College of Medicine , Miami , FL , USA
| | - Andrew Dakkak
- a Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA
| | - Benedict U Nwachukwu
- e Department of Orthopedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Frank McCormick
- f Department of Orthopedics , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA
- g Department of Sports Medicine , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA
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10
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Comparison of two interventional techniques for the treatment of chronic shoulder pain. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Mu A, Peng P, Agur A. Landmark-Guided and Ultrasound-Guided Approaches for Trochanteric Bursa Injection. Anesth Analg 2017; 124:966-971. [DOI: 10.1213/ane.0000000000001864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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A Cadaveric Study Evaluating the Feasibility of an Ultrasound-Guided Diagnostic Block and Radiofrequency Ablation Technique for Sacroiliac Joint Pain. Reg Anesth Pain Med 2017; 42:69-74. [DOI: 10.1097/aap.0000000000000515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Jang MH, Lee CH, Shin YI, Kim SY, Huh SC. Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke. Ann Rehabil Med 2016; 40:835-844. [PMID: 27847713 PMCID: PMC5108710 DOI: 10.5535/arm.2016.40.5.835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/10/2016] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke. Methods Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician. Results There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively. Conclusion IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.
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Affiliation(s)
- Myung Hun Jang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Chul Huh
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS. Postoperative pain control after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2016; 25:1204-13. [PMID: 27079219 DOI: 10.1016/j.jse.2016.01.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/17/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge. Although intravenous and oral opioids are the cornerstone of pain management after orthopedic procedures, they are associated with drowsiness, nausea, vomiting, and increased length of hospital stay. As health care reimbursements continue to become more intimately focused on quality, patient satisfaction, and minimizing of complications, the need for adequate pain control with minimal complications will continue to be a principal focus for providers and institutions alike. We present a review of alternative modalities for pain relief after ARCR, including cryotherapy, intralesional anesthesia, nerve blockade, indwelling continuous nerve block catheters, and multimodal anesthesia. In choosing among these modalities, physicians should consider patient- and system-based factors to allow the efficient delivery of analgesia that optimizes recovery and improves patient satisfaction.
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Affiliation(s)
- Carlos A Uquillas
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Brian M Capogna
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - William H Rossy
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Siddharth A Mahure
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA.
| | - Andrew S Rokito
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
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Korbe S, Udoji EN, Ness TJ, Udoji MA. Ultrasound-guided interventional procedures for chronic pain management. Pain Manag 2015; 5:465-82. [PMID: 26402316 PMCID: PMC4976830 DOI: 10.2217/pmt.15.46] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities.
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Affiliation(s)
- Samuel Korbe
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Esther N Udoji
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA
| | - Timothy J Ness
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Mercy A Udoji
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
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Huang CC, Lin CS. Ultrasound-guided chronic musculoskeletal pain control. ACTA ACUST UNITED AC 2014; 52:93-4. [PMID: 25248468 DOI: 10.1016/j.aat.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Chien-Chung Huang
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
| | - Chia-Shiang Lin
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
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17
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Affiliation(s)
- Philip Peng
- Toronto Western Hospital, University of Toronto, Canada, McL 2-405 Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada
| | - Neilesh Soneji
- Toronto Western Hospital, University of Toronto, Canada, McL 2-405 Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada
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19
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Tagliafico A, Russo G, Boccalini S, Michaud J, Klauser A, Serafini G, Martinoli C. Ultrasound-guided interventional procedures around the shoulder. Radiol Med 2013; 119:318-26. [PMID: 24297588 DOI: 10.1007/s11547-013-0351-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 02/10/2013] [Indexed: 01/08/2023]
Abstract
The aim of this review is to illustrate the spectrum of ultrasound-guided procedures around the shoulder. The shoulder is affected by a wide range of both, traumatic and degenerative diseases. Ultrasound guidance is a low-cost and safe tool to perform minimally invasive interventional procedures around the shoulder. The clinical outcome is shown by the use of clinical scores: visual analogue scale (VAS), Constant's score and Shoulder Pain Disability Index (SPADI). Rotator cuff calcification is a common painful condition that occurs in up to 7.5 % of otherwise healthy adults. Ultrasound-guided procedures include single-needle and double-needle approach with different needles. These techniques are described and the results are critically compared. Ultrasound-guided viscosupplementation is a new therapeutic approach for treatment of several shoulder pain disorders: osteoarthritis, rotator cuff tear and tendinosis. In adhesive capsulitis, different therapeutic ultrasound-guided techniques such as corticosteroid injection, capsular distension (sodium chlorate solution; sodium chlorate and corticosteroids; air) and viscosupplementation are evaluated. Acromion-clavear injection of steroid and lidocaine solution under ultrasound guidance is easy to perform and is indicated in conservative treatment of painful osteoarthrosis. The treatment of rotator cuff tendinosis and partial tears with ultrasound-guided injection of concentrated autologous platelets is also described.
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Affiliation(s)
- Alberto Tagliafico
- Department of Experimental Medicine, Institute of Anatomy, DIMES, University of Genova, Vie de Toni 14, 16132, Genoa, Italy,
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Díaz RCR, Lotero MAA, Giraldo DJG. Ultrasound-guided tricompartmental blockade of the shoulder. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rivera Díaz RC, Arcila Lotero MA, Giraldo Giraldo DJ. Bloqueo tricompartimental de hombro guiado por ultrasonografía. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rca.2013.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Arcila Lotero MA, Rivera Díaz RC, Campuzano Escobar D, Mejía Aguilar MA, Martínez Ramírez SM. Efficacy and safety of ultrasound-guided suprascapular nerve block in patients with chronic shoulder pain. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2013.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Arcila Lotero MA, Rivera Díaz RC, Campuzano Escobar D, Mejía Aguilar MA, Martínez Ramírez SM. Eficacia y seguridad del bloqueo de nervio supraescapular guiado por ultrasonido en pacientes con dolor crónico de hombro. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rca.2013.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Efficacy and safety of ultrasound-guided suprascapular nerve block in patients with chronic shoulder pain☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341020-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ultrasound-guided tricompartmental blockade of the shoulder☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341040-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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