Musculoskeletal ultrasound-guided physical therapy in hemiplegic shoulder pain: A CARE-compliant case report

Clinical reasoning of ultrasound imaging-guided manual passive manipulation for adhesion prevention in a patient with total knee arthroplasty: a case report

INTRODUCTION

Patients with total knee arthroplasty occasionally develop postoperative abnormalities such as posttraumatic knee stiffness and arthrofibrosis, which may affect activities of daily living. However, there are no clear assessment methods or interventions for knee stiffness. Musculoskeletal ultrasound imaging enables real-time evaluation of mobility and flexibility of tissues. The purpose of this case report was to describe the use of musculoskeletal ultrasound imaging for evaluating the optimal location and methods of passive manipulation.

CASE DESCRIPTION

The patient was an 82-year-old woman who had undergone total knee arthroplasty. She was unable to climb stairs due to limited knee flexion. Based on the results of musculoskeletal ultrasound imaging assessment, we hypothesized that the knee flexion limitation was caused by decreased sliding movement of the suprapatellar pouch. Hence, we performed passive manipulation on the tissue with decreased sliding under musculoskeletal ultrasound guidance.

OUTCOMES

The patient's knee flexion angle increased from 90° to 110° within 1 week of intervention, and her gait speed improved from 16.48 to 13.2 s per 10 m. Furthermore, after the intervention, she was able to climb 10 steps using a handrail.

DISCUSSION

Ultrasound imaging is important because it allows the examination of tissues with mobility changes such as in arthrofibrosis. Our work highlights the use of musculoskeletal ultrasound imaging for identifying the target region for therapy and for providing guidance during passive manipulation.

Intra-rater reliability of lower leg subcutaneous skin fold thickness derived from hand-held a-mode ultrasound

BACKGROUND: Ultrasound is an important tool to diagnose many clinical conditions. Yet hand-held devices may be prone to more data variability in part from the greater likelihood of human error. OBJECTIVE: Quantify intra-rater reliability of subcutaneous skin fold thickness from a hand-held ultrasound device. PARTICIPANTS: College-age subjects (18 men, 14 women) submitted to two sets of ultrasound subcutaneous skin fold measurements spaced (mean + sem) 10.6 + 2.2 days apart. Per measurement, they stood relaxed as ultrasound measured the subcutaneous skin fold thickness that covered their left leg’s calf muscle group. Measurements occurred with a hand-held device (BodyMetrix Pro System BX2000; Livermore, CA) used in accordance with the manufacturer’s guidelines. Four subcutaneous measurements were made 90∘ apart (anterior, medial, posterior, lateral) at the portion of the left calf with the largest circumference. To assess intra-rater reliability, we used intraclass correlation coefficients, limits of agreement, coefficient of variation and the smallest real difference. RESULTS: Intra-rater reliability was high for most of our statistical tests. CONCLUSION: Despite the relatively long period between measurements, our hand-held ultrasound device exhibited a high degree of intra-rater reliability. Given our results, ultrasound measurements may be a useful tool to quantify skin fold thickness.

Ultrasound image guided lateral cervical approach to stellate ganglion block for cervical headache

OBJECTIVE

To explore the feasibility and safety of real-time ultrasound-guided transcervical lateral stellate ganglion block.

METHODS

From September 2017 to December 2018, 80 cases of cervical headache were diagnosed by high-frequency ultrasound on the lateral cervical region, and evaluated at the level of the transverse process of cervical vertebrae 6 and 7. Risk factors for the ganglia. Choose a safe path and guide puncture and drug injection in real time.

RESULTS

The lateral approach of horizontal C6 and C7 transverse processes in 80 cases was explored. There are risk factors on the 32-sided puncture path, in which the inferior thyroid artery accounts for 34.4 % (11/32), the jugular vein accounts for 31.2 % (10/32), and the vertebral arteriovenous accounts for 12.5 % (4/32) The other arteries accounted for 21.9 % (7/32). The puncture was completed in 79 cases, and one patient gave up the puncture because of risk factors in the horizontal puncture path of C6 and C7. Horner syndrome occurred in 79 cases within 10 min after puncture. There were 4 cases (5.1 %) of minor side effects, including hoarseness in 2 cases, numbness in upper limbs and dizziness in 1 case, all of which resolved on their own. The VAS score of 79 cases before block (8.9 ± 0.9) points and 0.5h VAS score (5.7 ± 2.1) points after block were significantly lower than those before block (t = 13.154, P = 0.003); 1dVAS score (5.3 ± 2.5) after block was significantly lower than that before block (t = 12.626, P = 0.002).

CONCLUSION

High-frequency ultrasound guided stellate ganglion block in lateral cervical approach in real time has a high success rate and the method is safe.