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Liou H, Long J, Kransdorf M, Schmieder S. CT-guided quadratus femoris injection for ischiofemoral impingement. Eur Radiol 2023; 33:3956-3960. [PMID: 36917261 DOI: 10.1007/s00330-023-09497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To describe the technique, efficacy, and safety of CT-guided quadratus femoris injection with corticosteroid and local anesthetic for the treatment of ischiofemoral impingement in a series of cases at our institution. METHODS Cases of CT-guided quadratus femoris injections from 2000 to 2021 were identified in the enterprise-wide electronic medical record of our institution. Patient charts and our institutional picture archiving and communication system (PACS) were searched for demographics, pain level on a 0-10 scale before and immediately following the procedure, procedure technique, and follow-up outcomes if available. RESULTS There were 13 cases among 12 patients with clinical and imaging findings of ischiofemoral impingement included in this study. Of the 12 patients, 10 were female and two were male. There were eight posterior approaches and five posterolateral approaches. Of the 13 cases, 11 resulted in immediate pain reduction. The median reduction in pain score was four (average 3.46, range 0-8.5). There was no statistically significant difference in pain reduction between the posterior approach cases and the posterolateral approach cases. No cases reported immediate complications or increases in pain score. Of the 12 cases, seven resulted in at least 1 month of pain relief, three had subsequent surgeries, and three had no follow-up. CONCLUSION CT-guided quadratus femoris injection is safe and effective for treating ischiofemoral impingement. Further and larger scale study is needed to fully delineate differences in technique effectiveness. KEY POINTS • CT-guided quadratus femoris injection is safe and effective for treating ischiofemoral impingement. • We found no statistically significant difference in pain reduction between the posterior approach and the posterolateral approach.
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Affiliation(s)
- Harris Liou
- Mayo Clinic Alix School of Medicine, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Jeremiah Long
- Mayo Clinic Arizona, 5777 East Mayo Clinic Blvd, Phoenix, AZ, 85054, USA
| | - Mark Kransdorf
- Mayo Clinic Arizona, 5777 East Mayo Clinic Blvd, Phoenix, AZ, 85054, USA
| | - Stephanie Schmieder
- Creighton University at St Joseph's Hospital Phoenix, 350 West Thomas Rd, Phoenix, AZ, 85013, USA.
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Nasiri A, Rezaei Motlagh F, Vafaei MA. Efficacy comparison between ultrasound-guided injections of 5% dextrose with corticosteroids in carpal tunnel syndrome patients. Neurol Res 2023; 45:554-563. [PMID: 36617808 DOI: 10.1080/01616412.2022.2164453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is no standard guideline for treating mild to moderate carpal tunnel syndrome (CTS). 5% dextrose perineural injection has been a potential and innovative treatment with long-term effects for CTS; however, there is few published randomized clinical trial comparing the efficacy of 5% dextrose perineural injection versus corticosteroid injection in treating CTS. MATERIALS AND METHODS In this double-blinded randomized active-controlled trial, we randomly allocated 1 session of either 2 cc 5% dextrose or 1 cc methylprednisolone acetate mixed with 1 cc normal saline in 36 patients with mild to moderate CTS of single or both their wrists. The baseline VAS, BCTQ, electrophysiological studies, and sonography assessment of median nerve CSA were carried out at the baseline and 1-month and 3-month follow-ups, as well as recording demographic variables. RESULTS A statistically significant decreasing trend in VAS (P < 0.0001), BCTQ-ss (P < 0.0001), median nerve CSA (P = 0.05), SNAP-PL (P < 0.0001), and CMAP-OL (P = 0.048) in both methylprednisolone and 5% dextrose groups was observed. No significant difference was observed in slope of the trend of studied parameters, including VAS (P = 0.95), BCTQ-ss (P = 0.88), BCTQ-F (P = 0.34), median nerve CSA (P = 0.321), SNAP-PL (P = 0.9), CMAP-OL (P = 0.799), SNAP-amplitude (P = 0.798), and CMAP-amplitude (P = 0.584). CONCLUSION 5% dextrose perineural injection is an effective and safe treatment for mild to moderate CTS, in comparison with the short-term results attained from corticosteroids. Further randomized clinical trials with longer follow-up periods are warranted.
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Affiliation(s)
- Aref Nasiri
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Rezaei Motlagh
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Vafaei
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
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Ischiofemoral Impingement Syndrome: Clinical and Imaging/Guidance Issues with Special Focus on Ultrasonography. Diagnostics (Basel) 2022; 13:diagnostics13010139. [PMID: 36611431 PMCID: PMC9818255 DOI: 10.3390/diagnostics13010139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Ischiofemoral impingement syndrome is a neglected cause of posterior hip pain which is derived from narrowing of the space between the lateral aspect of the ischium and the medial aspect of the lesser trochanter. Its diagnosis is challenging and requires the combination of physical tests and imaging studies. In the present narrative review, we found that femoral anteversion predisposes patients to the narrowing of the ischiofemoral space and subsequent quadratus femoris muscle injury. Magnetic resonance imaging serves as the gold-standard diagnostic tool, which facilities the quantification of the ischiofemoral distance and the recognition of edema/fat infiltration/tearing of the quadratus femoris muscle. Ultrasound is useful for scrutinizing the integrity of deep gluteal muscles, and its capability to measure the ischiofemoral space is comparable to that of magnetic resonance. Various injection regimens can be applied to treat ischiofemoral impingement syndrome under ultrasound guidance and they appear to be safe and effective. Finally, more randomized controlled trials are needed to build solid bases of evidence on ultrasound-guided interventions in the management of ischiofemoral impingement syndrome.
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Jeyaraman M, Murugan J, Maffulli N, Jeyaraman N, Potty AG, Gupta A. Ischiofemoral impingement syndrome: a case report and review of literature. J Orthop Surg Res 2022; 17:393. [PMID: 35986379 PMCID: PMC9392291 DOI: 10.1186/s13018-022-03287-y] [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: 05/31/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The etiology of ischiofemoral impingement (IFI) syndrome, an unusual and uncommon form of hip pain, remains uncertain. Some patients demonstrate narrowing of the space between the ischial tuberosity and lesser trochanter from trauma or abnormal morphology of the quadratus femoris muscle. Combined clinical and imaging aid in the diagnosis.
Case report A 32-year-old female presented with a 3 years history of pain over the lower aspect of the right buttock, aggravated by movements of the right hip, and partially relieved with rest and medications. The right hip showed extreme restriction of abduction and external rotation. MRI of the right hip showed reduced ischiofemoral space and quadratus femoris space when compared to the left hip. The patient underwent endoscopic resection of the right lesser trochanter, with no recurrence of pain at 2 years.
Conclusion An unusual cause of hip pain, IFI syndrome, should be suspected when hip pain at extremes of movement is associated with signal abnormality of quadratus femoris muscle. Management is tailored to address the inciting factors that precipitated the IFI syndrome.
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Gabrielli AS, Tisherman RT, Curley AJ, Mauro CS, Arner JW. Open Ischiofemoral Impingement Decompression. Arthrosc Tech 2022; 11:e1149-e1155. [PMID: 35936857 PMCID: PMC9353069 DOI: 10.1016/j.eats.2022.02.024] [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: 12/15/2021] [Accepted: 02/10/2022] [Indexed: 02/03/2023] Open
Abstract
Ischiofemoral impingement is a relatively rare cause of posterior hip pain associated with narrowing of the space between the lateral aspect of the ischium and the lesser trochanter. Symptoms typically consist of lower buttock, groin, and/or medial thigh pain, which is commonly exacerbated by adduction, extension, and external rotation of the hip. This condition can be treated nonoperatively in many circumstances; however, recalcitrant cases may require surgical intervention. Whereas described operative treatment options for this pathology range from endoscopic to open procedures, this Technical Note describes a safe and reliable technique for open ischiofemoral decompression with sciatic nerve neurolysis through a posterior approach for treatment of ischiofemoral impingement refractory to conservative treatment.
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Affiliation(s)
- Alexandra S. Gabrielli
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Robert T. Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Andrew J. Curley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Craig S. Mauro
- Burke and Bradley Orthopedics, Pittsburgh, Pennsylvania, U.S.A
| | - Justin W. Arner
- Burke and Bradley Orthopedics, Pittsburgh, Pennsylvania, U.S.A.,Address correspondence to Justin W. Arner, M.D., Burke and Bradley Orthopedics, UPMC St Margaret, 200 Medical Arts Bldg, Ste 4010, 200 Delafield Rd, Pittsburgh, PA 15215, U.S.A.
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Güzel İ, Gül D, Akpancar S, Lyftogt J. Effectiveness of Perineural Injections Combined with Standard Postoperative Total Knee Arthroplasty Protocols in the Management of Chronic Postsurgical Pain After Total Knee Arthroplasty. Med Sci Monit 2021; 27:e928759. [PMID: 33547269 PMCID: PMC7874529 DOI: 10.12659/msm.928759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Despite increased experience and technical developments in total knee arthroplasty (TKA), chronic postsurgical pain (CPSP) remains one of physicians’ biggest challenges. The aim of the present study was to evaluate the effectiveness of perineural injection therapy (PIT) in the management of CPSP after TKA. Material/Methods A total of 60 patients who had been surgically treated with TKA because of advanced knee osteoarthritis was included in the present study. The study included 2 groups. Group A consisted of patients who received 3 rounds of PIT combined with standard postoperative TKA protocol during the same period. Group B received standard postoperative TKA protocols (rehabilitation programs, oral and intravenous analgesics). Clinical effectiveness was evaluated via Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analog Scale (VAS) at baseline and 1-, 3-, and 6-month follow-ups. Results All repeated measures showed significant improvements (P<0.001) in both groups for VAS and WOMAC scores. These scores were significantly better in group A in all follow-up periods compared with group B (P<0.001). Twenty-nine patients (93.5%) in group A reported excellent or good outcomes compared with 26 patients (89.6%) in group B. Conclusions PIT is a promising approach in CPSP with minimal cost, simple and secure injection procedures, minimal side effects, and higher clinical efficacy.
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Affiliation(s)
- İsmail Güzel
- Department of Orthopedic Surgery, Malatya Training and Research Hospital, Malatya, Turkey
| | - Deniz Gül
- Department of Orthopedic Surgery, Bursa Kestel State Hospital, Bursa, Turkey
| | - Serkan Akpancar
- Department of Orthopedic Surgery, Malatya Training and Research Hospital, Malatya, Turkey
| | - John Lyftogt
- Private Practice (Retired), Christchurch, New Zealand
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Vogrin M, Ličen T, Kljaić Dujić M. Ischiofemoral Impingement Syndrome: An Overview for Strength and Conditioning Professionals. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kheterpal AB, Harvey JP, Husseini JS, Martin SD, Torriani M, Bredella MA. Hip abductor tears in ischiofemoral impingement. Skeletal Radiol 2020; 49:1747-1752. [PMID: 32514583 DOI: 10.1007/s00256-020-03497-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Ischiofemoral impingement (IFI) is associated with abnormalities of the quadratus femoris muscle and narrowing of the ischiofemoral (IF) and quadratus femoris (QF) spaces. The hip abductors play an important role in pelvic stability and abductor tears might play a role in the pathophysiology of IFI. The purpose of our study was to assess the association between hip abductor tears and IFI on MRI. MATERIALS AND METHODS The study was IRB approved and HIPAA compliant. Inclusion criteria were MRI findings of IFI (narrowing of the IF space ≤ 15 mm or QF space ≤ 10 mm with associated ipsilateral quadratus femoris edema or fatty infiltration/atrophy). Two MSK radiologists assessed hip/pelvic MRIs and integrity of the tensor fascia lata, gluteus medius, and minimus tendons. IFI and control groups were compared with a two-tailed Student t test or chi-squared test. RESULTS We identified 140 patients with MRI findings of IFI (mean age 56 ± 13 years, 130 f, 10 m) and 140 controls of similar age and sex. Patients with IFI had a higher prevalence of gluteus medius/minimus partial tears (37 vs 21, p = 0.02) and full-thickness tears (24 vs 21, p = 0.03). Patients with IFI had a higher prevalence and higher grade of gluteal muscle atrophy compared with controls (p < 0.03). There were no tears of the tensor fascia lata in either group. CONCLUSION Patients with IFI had a higher prevalence of abductor tears and abductor muscle atrophy compared with matched controls. This suggests that abductor tears might play a role in the pathophysiology of IFI.
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Affiliation(s)
- Arvin B Kheterpal
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joel P Harvey
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jad S Husseini
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Scott D Martin
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 175 Cambridge Street, Boston, MA, 02114, USA
| | - Martin Torriani
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Colangelo MT, Galli C, Guizzardi S. Polydeoxyribonucleotide Regulation of Inflammation. Adv Wound Care (New Rochelle) 2020. [DOI: 10.1089/wound.2019.1031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Maria Teresa Colangelo
- Histology and Embryology Laboratory, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Galli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefano Guizzardi
- Histology and Embryology Laboratory, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Kim YN, Baek J, Kim YH, Hwang J, Ko YR, Lee MS, Kim YC, Park HJ. Full recovery of near complete tear of anterior cruciate ligament without surgery: a case report. Medicine (Baltimore) 2020; 99:e19899. [PMID: 32358356 PMCID: PMC7440291 DOI: 10.1097/md.0000000000019899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The anterior cruciate ligament (ACL) is the region where spraining or tearing is most prevalent when the knee is injured. Complete ACL ruptures have a much less favorable outcome without surgical intervention. Polydeoxyribonucleotide (PDRN) is a relatively safe substance widely used for regenerative therapy. PATIENT CONCERNS A 43-year-old female patient visited our clinic with Rt. knee pain after slipping, which she rated as 7/10 on a numeric rating scale. DIAGNOSIS She was diagnosed as having a near complete tear of the ACL at the femoral attachment, partial tear of the lateral collateral ligament. INTERVENTIONS Ultrasound-guided PDRN injections were carried out 5 times at intervals of about 2 weeks. OUTCOMES At 3-month follow-up, the patient demonstrated an improvement in knee symptoms (numeric rating scale 0) and ROM without any complications. Even after 2 years and 5 months since the diagnosis, she has been doing her daily life well without any pain. CONCLUSION This is the first report of successful PDRN injection for near complete tear of ACL and partial tear of lateral collateral ligament without surgery.
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Affiliation(s)
- Yoo Na Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital
| | - Jungwon Baek
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital
| | - Jaewoong Hwang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital
| | - Yu Ri Ko
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital
| | - Min soo Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital
| | - Young chan Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital
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Nakano N, Shoman H, Khanduja V. Treatment strategies for ischiofemoral impingement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:2772-2787. [PMID: 30426139 PMCID: PMC7471170 DOI: 10.1007/s00167-018-5251-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 10/22/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE There has been relatively little information about the treatment for ischiofemoral impingement (IFI) because of its rarity as well as the uncertainty of diagnosis. The aim of this study was to provide the reader with the available treatment strategies and their related outcomes for IFI based on the best available evidence, whilst highlighting classically accepted ways of treatment as well as relatively new surgical and non-surgical techniques. METHODS A systematic review of the literature from Medline, Embase, AMED, Cochrane and Google Scholar was undertaken since inception to December 2017 following the PRISMA guidelines. Clinical outcome studies, prospective/retrospective case series and case reports that described the treatment outcome for IFI were included. Animal or cadaveric studies, trial protocols, diagnostic studies without any description of treatments, technical notes without any results, and review articles were excluded. RESULTS This systematic review found 17 relevant papers. No comparative studies were included in the final records for qualitative assessment, which means all the studies were case series and case reports. Eight studies (47.1%) utilised non-surgical treatment including injection and prolotherapy, followed by endoscopic surgery (5 studies, 29.4%) then open surgery (4 studies, 23.5%). Mean age of the participants was 41 years (11-72 years). The mean follow-up was 8.4 months distributed from 2 weeks to 2.3 years. No complications or adverse effects were found from the systematic review. CONCLUSION Several treatment strategies have been reported for IFI, and most of them have good short- to medium-term outcomes with a low rate of complications. However, there are no comparative studies to assess the superiority of one technique over another, thus further research with randomised controlled trials is required in this arena. This study explores the wide variety and categories of different treatments used for IFI to guide physicians and shed light on what can be done for this challenging cohort of patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Naoki Nakano
- grid.24029.3d0000 0004 0383 8386Department of Trauma and Orthopaedic Surgery - Young Adult Hip Service, Addenbrooke’s-Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 37, Cambridge, CB2 0QQ UK
| | - Haitham Shoman
- grid.24029.3d0000 0004 0383 8386Department of Trauma and Orthopaedic Surgery - Young Adult Hip Service, Addenbrooke’s-Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 37, Cambridge, CB2 0QQ UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedic Surgery - Young Adult Hip Service, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 37, Cambridge, CB2 0QQ, UK.
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Lu B, Deng H, Chen B, Zhao J. The accuracy assessment of ultrasound for the diagnosis of ischiofemoral space - A Validation Study. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:605-614. [PMID: 31205010 DOI: 10.3233/xst-180482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate and evaluate the accuracy of ultrasound (US) imaging for measurement of ischiofemoral space (IFS) compared with magnetic resonance imaging (MRI). METHODS Twenty-five hips of 16 patients with hip pain and ipsilateral quadratus femoris muscle (QFM) edema were recruited to the IFI group, and 19 hips of 19 patients without hip pain and QFM edema were recruited as the control group. IFS of both groups was measured by US and MRI. The correlations and differences between US and MRI measurements were then assessed. Last, the receiver operating characteristic (ROC) data analysis was performed. RESULTS The US results revealed a decreased IFS in IFI hips compared with controls (P < 0.001), suggesting that US were valuable in identifying IFI. IFS measured by US and MRI showed positive correlations in both the IFI group (r = 0.409, P = 0.042) and control group (r = 0.575, P = 0.01). There were no statistically significant differences between IFS measured by US and MRI in the control group (P = 0.657), while IFS measurements in the IFI group performed with US were significantly greater than those with MRI (P < 0.001). ROC curve analysis revealed that the cutoff value of IFS measured with US was 2.14 cm, with a sensitivity of 92.0% and specificity of 68.4%, while measured by MRI was 1.87 cm, with a sensitivity of 96.0% and specificity of 84.2%. CONCLUSIONS IFS measurements obtained with US are very similar to those obtained with MRI. Therefore, US provides a low-cost and easy-to-operate alternative imaging modality to measure IFS.
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Affiliation(s)
- Bo Lu
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Heping Deng
- Department of Ultrasonography, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Baicheng Chen
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Jian Zhao
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Lee WY, Park KD, Park Y. The effect of polydeoxyribonucleotide on the treatment of radiating leg pain due to cystic mass lesion in inner aspect of right sciatic foramen: A CARE compliant case report. Medicine (Baltimore) 2018; 97:e12794. [PMID: 30313106 PMCID: PMC6203516 DOI: 10.1097/md.0000000000012794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Radiating leg pain usually originates from the lumbar spine and occasionally from peripheral lesions. Here we report a case involving a patient with radiating pain in the right leg who exhibited 2 suspicious lesions, including 1 spinal lesion and 1 extraspinal cystic mass lesion, on magnetic resonance imaging. Polydeoxyribonucleotide sodium (PDRN) was recently noted as such a substitute. PDRN has anti-inflammatory effects, as it lowers the expression of inflammatory cytokines including interleukin-6 and tumor necrosis factor-alpha. PATIENT CONCERNS A 51-year-old man (weight, 93 kg; height, 168 cm) working as a bus driver presented at the pain clinic with continuous right buttock pain, radiating leg pain and a tingling sensation involving the calf and dorsum of the foot, since 1 week. DIAGNOSES He was definitively diagnosed using differential blocks, which revealed the cyst to be the actual cause of the pain. INTERVENTIONS Surgical resection was not feasible because of the position of the cyst; therefore, corticosteroid injection under ultrasonographic guidance was attempted. However, this provided short-term relief. Subsequently, a solution containing PDRN was injected around the piriformis muscle and repeated 3 more times at intervals of 2 weeks. OUTCOMES After PDRN injection, we conducted two follow-up monitoring every two months for 2 months. Last follow-up, the patient no longer complained of pain. this resulted in relatively long-term relief from pain. LESSONS The findings from this case suggest that PDRN is an effective alternative for steroids in patients with radiating leg pain, although its efficacy and safety needs to be evaluated in further large-scale studies.
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Affiliation(s)
- Woo Yong Lee
- Department of Anesthesiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon
| | - Yongbum Park
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
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Boettcher BJ, Hollman JH, Payne JM, Johnson AC, Finnoff JT. Can a Brief Training Session Prepare Physician Sonographers of Differing Experience to Measure the Ischiofemoral Space? A Reliability Study. PM R 2018; 11:142-149. [PMID: 29964210 DOI: 10.1016/j.pmrj.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary aim of this study was to determine the inter- and intrarater reliability of ultrasound (US) measurements of the ischiofemoral space (IFS) following a brief training session. A secondary aim was to determine if reliability correlated with sonographer experience. DESIGN Prospective cohort study. SETTING Physical medicine and rehabilitation department within a tertiary care institution. PARTICIPANTS Seven male and 3 female individuals were recruited to serve as models. Nine physician sonographers (3 postgraduate year [PGY]-2 residents, 3 PGY-4 residents, 3 physicians) were recruited to serve as sonographers. METHODS OR INTERVENTIONS Sonographers received a 15-minute educational session on identifying the IFS with US, followed by 20 minutes of practice. Models were then placed in a prone position and secured to prevent hip movement. All operators measured bilateral IFSs in each model twice with a washout period between measurements. Operators were blinded to all measurements. MAIN OUTCOME MEASURES Primary outcomes were inter- and intrarater reliability interclass coefficients (ICCs) of IFS measurements among the groups with different levels of US experience. Secondary outcomes included comparisons of inter- and intrarater reliability ICCs of IFS measurements between groups, and the difference of mean IFS measurements between groups. RESULTS Intrarater reliability ICCs were 0.829, 0.680, and 0.596 for physician, PGY-4, and PGY-2 groups, respectively. Interrater reliability ICCs were 0.722, 0.427, and 0.558 for physician, PGY-4, and PGY-2 groups, respectively. No statistically significant differences in reliability were identified between groups. Mean IFS measurements were 31.2, 33.4, and 34.0 mm for physician, PGY-4, and PGY-2 groups, respectively. Physician measurements were significantly smaller than the PGY-4 and PGY-2 measurements (P < .049 and P < .01). CONCLUSIONS Following a brief training session, experienced sonographers demonstrated excellent IFS measurement intrarater reliability, whereas PGY-4 and PGY-2 sonographers demonstrated fair intrarater reliability. All sonographers demonstrated fair interrater reliability. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Brennan J Boettcher
- Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - John H Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jeffrey M Payne
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Adam C Johnson
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, 200 First St. SW, Rochester, MN 55905
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Abstract
In this review, we bring to the attention of the reader three relatively unknown types of hip impingement. We explain the concept of low anterior inferior iliac spine (AIIS) impingement, also known as sub-spine impingement, ischio-femoral impingement (IFI) and pelvi-trochanteric impingement. For each type of impingement, we performed a search of relevant literature.We searched the PubMed, Medline (Ovid) and Embase databases from 1960 to March 2016. For each different type of impingement, a different search strategy was conducted.In total, 19 studies were included and described. No data analysis was performed since there was not much comparable data between studies.An overview of symptoms, clinical tests and possible surgical treatment options for the three different types of extra-articular impingement is provided.Several disorders around the hip can cause similar complaints. Therefore, we plead for a standardized classification. In young and athletic patients, in particular, there is much to gain if hip impingement is diagnosed early. Cite this article: EFORT Open Rev 2018;3:30-38. DOI: 10.1302/2058-5241.3.160068.
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Ultrasound-Guided Prolotherapy with Polydeoxyribonucleotide for Painful Rotator Cuff Tendinopathy. Pain Res Manag 2018; 2018:8286190. [PMID: 29770163 PMCID: PMC5889899 DOI: 10.1155/2018/8286190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/20/2018] [Indexed: 12/12/2022]
Abstract
Background Rotator cuff tendinopathy is a primary cause of shoulder pain and dysfunction. Several effective nonsurgical treatment methods have been described for chronic rotator cuff tendinopathy. Prolotherapy with polydeoxyribonucleotide (PDRN), which consists of active deoxyribonucleotide polymers that stimulate tissue repair, is a nonsurgical regenerative injection that may be a viable treatment option. The objective of this study was to assess the efficacy of PDRN in the treatment of chronic rotator cuff tendinopathy. Method The records of patients with chronic rotator cuff tendinopathy (n=131) were reviewed retrospectively, and the patients treated with PDRN prolotherapy (n=32) were selected. We measured the main outcome of the shoulder pain and disability index score on a numerical rating scale of average shoulder pain. Results Compared with baseline data, significant improvements in the shoulder pain and disability index and pain visual analog scale scores were demonstrated at one week after the end of treatment, and at one month and three months later. Conclusions PDRN prolotherapy may improve the conservative treatment of painful rotator cuff tendinopathy for a specific subset of patients.
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Arévalo Galeano N, Santamaría Guinea N, Gredilla Molinero J, Grande Bárez M. Extra-articular hip impingement: a review of the literature. RADIOLOGIA 2017; 60:105-118. [PMID: 29110905 DOI: 10.1016/j.rx.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 01/10/2023]
Abstract
Hip and groin pain is a common clinical problem. Multiple causes can generate hip or groin pain, often sharing clinical and demographic characteristics. Diagnostic imaging tests play an important role in the etiological diagnosis. New forms of extra-articular hip impingement have recently been recognized as a cause of hip pain and limited function especially in young active patients. These conditions include ischiofemoral impingement, anterior inferior iliac spine and subspine impingement, iliopsoas impingement and greater trochanteric-pelvic impingement. In general, they are caused by a mechanical conflict with an abnormal or excessive contact between the proximal femur and pelvis and/or soft tissue between them. In this manuscript we review the physiopathology, clinical presentation, the most common radiologic findings and treatment of these forms of extra-articular hip impingement.
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Affiliation(s)
- N Arévalo Galeano
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, España.
| | - N Santamaría Guinea
- Unidad Central de Radiodiagnóstico, Hospital Universitario Infanta Leonor, Madrid, España
| | - J Gredilla Molinero
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Grande Bárez
- Unidad Central de Radiodiagnóstico, Hospital Universitario Infanta Leonor, Madrid, España
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Mun JU, Cho HR, Bae SM, Park SK, Choi S., Seo MS, Lim YS, RN SHW, Kim YU. Effect of polydeoxyribonucleotide injection on pes anserine bursitis: A case report. Medicine (Baltimore) 2017; 96:e8330. [PMID: 29069005 PMCID: PMC5671838 DOI: 10.1097/md.0000000000008330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Pes anserine (PA) bursitis is an inflammatory condition of the medial knee. The PA bursa becomes more painful when infected, damaged, or irritated. Although various treatment options have been attempted to treat PA bursitis, optimal treatments are still debated. This study aims to investigate the effect of polydeoxyribonucleotide (PDRN) injection on reducing pain and inflammation in a patient presenting with PA bursitis. PATIENT CONCERNS A 50-year-old female patient was admitted to our pain clinic with symptoms of tenderness and pain over the medial knee. Physical examination revealed the pain to be located over the proximal medial tibia at the insertion of the conjoined tendons of the PA. The knee had lost its range of movement and strength, and resisted knee flexion. DIAGNOSES She was diagnosed as having PA bursitis. INTERVENTIONS Ultrasound guided PA bursa injection was carried out. OUTCOMES Follow-up for the patient was more than eight months. She showed good improvement in PA bursitis without any complications. LESSONS This is the first successful report of successful PDRN injection for PA bursa.
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Affiliation(s)
- Jong-Uk Mun
- Department of Orthopedic Surgery, Changwon Gyeongsang National University Hospital, Incheon
| | - Hyung R. Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, College of Medicine, Seonam University, Goyang
| | - Sae M. Bae
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Incheon
| | - Soo K. Park
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Incheon
| | - Soo .l Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Mi S. Seo
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Young S. Lim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Soo H. Woo RN
- Department of Nursing, Kyung-In Women‘s University, Incheon, Republic of Korea
| | - Young U. Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
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Gollwitzer H, Banke IJ, Schauwecker J, Gerdesmeyer L, Suren C. How to address ischiofemoral impingement? Treatment algorithm and review of the literature. J Hip Preserv Surg 2017; 4:289-298. [PMID: 29250337 PMCID: PMC5721376 DOI: 10.1093/jhps/hnx035] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/30/2017] [Indexed: 12/30/2022] Open
Abstract
Ischiofemoral impingement (IFI) is a rare cause of hip pain defined by a narrowing of the space between the lateral aspect of the os ischium and the lesser trochanter of the femur. Several underlying anatomic, functional and iatrogenic pathologies have been identified for symptomatic IFI in native hip joints and after total hip arthroplasty. Clinical symptoms vary but most commonly consist of pain of the lower buttock and groin including the inner thigh, and a snapping or clunking phenomenon is often reported. Symptoms may be provoked by a combined extension, adduction and external rotation during physical examination and during long-stride walking. Radiographs of the pelvis and an axial or false-profile-view of the hip as well as magnetic resonance imaging (MRI)-scans should be obtained to strengthen the diagnosis. On MRI, the quadratus femoris muscle signal and the space confined by the anatomic structures surrounding the muscle, the quadratus femoris space, are to be assessed. Targeted infiltration of the muscle can be helpful both diagnostically and therapeutically. The literature on differential diagnoses and treatment options for IFI is limited; therapeutic suggestions are offered only in case reports and series. With this work, we aim to give a systematic approach to the non-surgical and surgical treatment options for IFI based upon the current literature and the authors' personal experience.
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Affiliation(s)
- Hans Gollwitzer
- Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Ismaninger Str. 22, DE 81925 Munich, Germany.,ATOS Klinik München, Effnerstr. 38, 81925 München, Germany
| | - Ingo J Banke
- Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Ismaninger Str. 22, DE 81925 Munich, Germany
| | - Johannes Schauwecker
- Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Ismaninger Str. 22, DE 81925 Munich, Germany
| | - Ludger Gerdesmeyer
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Sektion für Onkologische und Rheumatologische Orthopädie, Arnold-Heller-Straße 3 DE 24105 Kiel, Germany
| | - Christian Suren
- Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Ismaninger Str. 22, DE 81925 Munich, Germany
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Kang KN, Kim TW, Koh JW, Oh HB, Mun JU, Seo MS, Kim YU. Effect of transforaminal epidural polydeoxyribonucleotide injections on lumbosacral radiculopathy: A case report. Medicine (Baltimore) 2017; 96:e7174. [PMID: 28640096 PMCID: PMC5484204 DOI: 10.1097/md.0000000000007174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Transforaminal epidural glucocorticoids administration is widely performed for the management of lumbosacral radiculopathy. However, it may worsen the condition of patients with type 2 diabetes mellitus (DM). Polydeoxyribonucleotide (PDRN) was recently noted as a substitute for glucocorticoids. PATIENT CONCERNS A 44-year-old male patient was admitted to our pain clinic with symptoms of low back pain with severe pain and tingling sensation of left posterolateral leg. He had type 2 DM medicated with Glimepiride and Metformin. Blood glucose level was 367 mg/dL. He declined to use glucocorticoid. DIAGNOSES He was diagnosed as left foraminal disc protrusion at L4-5, left subarticular disc protrusion at L5-S1. INTERVENTIONS Fluoroscopically guided transforaminal epidural PDRN injections were carried out. OUTCOMES The patient was followed up for more than 6 months and demonstrated good improvement in lumbosacral radiculopathy without any complications. LESSONS This is the first successful report on epidural injection of PDRN.
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Affiliation(s)
- Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul
| | - Tae Woong Kim
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul
| | - Jin Woo Koh
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul
| | - Han Byeol Oh
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul
| | - Jong-Uk Mun
- Department of Orthopaedic Surgery, Changwon Gyeongsang National University Hospital
| | - Mi Sook Seo
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
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Veronesi F, Dallari D, Sabbioni G, Carubbi C, Martini L, Fini M. Polydeoxyribonucleotides (PDRNs) From Skin to Musculoskeletal Tissue Regeneration via Adenosine A 2A Receptor Involvement. J Cell Physiol 2017; 232:2299-2307. [PMID: 27791262 DOI: 10.1002/jcp.25663] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 12/17/2022]
Abstract
Polydeoxyribonucleotides (PDRNs) are low molecular weight DNA molecules of natural origin that stimulate cell migration and growth, extracellular matrix (ECM) protein production, and reduce inflammation. Most preclinical and clinical studies on tissue regeneration with PDRNs focused on skin, and only few are about musculoskeletal tissues. Starting from an overview on skin regeneration studies, through the analysis of in vitro, in vivo, and clinical studies (1990-2016), the present review aimed at defining the effects of PDRN and their mechanisms of action in the regeneration of musculoskeletal tissues. This would also help future researches in this area. A total of 29 studies were found by PubMed and www.webofknowledge.com searches: 20 were on skin (six in vitro, six in vivo, one vitro/vivo, seven clinical studies), while the other nine regarded bone (one in vitro, two in vivo, one clinical studies), cartilage (one in vitro, one vitro/vivo, two clinical studies), or tendon (one clinical study) tissues regeneration. PDRNs improved cell growth, tissue repair, ECM proteins, physical activity, and reduced pain and inflammation, through the activation of adenosine A2A receptor. PDRNs are currently used for bone, cartilage, and tendon diseases, with a great variability regarding the PDRN dosage to be used in clinical practice, while the dosage for skin regeneration is well established. PDRNs are usually administered from a minimum of three to a maximum of five times and they act trough the activation of A2A receptor. Further studies are advisable to confirm the effectiveness of PDRNs and to standardize the PDRN dose. J. Cell. Physiol. 232: 2299-2307, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Via Di Barbiano, Bologna, Italy
| | - Dante Dallari
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Giacomo Sabbioni
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Chiara Carubbi
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Lucia Martini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Via Di Barbiano, Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Via Di Barbiano, Bologna, Italy
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Lim TH, Cho HR, Kang KN, Rhyu CJ, Chon SW, Lim YS, Yoo JI, Kim JW, Kim YU. The effect of polydeoxyribonucleotide prolotherapy on posterior tibial tendon dysfunction after ankle syndesmotic surgery: A case report. Medicine (Baltimore) 2016; 95:e5346. [PMID: 28002322 PMCID: PMC5181806 DOI: 10.1097/md.0000000000005346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Ankle syndesmotic injuries occasionally require long-term therapy for recovery and can result in tendon injury. Posterior tibial tendon dysfunction (PTTD) is an acquired deformity that can cause flatfoot deformity. The current nonoperative management of PTTD includes nonsteroidal antiinflammatory drugs (NSAIDs), orthopedic devices. Although various treatment options have been attempted, optimal treatments for each stage of the condition are debated. Polydeoxyribonucleotide (PDRN) is effective in healing of chronic wounds associated with tissue damage by attracting tissue growth factors. PATIENT CONCERNS A 67-year-old woman who presented at our pain clinic with pain on the inside of ankle. She had a syndesmotic screw fixation 3 years prior. Her ankle pain had persisted after the removal of screws and edema for about 1 month resulting from long-term NSAIDs administration. DIAGNOSES The origin of the pain was possibly tibialis posterior muscle and posterior tibial tendon and she was diagnosed as PTTD after syndesmosis surgery. INTERVENTIONS Sono guided prolotherapy with PDRN was carried out. OUTCOMES Patient showed improvement in the arch of the foot, experienced pain relief, and was able to wear regular shoes without any orthopedic device. LESSONS This case report highlights that PDRN prolotherapy is a safe and efficient therapeutic option for the treatment of PTTD.
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Affiliation(s)
- Tae-Ha Lim
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, College of Medicine, Seonam University, Goyang
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul
| | - Chang Joon Rhyu
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul
| | - Sung Won Chon
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul
| | - Young Su Lim
- Department of Anesthesiology and Pain Medicine, Institute for Integrative medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Jee In Yoo
- Department of Anesthesiology and Pain Medicine, Institute for Integrative medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Jung-Won Kim
- Department of Anesthesiology and Pain Medicine, Institute for Integrative medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Institute for Integrative medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
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Yoon YC, Lee DH, Lee MY, Yoon SH. Polydeoxyribonucleotide Injection in the Treatment of Chronic Supraspinatus Tendinopathy: A Case-Controlled, Retrospective, Comparative Study With 6-Month Follow-Up. Arch Phys Med Rehabil 2016; 98:874-880. [PMID: 27914921 DOI: 10.1016/j.apmr.2016.10.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the efficacy of polydeoxyribonucleotide (PDRN) injection for rotator cuff disease (RCD). DESIGN Case-controlled, retrospective, comparative study. SETTING Outpatient clinic at a university-affiliated tertiary care hospital. PARTICIPANTS Patients (N=106) with chronic nontraumatic refractory RCD who were unresponsive to at least 1 month of conservative treatment: 55 patients received PDRN injection (PDRN group) and 51 continued conservative treatment (control group). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Shoulder Pain and Disability Index, score on a visual analog scale of the average shoulder pain level, number of analgesic ingestions per day, isometric strength of shoulder abductor, active range of motion (flexion, abduction, internal rotation, external rotation), and maximal tear size of tendon on ultrasonography at pretreatment and 3 and 6 months postinjection. RESULTS There was no significant difference between the 2 groups in terms of age, sex, shoulder affected, duration of symptoms, and ultrasonographic findings at pretreatment. Compared with the control group, the treatment group showed a significant improvement in Shoulder Pain and Disability Index, visual analog scale score, and number of analgesic ingestions per day. However, there was no difference in isometric strength, active range of motion, and maximal tear size of tendon. No adverse events were reported. CONCLUSIONS To our knowledge, this is the first study to assess the efficacy of PDRN injection for patients with RCD. The PDRN injection group showed improvement in pain and subjective disability in patients with RCD and continued to show improvement for 3 months thereafter; the PDRN injection can be an optional treatment for patients with chronic RCD who show no response to other treatments.
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Affiliation(s)
- Young Chun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Doo-Hyung Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Michael Young Lee
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Seung-Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea.
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Jang KS, Kim HS. Treatment for Acute Stage Complex Regional Pain Syndrome Type II with Polydeoxyribonucleotide Injection. J Korean Neurosurg Soc 2016; 59:529-32. [PMID: 27651875 PMCID: PMC5028617 DOI: 10.3340/jkns.2016.59.5.529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/30/2022] Open
Abstract
Complex regional pain syndrome (CRPS) type II is a syndrome that develops after nerve injury. Symptoms may be severe, and vary depending on the degree of sympathetic nerve involvement. As yet, there is no satisfactory treatment. We report the case of a female patient who had an L5 left transverse process fracture and an S2 body fracture, who developed symptoms of CRPS type II in her left lower leg that were aggravated during ambulation in spite of absolute bed rest for one month after the trauma. Several treatments, including bed rest, medication, and numerous nerve blocks were attempted, but the pain persisted. We finally tried injection of polydeoxyribonucleotide (PDRN) solution at the left L5 transverse process fracture site because we knew of the anti-inflammatory effect of PDRN. One day after this treatment, her symptoms had almost disappeared and three days later, she was discharged. We will also further discuss the possibility of using PDRN solution for the treatment of CRPS.
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Affiliation(s)
- Kun Soo Jang
- Department of Neurosurgery, SunHan Hospital, Gwangju, Korea
| | - Hyeun Sung Kim
- Department of Neurosurgery, SunHan Hospital, Gwangju, Korea
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Finnoff JT, Johnson AC, Hollman JH. Can Ultrasound Accurately Assess Ischiofemoral Space Dimensions? A Validation Study. PM R 2016; 9:392-397. [PMID: 27418573 DOI: 10.1016/j.pmrj.2016.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/21/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ischiofemoral impingement is a potential cause of hip and buttock pain. It is evaluated commonly with magnetic resonance imaging (MRI). To our knowledge, no study previously has evaluated the ability of ultrasound to measure the ischiofemoral space (IFS) dimensions reliably. OBJECTIVE To determine whether ultrasound could accurately measure the IFS dimensions when compared with the gold standard imaging modality of MRI. DESIGN A methods comparison study. SETTING Sports medicine center within a tertiary-care institution. PARTICIPANTS A total of 5 male and 5 female asymptomatic adult subjects (age mean = 29.2 years, range = 23-35 years; body mass index mean = 23.5, range = 19.5-26.6) were recruited to participate in the study. METHODS Subjects were secured in a prone position on a MRI table with their hips in a neutral position. Their IFS dimensions were then acquired in a randomized order using diagnostic ultrasound and MRI. MAIN OUTCOME MEASUREMENTS The main outcome measurements were the IFS dimensions acquired with ultrasound and MRI. RESULTS The mean IFS dimensions measured with ultrasound was 29.5 mm (standard deviation [SD] 4.99 mm, standard error mean 1.12 mm), whereas those obtained with MRI were 28.25 mm (SD 5.91 mm, standard error mean 1.32 mm). The mean difference between the ultrasound and MRI measurements was 1.25 mm, which was not statistically significant (SD 3.71 mm, standard error mean 3.71 mm, 95% confidence interval -0.49 mm to 2.98 mm, t19 = 1.506, P = .15). The Bland-Altman analysis indicated that the 95% limits of agreement between the 2 measurement was -6.0 to 8.5 mm, indicating that there was no systematic bias between the ultrasound and MRI measurements. CONCLUSIONS Our findings suggest that the IFS measurements obtained with ultrasound are very similar to those obtained with MRI. Therefore, when evaluating individuals with suspected ischiofemoral impingement, one could consider using ultrasound to measure their IFS dimensions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, 600 Hennepin Ave, #310, Minneapolis, MN 55403(∗).
| | - Adam C Johnson
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN(†)
| | - John H Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN(‡)
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Hernando MF, Cerezal L, Pérez-Carro L, Canga A, González RP. Evaluation and management of ischiofemoral impingement: a pathophysiologic, radiologic, and therapeutic approach to a complex diagnosis. Skeletal Radiol 2016; 45:771-87. [PMID: 26940209 DOI: 10.1007/s00256-016-2354-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/23/2016] [Accepted: 02/15/2016] [Indexed: 02/02/2023]
Abstract
Ischiofemoral impingement syndrome (IFI) is an underrecognized form of atypical, extra-articular hip impingement defined by hip pain related to narrowing of the space between the ischial tuberosity and the femur. The etiology of IFI is multifactorial and potential sources of ischiofemoral engagement include anatomic variants of the proximal femur or pelvis, functional disorders as hip instability, pelvic/spinal instability, or abductor/adductor imbalance, ischial tuberosity enthesopathies, trauma/overuse or extreme hip motion, iatrogenic conditions, tumors and other pathologies. Magnetic resonance imaging (MRI) is the diagnostic procedure of choice for assessing IFI and may substantially influence patient management. The injection test of the ischiofemoral space (IFS) has both a diagnostic and therapeutic function. Endoscopic decompression of the IFS appears useful in improving function and diminishing hip pain in patients with IFI but conservative treatment is always the first step in the treatment algorithm. Because of the ever-increasing use of advanced MRI techniques, the frequent response to conservative treatment, and the excellent outcomes of new endoscopic treatment, radiologists must be aware of factors that predispose or cause IFI. In addition, focused treatment in these conditions is often more important than in secondary impingement. In this article, we briefly describe the anatomy of the IFS, review the clinical examination and symptoms, assess the diagnostic imaging criteria and pathophysiological mechanisms, and develop an understandable classification of IFI, with particular focus on its etiology, predisposing factors, and associated musculoskeletal abnormalities. We also assess the role of the radiologist in the diagnosis, treatment, and preoperative evaluation of both primary and secondary IFI.
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Affiliation(s)
- Moisés Fernández Hernando
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Calle Castilla 6 Bajo, 39002, Santander, Cantabria, Spain.
| | - Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Calle Castilla 6 Bajo, 39002, Santander, Cantabria, Spain
| | - Luis Pérez-Carro
- Orthopedic Surgery Department, Clínica Mompía, Santander, Cantabria, Spain
| | - Ana Canga
- Department of Radiology, Valdecilla University Hospital, Santander, Cantabria, Spain
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Conservative Management of Second Metatarsophalangeal Joint Instability in a Professional Dancer: A Case Report. J Orthop Sports Phys Ther 2016; 46:114-23. [PMID: 26755404 DOI: 10.2519/jospt.2016.5824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Professional ballet and modern dancers spend an inordinate amount of time on demi pointe (rising onto their forefeet), placing excessive force on the metatarsophalangeal joints and putting them at risk of instability. Surgical treatment of this condition is well described in the literature. However, studies describing conservative management, particularly in dance populations, are lacking. CASE DESCRIPTION A 33-year-old dancer presented with insidious onset of medial arch and second and third metatarsophalangeal joint pain. Functional deficits included the inability to walk barefoot, perform demi relevé, or balance on demi pointe. Imaging studies revealed osteoarthritis of the first metatarsophalangeal joint, second metatarsophalangeal joint calcification, capsulitis, and plantar plate rupture, leading to a diagnosis of instability. The dancer underwent a treatment program that included taping, padding, physical therapy, a series of prolotherapy injections, and activity modification. OUTCOMES The dancer was seen for a total of 37 physical therapy sessions over the 16-week rehabilitation period. At the time of discharge, the patient had returned to full duty and performed all choreography with taping and padding. Repeated single-leg jumps and turns on the right foot, however, still caused discomfort. At her 6-month follow-up, the dancer's total Dance Functional Outcome Survey (DFOS) score had improved from 16% to 86%, and her Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical scores improved from 24 to 47. One year after discharge, the dancer reported pain-free dancing with no taping or padding. DISCUSSION This case report describes early diagnosis and a multimodal treatment approach in a professional dancer with significant disability secondary to metatarsophalangeal joint instability. LEVEL OF EVIDENCE Therapy, level 4.
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Papoutsi D, Daniels J, Mistry A, Chandraseker C. Ischiofemoral impingement due to a lipoma of the ischiofemoral space. BMJ Case Rep 2016; 2016:bcr-2015-213210. [PMID: 26746832 DOI: 10.1136/bcr-2015-213210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Non-focal hip and groin pain can frequently be a diagnostic problem, particularly if it is related to uncommon causes such as ischiofemoral impingement. The vast majority of published cases of ischiofemoral impingement are caused by osseous changes of the ischiofemoral interval. We describe an unusual case of ischiofemoral impingement caused by an intermuscular lipoma. Surgical resection of the tumour and histology confirmed the lipomatous nature of the tumour, with subsequent resolution of symptoms. To the best of our knowledge, this is the first case of a lipoma causing ischiofemoral impingement described in the English literature and emphasises that impingement can occur on the basis of a soft tissue mass occupying the interval of otherwise normal osseous interval and boundaries.
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Kang M, Bang SY, Ryu JA, Gim S, Park ES, Lee H, Lee HS. A Case of Ischiofemoral Impingement Syndrome as a Differential Diagnosis of Ankylosing Spondylitis. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.3.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Minkoo Kang
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - So-Young Bang
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Jeong Ah Ryu
- Department of Radiology, Hanyang University Guri Hospital, Guri, Korea
| | - Seungjun Gim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Eun-Sik Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyeyoung Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hye-Soon Lee
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
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Abstract
In the last 20 years, femoroacetabular impingement has been at the forefront of clinical practice as a cause of hip pain in young adults. As arthroscopic techniques for the hip continue to evolve, the possible presence of a new group of conditions creating mechanical conflict in and around the hip joint (ischiofemoral, subspine and iliopsoas impingement) has recently been elucidated whilst interest in already known 'impingement' syndromes (pelvic-trochanteric and pectineofoveal impingement) is now revived. This article attempts to increase awareness of these relatively uncommon clinical entities by describing their pathomorphology, contact mechanics, treatment and published results available to present. It is hoped that such knowledge will diversify therapeutic options for the clinician, thereby improving outcomes in a small but not negligible portion of patients with previously unexplained persistent symptoms.
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Beckmann JT, Safran MR, Abrams GD. Extra-Articular Impingement: Ischiofemoral Impingement and Trochanteric-Pelvic. OPER TECHN SPORT MED 2015. [DOI: 10.1053/j.otsm.2015.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ischiofemoral impingement syndrome: a meta-analysis. Skeletal Radiol 2015; 44:831-7. [PMID: 25672947 DOI: 10.1007/s00256-015-2111-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/19/2014] [Accepted: 01/26/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of this article are to review the imaging characteristics of ischiofemoral impingement (IFI), summarize measurement thresholds for radiologic diagnosis based on a meta-analysis of the literature and raise awareness among radiologists and clinicians of this entity. MATERIALS AND METHODS A PubMed search restricted to the English language containing the keywords "ischiofemoral impingement" and "quadratus femoris MRI" was performed, and citations in these articles were also used to identify a total of 27 studies discussing ischiofemoral impingement. After excluding case reports and non-representative studies, there were five remaining articles including 193 hip MRIs of IFI in 154 subjects (133 female, 21 male) and 135 asymptomatic control hip MRIs from 74 subjects (55 female, 19 male). Additionally, we performed a retrospective database search of pelvic and hip MRI reports from our institution including the terms "quadratus femoris" or "ischiofemoral impingement" from a 9-year period and 24 hip MRIs from 21 patients (18 female, 3 male) with IFI with 5 asymptomatic contralateral control hip MRIs identified. In all, 217 hip MRIs of IFI and 140 control cases were included. A meta-analysis of these hip MRIs was conducted to determine optimal thresholds of the ischiofemoral space (IFS) and quadratus femoris space (QFS) for identifying IFI. RESULTS Cases of IFI showed significantly smaller IFS and QFS compared to controls (14.91 ± 4.8 versus 26.01 ± 7.98 and 9.57 ± 3.7 versus 15.97 ± 6.07, measured in mm, respectively, p < 0.0001 for both). Pooled analysis revealed that for IFS, using a cutoff of ≤ 15 mm yielded a sensitivity of 76.9%, specificity of 81.0% and overall accuracy of 78.3%. For QFS, a cutoff of ≤ 10.0 mm resulted in 78.7% sensitivity, 74.1% specificity and 77.1% overall accuracy. CONCLUSION IFI is a potential cause of hip pain that can be accurately diagnosed with MRI in conjunction with clinical findings. Using the proposed measurement thresholds may better identify patients with this impingement syndrome so that optimal treatment options can be pursued.
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Kim I, Kim H, Park K, Karki S, Khadka P, Jo K, Kim SY, Ro J, Lee J. Viscoelastic interactions between polydeoxyribonucleotide and ophthalmic excipients. Drug Dev Ind Pharm 2015; 42:231-7. [PMID: 26023993 DOI: 10.3109/03639045.2015.1040417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study investigated the interaction between polydeoxyribonucleotide (PDRN) and several ionic and nonionic isotonic agents, thickeners and a preservative that were employed as excipients in ophthalmic preparations. Interaction of each individual excipient and PDRN aqueous solution was evaluated by analyzing their rheological properties. Rheological properties of PDRN solutions were evaluated by dynamic oscillatory shear tests and values of elastic modulus (G'), viscous modulus (G″) and loss tangent (tan δ) were used to assess the relative changes in viscoelastic properties. At given concentrations, sodium chloride was found to show alteration in viscoelastic properties of PDRN solution while nonionic isotonic agents like d-glucose and d-sorbitol did not alter them. Similarly, nonionic water soluble polymers like polyvinylpyrrolidone (PVP) and hydroxypropyl methylcellulose (HPMC) also did not interact with PDRN to alter the viscoelastic properties. However, there were changes observed when carbopol 940 was used as a thickener. Therefore, PDRN was found to interact with ionic excipients and the interactions were negligible when nonionic materials were examined, which suggests that nonionic excipients are suitable to be formulated with PDRN.
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Affiliation(s)
- Iksoo Kim
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
| | - Hyeongmin Kim
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
| | - Kyunghee Park
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
| | - Sandeep Karki
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
| | - Prakash Khadka
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
| | - Kanghee Jo
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
| | - Seong Yeon Kim
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
| | - Jieun Ro
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
| | - Jaehwi Lee
- a Pharmaceutical Formulation Design Laboratory , College of Pharmacy, Chung-Ang University , Seoul , Korea
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