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Margenfeld F, Zendehdel A, Tamborrini G, Müller-Gerbl M. The advantages of utilizing different ultrasound imaging techniques on joints of human cadavers in the teaching of anatomy - A scoping review. Ann Anat 2024; 251:152179. [PMID: 37879500 DOI: 10.1016/j.aanat.2023.152179] [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: 06/26/2023] [Revised: 08/05/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND A common approach to define sonoanatomy is a reciprocal exchange of macroscopic and microscopic information in ultrasound imaging. High-resolution ultrasound has been long established and is crucial as an inexpensive and adaptable tool, not just in clinical settings but also while teaching anatomy. Early application of ultrasonography provides medical students with a couple of benefits: they acquire an improved understanding of anatomy and learn how to use it. METHODS A comprehensive literature review has been carried out, with relevant studies discovered in the following databases: MEDLINE, EMBASE, CENTRAL, BIOSIS Previews and Web of Science Core Collection. Gray literature was also considered in two different ways: (1) Regarding grey literature databases: National Gray Literature Collection. (2) For PhD theses and dissertations, the databases EThOS and Open Access Theses and Dissertations were screened for relevant studies by combining the keywords used in the search string. The reference lists of all relevant papers were scanned. Search process was performed on January 3rd, 2023. The search string was developed with the aid of and finally checked by a professional librarian. Only ultrasound studies on human cadavers were included, not animals or phantoms. If the studied subject was a joint, the article was included. Only B-Mode ultrasound was included, whereas Elastosonography, Doppler sonography and quantitative approaches including among others sound speed, backscatter attenuation were excluded. Intravascular, intraosseous, intraarticular, and three-dimensional or four-dimensional ultrasonography were also eliminated from the analysis. All appropriate information comprising articles, PhD theses, dissertations and chapters in textbooks were considered. There were solely English and German studies covered. There was no additional restriction on the publishing year. The included studies' general characteristics and ultrasound techniques were taken from them and examined. Using VOS viewer, a keyword analysis was also carried out. RESULTS 142 of the 8899 results that were returned by the search satisfied the requirements. With a quarter of the included studies, the knee joint was the most extensively studied joint, followed by the elbow joint (10.6%) and the shoulder joint (9.2%). The methodological analysis includes 125 studies. Both the sample size and the ultrasonographer's qualifications were diverse. The probe position and the ultrasound method were precisely documented so that a reader could duplicate them in about three-quarters of the included studies (72.8%). CONCLUSION The current study, in our perspective, is the first scoping review to screen ultrasound studies on human cadaver joints. A heterogeneous field was shown by the methodological investigation. We suggest using a uniform method for conducting and presenting ultrasound examinations in future studies.
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Affiliation(s)
- Felix Margenfeld
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland.
| | - Adib Zendehdel
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland
| | - Giorgio Tamborrini
- Swiss Ultrasound Center UZR and Institute for Rheumatology, Aeschenvorstadt 68, Basel 4051, Switzerland; Rheumatology Clinic, University Hospital of Basel, Basel 4001 Switzerland
| | - Magdalena Müller-Gerbl
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland
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Puebla DL, Apicella M, Mechanic OJ, Farrow RA. Point of care ultrasound needle guidance to assist diagnosis of acute gluteal compartment syndrome. Am J Emerg Med 2022; 62:147.e5-147.e7. [PMID: 36163064 DOI: 10.1016/j.ajem.2022.09.004] [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: 06/24/2022] [Revised: 08/18/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022] Open
Abstract
Gluteal compartments can be difficult to assess for acute compartment syndrome (ACS) compared to other fascial compartments due to their anatomy and rarity of presentation. Point-of-care ultrasound (POCUS) needle guidance may assist in obtaining accurate compartment pressure measurements within the gluteal compartments. We present a case in which a 69-year-old woman presented following a fall resulting in a superior prosthetic hip dislocation. One-hour post hip-reduction, the patient began to experience severe pain of the right leg, swelling to the gluteal region, and numbness to her foot. With consideration of a developing gluteal compartment syndrome in mind, POCUS was used to guide the needle of a compartmental pressure monitor system into the gluteal maximus and medius-minimus compartments which demonstrated elevated compartment pressures consistent with ACS. The patient was subsequently taken for emergent fasciotomy and hematoma evacuation. There has been limited investigation into compartment pressure measurement under US guidance versus a palpation/landmark-guided technique. This case shows the feasibility of US needle guidance when assessing compartment pressures for this uncommon diagnosis.
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Affiliation(s)
- Daniel L Puebla
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, 4300 Alton Road, Miami, FL, United States of America.
| | - Matthew Apicella
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, 4300 Alton Road, Miami, FL, United States of America
| | - Oren J Mechanic
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, 4300 Alton Road, Miami, FL, United States of America; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at FIU, 11200 SW 8th St, Miami, FL 33199, United States of America; Department of Medical Education, University of Miami Miller, School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United States of America
| | - Robert A Farrow
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, 4300 Alton Road, Miami, FL, United States of America; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at FIU, 11200 SW 8th St, Miami, FL 33199, United States of America
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Medina-Porqueres I, Martin-Garcia P, Sanz-De-Diego S, Gomez-Caceres A, Moya-Torrecilla F, Reyes-Eldblom M, Rosado-Velazquez D. Clinical and Functional Outcome of Meniscal Injuries Treated with Platelet-Rich Plasma: A Single-Center Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127118. [PMID: 35742366 PMCID: PMC9222768 DOI: 10.3390/ijerph19127118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Meniscal injuries are among the most frequently encountered conditions in the knee joint. Therapeutic approaches are diverse and are largely dependent on the extent and location of the injury. The purpose of this study was to describe the clinical and functional outcomes of an intraarticular and percutaneous platelet-rich plasma (PRP) injection regime in patients with stable meniscal injuries. Demographics, the type of tear, affected knee, surgical procedure, type of intervention, follow-up period, and outcomes were recorded in all cases. Patient-reported outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity level scale. Overall patient satisfaction, quality of life, and pain intensity were also assessed. A total of 38 cases (8 females) had sustained a stable meniscal lesion (32 medial, 6 lateral) and met the inclusion criteria. All of them received three intraarticular and percutaneous PRP injections. Patients receiving the PRP injection regime reported clinically (p = 0.000) and functionally (p = 0.000 and p = 0.001) significant improvement in all outcome measures during this interval. All patients reported they were very satisfied or satisfied with the outcome. The results of this study suggest that the treatment of stable meniscal injuries with percutaneous-intraarticular PRP injections can achieve a significant clinical and functional improvement.
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Affiliation(s)
- Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Malaga Football Club, Medical Services, 29011 Malaga, Spain; (A.G.-C.); (D.R.-V.)
- Correspondence:
| | - Pablo Martin-Garcia
- Onco-Hematology Unit, University Hospital Virgen de la Victoria, 29010 Malaga, Spain;
| | | | - Abel Gomez-Caceres
- Malaga Football Club, Medical Services, 29011 Malaga, Spain; (A.G.-C.); (D.R.-V.)
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Thein R, Tilbor I, Rom E, Herman A, Haviv B, Burstein G, Tenenbaum S. Return to sports after chronic anterior exertional compartment syndrome of the leg: Conservative treatment versus surgery. J Orthop Surg (Hong Kong) 2020; 27:2309499019835651. [PMID: 30909799 DOI: 10.1177/2309499019835651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM To evaluate whether surgical treatment for anterior chronic exertional compartment syndrome (CECS) of the lower leg will lead to full athletic activity recovery compared to conservative treatment. METHODS Patients diagnosed with anterior CECS of the leg were offered surgical treatment, as surgery considered today to be the mainstay of treatment. Patients unwilling to be treated surgically were treated conservatively. They were followed up, assessing both groups for pain, functional status, and the Tegner sports activity score with comparisons at diagnosis and following treatment. RESULTS Forty-three patients were treated for CECS (31; 72.1% with surgery and 12; 27.9% conservatively) with a mean follow-up of 28.15 (4.16-54.09) months. Reported pain improved at follow-up by 1.59 (0-6) points and by 4.27 ± (0-10) points in the conservatively and the surgically treated patient groups, respectively ( p = 0.014) with a mean change in the Tegner score of 0.09 (-5 to 5) and 3.22 (-4 to 7), respectively ( p = 0.009). Three patients in the conservatively treated group (25% of 12) and 24 patients in the operated group (77.4% of 31) reported full resumption of their pre-diagnosis activity level ( p = 0.001). CONCLUSION This study supports surgery as the treatment of choice for anterior CECS of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity.
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Affiliation(s)
- Ran Thein
- 1 Department of Orthopedic Surgery, Sheba Medical Center, Tel HaShomer, Tel Aviv University, Tel Aviv, Israel
- 2 Department of Orthopedic, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Tilbor
- 1 Department of Orthopedic Surgery, Sheba Medical Center, Tel HaShomer, Tel Aviv University, Tel Aviv, Israel
- 2 Department of Orthopedic, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Rom
- 1 Department of Orthopedic Surgery, Sheba Medical Center, Tel HaShomer, Tel Aviv University, Tel Aviv, Israel
- 2 Department of Orthopedic, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Herman
- 1 Department of Orthopedic Surgery, Sheba Medical Center, Tel HaShomer, Tel Aviv University, Tel Aviv, Israel
- 2 Department of Orthopedic, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Haviv
- 2 Department of Orthopedic, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- 3 Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Gideon Burstein
- 1 Department of Orthopedic Surgery, Sheba Medical Center, Tel HaShomer, Tel Aviv University, Tel Aviv, Israel
- 2 Department of Orthopedic, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Tenenbaum
- 1 Department of Orthopedic Surgery, Sheba Medical Center, Tel HaShomer, Tel Aviv University, Tel Aviv, Israel
- 2 Department of Orthopedic, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Musculoskeletal interventional procedures: With or without imaging guidance? Best Pract Res Clin Rheumatol 2016; 30:736-750. [PMID: 27931965 DOI: 10.1016/j.berh.2016.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/22/2022]
Abstract
Aspiration and injection of joints and soft tissues is an indispensable skill used in everyday practice by the clinical rheumatologist. Most rheumatologists recognise that performing these procedures using anatomical landmarks is not always successful, particularly in the case of small or infrequently injected joints, bursae or tendon sheaths. Musculoskeletal ultrasound confirms the local pathological-anatomical diagnosis and is the most applicable and feasible imaging method that can be applied in clinical practice in guiding musculoskeletal interventional procedures. From 1993, there has been substantial examination of the accuracy of landmark- and imaging-guided procedures. We have searched the literature and ascertained whether imaging techniques improve the accuracy of musculoskeletal procedures and whether the accuracy of needle placement can be translated into improved clinical outcome (efficacy).
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Winkes MB, Tseng CM, Pasmans HL, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Scheltinga MR. Accuracy of Palpation-Guided Catheter Placement for Muscle Pressure Measurements in Suspected Deep Posterior Chronic Exertional Compartment Syndrome of the Lower Leg: A Magnetic Resonance Imaging Study. Am J Sports Med 2016; 44:2659-2666. [PMID: 27407086 DOI: 10.1177/0363546516652113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A diagnosis of lower leg deep posterior chronic exertional compartment syndrome (dp-CECS) is made by a dynamic pressure measurement. The insertion of a pressure catheter is guided by anatomic landmarks (freehand) or by ultrasound. The catheter tip is ideally positioned in the tibialis posterior muscle (TP). The accuracy of in vivo catheter placement using lower leg magnetic resonance imaging (MRI) in healthy patients suspected of having dp-CECS has never been studied. PURPOSE To analyze whether a freehand catheter insertion results in accurate positioning in the TP as confirmed by MRI in patients with suspected dp-CECS. STUDY DESIGN Case series; Level of evidence, 4. METHODS Catheters were inserted into central portions of the TP using a standard puncturing technique guided by lower leg anatomic landmarks. After timed muscle pressure measurements during a standard provocative treadmill running test, lower leg MRI scans were obtained and evaluated by 2 skilled radiologists. Catheter tip placement was termed accurate (in the TP), suboptimal (in the deep posterior compartment but outside the TP), or inaccurate (outside the deep posterior compartment). RESULTS Between March 2013 and September 2014, a total of 24 patients (8 male, 16 female; mean age, 30 years [range, 18-54 years]) underwent an intracompartmental pressure (ICP) measurement, followed by MRI. Cardinal symptoms were pain during exertion (20% very severe, 53% severe, and 20% moderate) and tightness (29% very severe, 43% severe). Symptoms were bilateral in 74% of patients. Nine of the 24 patients were diagnosed with dp-CECS based on elevated ICPs. Of the 24 patients, catheter tip placement was accurate in 10 (42%), whereas suboptimal placement was achieved in 9 (38%). Five procedures were inaccurate (transition zone between the deep and superficial compartments, n = 3; in the superficial lower leg compartment, n = 2). Signs of a hematoma were found in 38% of the patients, although there were no associated clinical symptoms. CONCLUSION Palpation-guided placement of catheters for TP pressure measurements is suboptimal in more than half of the patients with suspected lower leg dp-CECS. Optimizing the pressure catheter tip positioning technique may improve diagnostic accuracy in dp-CECS.
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Affiliation(s)
- Michiel B Winkes
- Department of General Surgery, Máxima Medical Center, Veldhoven, the Netherlands
| | - Carroll M Tseng
- Department of Radiology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Huub L Pasmans
- Department of Radiology, Máxima Medical Center, Veldhoven, the Netherlands
| | | | - Adwin R Hoogeveen
- Department of Sports Medicine, Máxima Medical Center, Veldhoven, the Netherlands
| | - Marc R Scheltinga
- Department of General Surgery, Máxima Medical Center, Veldhoven, the Netherlands CARIM Research School, Maastricht University, Maastricht, the Netherlands
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Jang Y, Park GY, Park J, Choi A, Kim SY, Boulias C, Phadke CP, Ismail F, Im S. Survey of Botulinum Toxin Injections in Anticoagulated Patients: Korean Physiatrists' Preference in Controlling Anticoagulation Profile Prior to Intramuscular Injection. Ann Rehabil Med 2016; 40:279-87. [PMID: 27152278 PMCID: PMC4855122 DOI: 10.5535/arm.2016.40.2.279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate Korean physiatrists' practice of performing intramuscular botulinum toxin injection in anticoagulated patients and to assess their preference in controlling the bleeding risk before injection. Methods As part of an international collaboration survey study, a questionnaire survey was administered to 100 Korean physiatrists. Physiatrists were asked about their level of experience with botulinum toxin injection, the safe international normalized ratio range in anticoagulated patients undergoing injection, their tendency for injecting into deep muscles, and their experience of bleeding complications. Results International normalized ratio <2.0 was perceived as an ideal range for performing Botulinum toxin injection by 41% of the respondents. Thirty-six respondents replied that the international normalized ratio should be lowered to sub-therapeutic levels before injection, and 18% of the respondents reported that anticoagulants should be intentionally withheld and discontinued prior to injection. In addition, 20%–30% of the respondents answered that they were uncertain whether they should perform the injection regardless of the international normalized ratio values. About 69% of the respondents replied that they did have any standardized protocols for performing botulinum toxin injection in patients using anticoagulants. Only 1 physiatrist replied that he had encountered a case of compartment syndrome. Conclusion In accordance with the lack of consensus in performing intramuscular botulinum toxin injection in anticoagulated patients, our survey shows a wide range of practices among many Korean physiatrists; they tend to avoid botulinum toxin injection in anticoagulated patients and are uncertain about how to approach these patients. The results of this study emphasize the need for formulating a proper international consensus on botulinum toxin injection management in anticoagulated patients.
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Affiliation(s)
- Yongjun Jang
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihye Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Asayeon Choi
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada
| | - Chetan P Phadke
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada.; Faculty of Health, York University, Toronto, Canada
| | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. PM R 2015; 7:151-68.e12. [PMID: 25708351 DOI: 10.1016/j.pmrj.2015.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 12/23/2022]
Abstract
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based upon the evidence, the official AMSSM position relevant to each subject is made.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, University of California, Davis School of Medicine, Sacramento, CA; Tahoe Orthopedics and Sports Medicine, 1139 Third St, South Lake Tahoe, CA 96150.(∗); Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, IA(†).
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, IA(†)
| | - Erik Adams
- Midwest Sports Medicine Institute, Middleton, WI(‡)
| | - David Berkoff
- Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC(§)
| | - Andrew L Concoff
- Outpatient Musculoskeletal Rehabilitation, St Jude Medical Center, Fullerton, CA(¶)
| | - William Dexter
- Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA(#)
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN; Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN(∗∗)
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Abstract
Chronic exertional compartment syndrome is diagnosed based on historical and physical exam findings combined with elevated intracompartmental pressures. Direct static testing with a large bore needle device is the most common instrument used for diagnosis. Based on the most recent systematic reviews, there is poor evidence for the traditional diagnostic pressures used in practice with no standardization of the procedure. New research has introduced a standardized approach with dynamic testing of the limb with transducer-tipped catheters. Less invasive methods of testing using radiologic techniques are currently under investigation. A detailed understanding of the anatomy and physiology of the limb is paramount in executing a safe and accurate procedure.
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Affiliation(s)
- David Flick
- Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859
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American Medical Society for Sports Medicine position statement: interventional musculoskeletal ultrasound in sports medicine. Clin J Sport Med 2015; 25:6-22. [PMID: 25536481 DOI: 10.1097/jsm.0000000000000175] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based on the evidence, the official AMSSM position relevant to each subject is made.
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Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. Br J Sports Med 2014; 49:145-50. [PMID: 25330777 DOI: 10.1136/bjsports-2014-094219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. OBJECTIVE Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues. DESIGN Systematic review of the literature. RESULTS USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). CONCLUSIONS The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, California, USA Department of Physical Medicine and Rehabilitation, Mayo Clinic college of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, Iowa, USA
| | - Erik Adams
- Midwest Sports Medicine Institute, Middleton, Wisconsin, USA
| | - David Berkoff
- Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew L Concoff
- Outpatient Musculoskeletal Rehabilitation, St. Jude Medical Center, Fullerton, California, USA Department of Family Medicine, Division of Sports Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - William Dexter
- Maine Medical Center, Portland, Maine, USA Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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An Unusual Complication of Weightlifting: A Case Report. Ann Emerg Med 2014; 63:357-60. [DOI: 10.1016/j.annemergmed.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 11/23/2022]
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Brewer RB, Gregory AJM. Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment. Sports Health 2012; 4:121-7. [PMID: 23016078 PMCID: PMC3435913 DOI: 10.1177/1941738111426115] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Context: Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse. Evidence Acquisition: PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment. Results: Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary. Conclusion: Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians.
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