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Wu WT, Chang KV, Özçakar L. Integrating Ultrasound-Guided Multifidus Injections with Repeated Peripheral Magnetic Stimulation for Low Back Pain: A Feasibility Study. J Pain Res 2024; 17:2873-2880. [PMID: 39247174 PMCID: PMC11380848 DOI: 10.2147/jpr.s473079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 08/18/2024] [Indexed: 09/10/2024] Open
Abstract
Background Low back pain is a globally prevalent musculoskeletal issue. Repetitive peripheral magnetic stimulation (rPMS) is emerging as a promising modality for managing musculoskeletal pain, while ultrasound-guided lumbar facet/multifidus injections are a potential therapeutic option for low back pain. This study explores the feasibility of combining these two treatments for managing low back pain. Materials and Methods Ultrasound-guided injections were administered using 5 mL of 50% dextrose and 5 mL of 1% lidocaine. Bilateral injections targeted the L4/L5 and L5/S1 facet joints with 1 mL at each site, and the remaining 8 mL was distributed over the multifidus muscles using peppering techniques. Following injections, rPMS therapy was conducted with the TESLA Stym® device, targeting the bilateral lumbosacral region over 12 sessions. Pain intensity was measured using the visual analog scale (VAS), and disability was assessed with the Oswestry disability index (ODI) at baseline, after six sessions, and after 12 sessions of rPMS. Results Three participants were enrolled. Baseline VAS and ODI scores were 8.33 ± 0.29 cm and 49.63 ± 1.28%, respectively. After six rPMS sessions, VAS and ODI scores changed to 4.33 ± 3.75 cm and 21.48 ± 19.42%, respectively. After 12 sessions, VAS decreased to 0.83 ± 1.44 cm and ODI to 5.19 ± 8.98%. Significant differences were observed between baseline and final assessments. Conclusion Combining ultrasound-guided lumbar facet/multifidus injections with rPMS shows promise for treating low back pain. However, long-term efficacy and comparison with conventional treatments require further investigation through prospective randomized controlled trials.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Pruidze P, Rossmann T, Schwendt KM, Liederer A, Rauschka H, Weninger WJ, Meng S. Ultrasound-Guided Blockade of the Lateral Cutaneous Branch of the Iliohypogastric Nerve to Differentiate Neuropathy From Greater Trochanteric Pain Syndrome: Cadaver Study and Initial Case Series. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00315-6. [PMID: 39217027 DOI: 10.1016/j.ultrasmedbio.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/19/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Neuropathy of the lateral cutaneous branch of the iliohypogastric nerve (LCBIN) may represent a differential diagnosis for greater trochanteric pain syndrome (GTPS). Ultrasound-guided neural blockade of the LCBIN may lead to diagnosis of this neuropathy. The aim of this study was to evaluate the accuracy of ultrasound-guided nerve block in cadavers and to present a first clinical case series of patients with neuropathy of the LCBIN where the workup for GTPS remained unremarkable. Ultrasound-guided nerve block led to pain relief in these patients, indicating LCBIN neuropathy. METHODS First, ultrasound-guided injections at the LCBIN were performed bilaterally in 24 fresh, non-frozen, non-embalmed body donors. Accuracy and nerve localization were validated by anatomic dissection. Second, a clinical case series of nine patients with suspected GTPS who underwent ultrasound-guided diagnostic LCBIN blockade was retrospectively analyzed. RESULTS Ultrasound-guided injections at the LCBIN yielded 91.7% accuracy (95% confidence interval: 0.80-0.98). On the right side the nerve was found within a range of 3-14 cm from the anterior superior iliac spine, and within a range of 7-15 cm on the left side. This clinical case series indicates that ultrasound-guided blockade at the LCBIN provides temporary pain relief and indicates the presence of LCBIN neuropathy. CONCLUSION Ultrasound has demonstrated high accuracy for localization and injection guidance in the examination of LCBIN. Ultrasound-guided injection of local anesthetics may help to identify LCBIN neuropathy as a differential diagnosis in patients with suspected GTPS.
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Affiliation(s)
- Paata Pruidze
- Division of Anatomy, Medical University of Vienna, Austria
| | - Tobias Rossmann
- Division of Anatomy, Medical University of Vienna, Austria; Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | | | | | - Helmut Rauschka
- Department of Neurology, Donaustadt Clinic, Vienna, Austria; Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
| | | | - Stefan Meng
- Division of Anatomy, Medical University of Vienna, Austria; Department of Radiology, Hanusch Hospital, Vienna, Austria.
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3
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Wu WT, Chang KV, Ricci V, Özçakar L. Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:179-187. [PMID: 38925874 PMCID: PMC11294799 DOI: 10.12701/jyms.2024.00416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Hung CY, Wang B, Chang HC, Wu WT, Liu PT, Chang KV, Su DCJ, Mezian K, Ricci V, Özçakar L. Pictorial Essay on Ultrasound and Magnetic Resonance Imaging of Paraspinal Muscles for Myofascial Pain Syndrome. Life (Basel) 2024; 14:499. [PMID: 38672769 PMCID: PMC11051048 DOI: 10.3390/life14040499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.
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Affiliation(s)
- Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan;
| | - Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, Taipei 24213, Taiwan;
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
| | | | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, 12800 Prague, Czech Republic;
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Department of Biomedical and Neuromotor Science, Istituto di Ricovero e Cura a Carattere Scientifico Rizzoli Orthopedic Institute, 40136 Bologna, Italy;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
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Diwan SM, Dongre HV, Bhong G, Sancheti P. Ultrasound-guided Parasagittal Infraclavicular Block for Patients without Neurostimulation Endpoints: A Case Report in Crush Injuries of the Upper Limb. J Med Ultrasound 2024; 32:183-185. [PMID: 38882608 PMCID: PMC11175369 DOI: 10.4103/jmu.jmu_92_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 06/18/2024] Open
Abstract
Evoked motor responses (distal muscle responses) to a specific nerve stimulation are considered an endpoint. Often in crush injuries of the upper limb below the level of the elbow, the distal muscle responses are irrelevant. We report 14 cases of crush injuries of the upper limb that underwent an amputation below the level of the elbow. A parasagittal ultrasound-guided infraclavicular block without neurostimulation was administered in all patients. A reliable local anesthetic (LA) spread either in the perineural or perivascular area is considered adequate. Adequate intraoperative anesthesia and postoperative analgesia were achieved with the deposition of LA beneath the axillary artery.
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Affiliation(s)
| | | | - Ganesh Bhong
- Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India
| | - Parag Sancheti
- Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India
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Le VT, Nguyen CH, Do PT, Nguyen AM, Vo KH. Guidance of Nerve Stimulator and Ultrasound for Transforaminal Epidural Steroid Injection in Lumbosacral Radicular Pain : A Single Institution Experience in Vietnam. J Korean Neurosurg Soc 2024; 67:194-201. [PMID: 37661090 PMCID: PMC10924910 DOI: 10.3340/jkns.2023.0002] [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: 01/02/2023] [Revised: 03/15/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical feasibility of the combination of ultrasound and nerve stimulator guidance in transforaminal epidural steroid injections (TESIs) to manage lumbosacral chronic radicular pain. METHODS Using the combination of nerve stimulator and ultrasound guidance, TESIs were performed in 125 segments of 78 patients who presented with chronic lumbar radicular pain. Demographic characteristics and surgical outcomes were recorded on admission, pre-procedural and post-procedural for 1-week, 1-month, 3-month, and 6-month follow-ups. The result was measured using the Numeric rating scale (NRS) and Oswestry disability index (ODI). RESULTS Patients who received TESIs showed significant improvements on two evaluation tools (NRS, ODI), compared to that before procedure (p<0.001). No significant complications were observed for 6 months' follow-up. CONCLUSION The result suggests that a combination of ultrasound and nerve stimulator guidance in transforaminal epidural injections is safe, reliable and effective for short-term management of lumbar disc herniation. It is a promising technique and has shown good results in providing intermediate pain relief.
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Affiliation(s)
- Viet-Thang Le
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
- Pain Management Unit, Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Chi Hue Nguyen
- Department of Anesthesia, Intensive Care and Pain Management, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Phuoc Trong Do
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
- Pain Management Unit, Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Anh Minh Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
- Pain Management Unit, Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Khoi Hong Vo
- Department of Neurology, Hanoi Medical University, Hanoi, Vietnam
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Lai KKL, Lee TTY, Lau HHT, Chu WCW, Cheng JCY, Castelein RM, Schlösser TPC, Lam TP, Zheng YP. Monitoring of Curve Progression in Patients with Adolescent Idiopathic Scoliosis Using 3-D Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:384-393. [PMID: 38114347 DOI: 10.1016/j.ultrasmedbio.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The aim of the work described here was to determine whether 3-D ultrasound can provide results comparable to those of conventional X-ray examination in assessing curve progression in patients with adolescent idiopathic scoliosis (AIS). METHODS One hundred thirty-six participants with AIS (42 males and 94 females; age range: 10-18 y, mean age: 14.1 ± 1.9 y) with scoliosis of different severity (Cobb angle range: 10º- 85º, mean: of 24.3 ± 14.4º) were included. Each participant underwent biplanar low-dose X-ray EOS and 3-D ultrasound system scanning with the same posture on the same date. Participants underwent the second assessment at routine clinical follow-up. Manual measurements of scoliotic curvature on ultrasound coronal projection images and posterior-anterior radiographs were expressed as the ultrasound curve angle (UCA) and radiographic Cobb angle (RCA), respectively. RCA and UCA increments ≥5º represented a scoliosis progression detected by X-ray assessment and 3-D ultrasound assessment, respectively. RESULTS The sensitivity and specificity of UCA measurement in detecting scoliosis progression were 0.93 and 0.90, respectively. The negative likelihood ratio of the diagnostic test for scoliosis progression by the 3-D ultrasound imaging system was 0.08. CONCLUSION The 3-D ultrasound imaging method is a valid technique for detecting coronal curve progression as compared with conventional radiography in follow-up of AIS. Substituting conventional radiography with 3-D ultrasound is effective in reducing the radiation dose to which AIS patients are exposed during their follow-up examinations.
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Affiliation(s)
- Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong; Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong
| | - Heidi Hin-Ting Lau
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jack Chun-Yiu Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - René Marten Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom P C Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tsz-Ping Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong; Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong.
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Bruckmoser R, Antoniadis G, Katzensteiner M, Wutte C, Schlagheck J, Stuby FM, Strowitzki M, Leister I. High-resolution ultrasound of the supra- and infraclavicular levels of the brachial plexus including the axillary nerve: imaging anatomy based on multiplanar reconstructions and technical guide. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023. [PMID: 38151035 DOI: 10.1055/a-2191-1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
PURPOSE The diagnosis of peripheral nerve injuries remains challenging. Electromyography and nerve conduction studies do not allow precise localization of the lesion and differentiation between lesions in continuity and non-continuity in cases with complete axonotmesis. Improved ultrasound technology allows the examination of almost the entire peripheral nervous system. The complex sono-anatomy of the brachial plexus outside of the standard scanning planes makes it difficult to access this region. METHODS On the basis of the Visible Human Project of the National Institutes of Health (NIH), multiplanar reconstructions were created with the 3D Slicer open-source software in the various planes of the ultrasound cross-sections. The ultrasound examination itself and the guidance of the ultrasound probe in relation to the patient were recorded as video files and were synchronized through the audio channel. Subsequently, image matching was performed. RESULTS Multiplanar reconstructions facilitate visualization of anatomical regions which are challenging to access thereby enabling physicians to evaluate the course of the peripheral nerve of interest in dynamic conditions. Sonographically visible structures could be reproducibly identified in single-frame analysis. CONCLUSION With precise knowledge of the ultrasound anatomy, the nerve structures of the brachial plexus can also be dynamically assessed almost in their entire course. An instructional video on ultrasound of the brachial plexus supplements this manuscript and has been published on Vimeo.com.
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Affiliation(s)
| | | | | | | | | | - Fabian M Stuby
- Trauma and Orthopedic Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | | | - Iris Leister
- ParaMove, SCI Research Unit, BG Unfallklinik Murnau, Murnau, Germany
- Spinal Cord Injury Center, Clinical Research Unit, BG Unfallklinik Murnau, Murnau, Germany
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
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9
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Shojaie P, Botchu R, Iyengar K, Drakonaki E, Sharma GK. Ultrasound-guided median nerve hydrodissection of pronator teres syndrome: a case report and a literature review. J Ultrason 2023; 23:e165-e169. [PMID: 37701054 PMCID: PMC10494808 DOI: 10.15557/jou.2023.0026] [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: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 09/14/2023] Open
Abstract
Aim of the study To describe the sonographic appearance of pronator teres syndrome and the role of ultrasound-guided hydrodissection for its management. Case description Pronator teres syndrome is a well-known compressive neuropathy of the median nerve between the two heads of pronator teres. However, the clinical presentation of this syndrome can be indolent with vague pain at the proximal volar forearm leading to a delay in diagnosis. We describe our experience in the management of pronator teres syndrome in a healthy young badminton player with ultrasound-guided median nerve hydrodissection. We highlight the clinical presentation, the role of dynamic Ultrasound scan (USS) in the diagnosis and effective treatment of pronator teres syndrome. Conclusions In conclusion, managing PTS can be challenging, and this case highlights the importance of ultrasound-guided hydrodissection, when conservative measures have failed to improve the symptoms. Further studies are required to assess and compare the long-term outcomes of these interventions.
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Affiliation(s)
- Parham Shojaie
- Medical School, Aston Medical School, Aston, United Kingdom
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, United Kingdom
| | - Karthikeyan Iyengar
- Department of Orthopaedics, South Port and Ormskirk Hospital NHS Trust, Southport, United Kingdom
| | - Elena Drakonaki
- Department of Anatomy, Clinical Radiologist University of Crete, Crete, Greece
| | - Gaurav Kant Sharma
- Department of Musculoskeletal Radiology, Jaipur Institute of Pain & Sports Injuries (JIPSI), Jaipur, India
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Hashiba J, Yokota H, Abe K, Sekiguchi Y, Ikeda S, Sugiyama A, Kuwabara S, Uno T. Ultrasound-based radiomic analysis of the peripheral nerves for differentiation between CIDP and POEMS syndrome. Acta Radiol 2023; 64:2627-2635. [PMID: 37376758 DOI: 10.1177/02841851231181680] [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] [Indexed: 06/29/2023]
Abstract
BACKGROUND Demyelinating peripheral neuropathy is characteristic of both polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP). We hypothesized that the different pathogeneses underlying these entities would affect the sonographic imaging features. PURPOSE To investigate whether ultrasound (US)-based radiomic analysis could extract features to describe the differences between CIDP and POEMS syndrome. MATERIAL AND METHODS In this retrospective study, we evaluated nerve US images from 26 with typical CIDP and 34 patients with POEMS syndrome. Cross-sectional area (CSA) and echogenicity of the median and ulnar nerves were evaluated in each US image of the wrist, forearm, elbow, and mid-arm. Radiomic analysis was performed on these US images. All radiomic features were examined using receiver operating characteristic analysis. Optimal features were selected using a three-step feature selection method and were inputted into XGBoost to build predictive machine-learning models. RESULTS The CSAs were more enlarged in patients with CIDP than in those with POEMS syndrome without significant differences, except for that of the ulnar nerve at the wrist. Nerve echogenicity was significantly more heterogeneous in patients with CIDP than in those with POEMS syndrome. The radiomic analysis yielded four features with the highest area under the curve (AUC) value of 0.83. The machine-learning model showed an AUC of 0.90. CONCLUSION US-based radiomic analysis has high AUC values in differentiating POEM syndrome from CIDP. Machine-learning algorithms further improved the discriminative ability.
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Affiliation(s)
- Jun Hashiba
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kota Abe
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukari Sekiguchi
- Department of Neurology, JR Tokyo General Hospital, Tokyo, Japan
| | - Shinobu Ikeda
- Devision of Laboratory Medicine, Chiba University Hospital, Chiba, Japan
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Szabó G, Madár I, Hudelist G, Arányi Z, Turtóczki K, Rigó J, Ács N, Lipták L, Fancsovits V, Bokor A. Visualization of sacral nerve roots and sacral plexus on gynecological transvaginal ultrasound: feasibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:290-299. [PMID: 36938682 DOI: 10.1002/uog.26204] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate the feasibility of identifying and measuring the normal sacral plexus (SP) on gynecological transvaginal ultrasound (TVS) examination. METHODS This was a prospective observational study conducted at a single tertiary gynecological referral center, including consecutive women undergoing TVS for various indications between November 2021 and January 2022. A standardized assessment of the pelvic organs was performed and the presence of any congenital or acquired uterine pathology or ovarian abnormality was recorded. Visualization of the right and left SP was attempted in all cases. The success rate and the time needed to identify the SP were recorded and measurements of the SP were made. RESULTS A total of 326 patients were included in the study. In all women, the SP was identified successfully on at least one side. SP were visualized bilaterally in 317 (97.2% (95% CI, 94.4-98.5%)) women. Only the right SP was seen in 3/326 (0.9% (95% CI, 0.2-2.7%)) and only the left in 6/326 (1.8% (95% CI, 0.6-4.0%)) (P = 0.5048). There was no significant difference in the median time required to visualize the right vs left SP (9.0 (interquartile range (IQR), 8.0-10.0) s vs 9.0 (IQR, 8.0-10.0) s; P = 0.0770). The median transverse diameter of the right SP was 15.0 (IQR, 14.2-15.6) mm and that of the left SP was 14.9 (IQR, 14.4-15.6) mm. CONCLUSIONS We describe a novel method which allows for the consistent and rapid identification of the SP on TVS. Integrating assessment of the SP into routine pelvic TVS may be helpful particularly for women suffering from deep endometriosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G Szabó
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - I Madár
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - G Hudelist
- Department of Gynaecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
- Rudolfinerhaus Private Clinic and Campus, Vienna, Austria
| | - Z Arányi
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - K Turtóczki
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - J Rigó
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Clinical Studies in Obstetrics and Gynaecology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - N Ács
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - L Lipták
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - V Fancsovits
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - A Bokor
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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12
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Chang KV. Ultrasound Diagnosis and Guided Intervention of Musculoskeletal/Neuromuscular Pathology 2022. Diagnostics (Basel) 2023; 13:diagnostics13111945. [PMID: 37296797 DOI: 10.3390/diagnostics13111945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
The field of musculoskeletal medicine has been revolutionized by the introduction of ultrasound imaging [...].
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
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13
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Ricci V, Mezian K, Chang KV, Tarantino D, Güvener O, Gervasoni F, Naňka O, Özçakar L. Ultrasound Imaging and Guidance for Cervical Myofascial Pain: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3838. [PMID: 36900848 PMCID: PMC10001397 DOI: 10.3390/ijerph20053838] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Cervical myofascial pain is a very common clinical condition in the daily practice of musculoskeletal physicians. Physical examination is currently the cornerstone for evaluating the cervical muscles and identifying the eventual presence of myofascial trigger points. Herein, the role of ultrasound assessment in precisely localizing them is progressively mounting in the pertinent literature. Moreover, using ultrasound, not only the muscle tissue but also the fascial and neural elements can be accurately located/evaluated. Indeed, several potential pain generators, in addition to paraspinal muscles, can be involved in the clinical scenario of cervical myofascial pain syndrome. In this article, the authors extensively reviewed the sonographic approach for cervical myofascial pain in order to better diagnose or guide different procedures that can be performed in the clinical practice of musculoskeletal physicians.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital, Charles University, 12800 Prague, Czech Republic
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei Hu Branch, Taipei 10845, Taiwan
| | - Domiziano Tarantino
- Department of Public Health, Rehabilitation Unit, University Federico II of Naples, 80131 Naples, Italy
| | - Orhan Güvener
- Department of Physical and Rehabilitation Medicine, Mersin University Medical School, 33000 Mersin, Turkey
| | - Fabrizio Gervasoni
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey
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14
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Kang BH, Lee DW, Kang S, Yoon JS. Risk assessment of dorsal scapular nerve injury in the medial scapular area associated with upper extremity position: An ultrasonographic study. Muscle Nerve 2023; 67:39-44. [PMID: 36354084 DOI: 10.1002/mus.27750] [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: 05/16/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS Injuries to the dorsal scapular nerve (DSN) in the interscapular region are relatively uncommon. Physicians may therefore underestimate the risk of damage to the DSN during procedures. The aim of this study was to identify the topographic position of the DSN in the interscapular region and to identify injection positions for the upper extremities that minimize the risk of damage to the DSN during procedures. METHODS The positional relationships between the DSN and scapula were quantified by ultrasonography in 46 healthy volunteers. The distances between the medial scapular line and DSN and the DSN depths from the surface in Zones 1 (the superior angle), 2 (the scapular spine), and 3 (between the scapular spine and inferior angle) were measured in the anatomical and contralateral shoulder touch positions (positions 1 and 2, respectively). RESULTS The DSN was located further away from the medial border of the scapula and closer to the skin in position 2 than in position 1. The horizontal distance of the DSN in Zone 2 differed significantly between the two positions (0.85 ± 0.38 vs 1.23 ± 0.38, P < .001). The results suggest a safe area as just medial to the medial scapular border in Zone 2 in position 2. The safety margin should be considered at least 1.5 cm medial to the medial border of the scapula in Zone 3 in position 1. DISCUSSION Performing invasive procedures in the interscapular region, appropriate individualized positioning may reduce the risk of DSN injury.
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Affiliation(s)
- Byung Heon Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Dae Wook Lee
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
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15
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Kim M, Goh D, Cho S, Noh Y, Hwang B. Serratus anterior plane block with ultrasound-guided hydrodissection for lateral thoracic pain caused by long thoracic nerve neuropathy - A case report. Anesth Pain Med (Seoul) 2022; 17:434-438. [PMID: 36317437 PMCID: PMC9663951 DOI: 10.17085/apm.21120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/18/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Long thoracic nerve (LTN) neuropathy occasionally occurs in young people who engage in various sports. It may have a traumatic or non-traumatic etiology. The landmark manifestation of LTN neuropathy is scapular winging; however, it can also occur without scapular winging and specific magnetic resonance imaging findings. CASE An 18-year-old male complained of right-sided lateral chest pain for 7 months. He was treated with medication, trigger point injection, and physical therapy but showed no improvement. Electromyelogram findings suggested LTN neuropathy in the right lateral chest. We performed a serratus anterior (SA) plane block with ultrasound (US)-guided hydrodissection and achieved pain relief. CONCLUSIONS We report the successful treatment of LTN neuropathy with an SA plane block and US-guided hydrodissection.
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Affiliation(s)
| | | | | | | | - Byeongmun Hwang
- Corresponding author: Byeongmun Hwang, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, 1 Gangwondaehak-gil, Chuncheon 24341, Korea Tel: 82-33-258-2238 Fax: 82-33-258-2271 E-mail:
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16
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Wu WT, Chang KV, Ozcakar L. Ultrasound Examination Facilitated the Diagnosis of an Intercostal Schwannoma. Cureus 2022; 14:e26079. [PMID: 35865427 PMCID: PMC9293252 DOI: 10.7759/cureus.26079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 12/01/2022] Open
Abstract
Ultrasound imaging is known for its capability in scrutinizing superficial soft tissue disorders. We report a rare case of a 71-year-old male who presented with a history of rectal cancer with lymph node metastasis and had complete remission after surgery and chemotherapy. He had a palpable mass over the right anterior lower chest, which became gradually painful in the recent six months. Ultrasound facilitated the diagnosis of an intercostal schwannoma, which was also evident on magnetic resonance imaging and was confirmed by the histopathological study. Following the tumor excision, the patient had complete pain relief at the second-month follow-up. The case report highlighted the usefulness of ultrasound in clarification of the exact location of a chest wall tumor in relation to ribs, pleura, adjacent muscles, and intercostal neurovascular bundles as well as delineation of its echotexture and internal vascularity.
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17
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Easy to treat when the diagnosis is made: Three cases of clunealgia and the advantage of ultrasonography. Turk J Phys Med Rehabil 2022; 68:300-305. [PMID: 35989956 PMCID: PMC9366497 DOI: 10.5606/tftrd.2022.6550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022] Open
Abstract
In this article, we present three cases of clunealgia admitted with low back pain. Their pain relieved with superior cluneal nerve block. The posterior side of the iliac crest, which is the location where the superior cluneal nerve passes, was identified using a high-frequency linear transducer. The drug injected separates the erector spinae muscle and thoracolumbar fascia and accumulates between these two structures. All patients were discharged with a complete pain relief. This report highlights the fact that superior cluneal nerve entrapment should be kept in mind in patients with low back pain and that ultrasound guidance can correctly identify the infiltration and eliminate anesthetization of other surrounding structures.
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18
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Drakonaki EE, Adriaensen MEAPM, Al-Bulushi HIJ, Koliarakis I, Tsiaoussis J, Vanderdood K. Sonoanatomy of the ilioinguinal, iliohypogastric, genitofemoral, obturator, and pudendal nerves: a practical guide for US-guided injections. J Ultrason 2022; 22:e44-e50. [PMID: 35449704 PMCID: PMC9009344 DOI: 10.15557/jou.2022.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022] Open
Abstract
The ilioinguinal, iliohypogastric, genitofemoral, obturator, and pudendal nerves are the major sensory nerves that may be involved in chronic groin and genital pain with a significant impact on the quality of life of patients. The diagnosis remains clinical, and US-guided diagnostic injections using an anesthetic may aid in confirming the clinical suspicion. The anatomy of the peripheral nerves can be successfully studied using imaging. High-resolution ultrasound is increasingly used in the clinical setting for visualizing small peripheral nerves, and magnetic resonance imaging provides an anatomical overview of the relationship between small nerves and surrounding structures. In this pictorial assay, we review the anatomy and clinical relevance of the ilioinguinal, iliohypogastric, genitofemoral, obturator, and pudendal nerves. We summarize the various techniques for ultrasound identification, and present the ultrasound-guided infiltration techniques for injecting the ilioinguinal, iliohypogastric, genitofemoral, obturator, and pudendal nerves. Corresponding magnetic resonance images and clinical photos of the probe placement technique are provided for anatomical correlation. This paper is aimed to serve as a practical technical guide for physicians to familiarize themselves with the ultrasound anatomy of the major inguinal sensory nerves and to enable successful ultrasound identification and ultrasound-guided diagnostic or therapeutic infiltrations for pain management of the ilioinguinal, iliohypogastric, genitofemoral, obturator, and pudendal nerves.
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Affiliation(s)
- Elena E Drakonaki
- Department of Anatomy, School of Medicine, University of Crete, Greece.,Department of MSK imaging, Diagnostic and Interventional Ultrasound Practice, Greece
| | | | | | | | - John Tsiaoussis
- Department of Anatomy, School of Medicine, University of Crete, Greece
| | - Kurt Vanderdood
- Department of Medical Imaging, Zuyderland Medical Center, Netherlands
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19
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Wu WT, Chang KV, Lin CP, Yeh CC, Özçakar L. Ultrasound imaging for inguinal hernia: a pictorial review. Ultrasonography 2022; 41:610-623. [PMID: 35569836 PMCID: PMC9262670 DOI: 10.14366/usg.21192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/24/2022] [Indexed: 11/03/2022] Open
Abstract
Inguinal hernia is the most prevalent type of abdominal wall hernia. Indirect inguinal hernia is twice as common as direct inguinal hernia. Computed tomography and magnetic resonance imaging can be used to evaluate inguinal hernia, but these modalities are greatly limited by their cost and availability. Ultrasonography has emerged as the most convenient imaging tool for diagnosing inguinal hernia due to its advantages, such as portability and absence of radiation. The present pictorial review presents an overview on the use of ultrasonography in the evaluation of inguinal hernia with a particular emphasis on the regional anatomy, relevant scanning tips, identification of subtypes, postoperative follow-up, and diagnosis of pathologies mimicking inguinal hernia.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.,Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Chuan Yeh
- Department of Medical Education, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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20
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Scobie J, Winston P. Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:719054. [PMID: 36188857 PMCID: PMC9397777 DOI: 10.3389/fresc.2021.719054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
Spasticity is common and difficult to manage complication of cerebral palsy that significantly affects the function and quality of life of patients. This case study reports a 15-year-old male with quadriplegic cerebral palsy, Gross Motor Function Classification System 5 (GMFCS 5), who presented with significant bilateral adducted and internally rotated shoulders as a component of generalized spasticity. Spasticity in the lower limb of the patient had been treated with botulinum toxin A (BoNT-A) injections; however, the shoulder region was spared due to concerns of toxin spread and aspiration risk. Following diagnostic nerve blocks, the patient underwent bilateral cryoneurotomies of the right and left lateral pectoral nerves (LPNs) lasting 3.5 min for each lesion. One month after the cryoneurotomies, the range of motion (ROM) had improved from 86° to 133° on the right and 90° to 139° on the left. Improvements in ROM were retained at 9 months post-procedure. At 8.5 months following the cryoneurotomies, the caregiver reported improvements in upper body dressing, upper body washing, transferring, and the ability of the patient to remain sitting in his wheelchair for extended periods. Cryoneurotomy may be an effective procedure for improving shoulder ROM and specific functional outcomes for caregivers of patients with spasticity arising from cerebral palsy.
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Affiliation(s)
- Jack Scobie
- Island Medical Program, University of British Columbia, Victoria, BC, Canada
| | - Paul Winston
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Victoria, BC, Canada
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- *Correspondence: Paul Winston orcid.org/0000-0002-8403-6988
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21
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Sharma GK, Botchu R. Response to the "Comments on 'Dorsal scapular nerve entrapment neuropathy managed by ultrasound-guided hydrodissection - a case report'". J Ultrason 2021; 21:e270. [PMID: 34540286 PMCID: PMC8438505 DOI: 10.15557/jou.2021.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Rajesh Botchu
- Musculoskeletal Radiology, The Royal Orthopedic Hospital, United Kingdom
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22
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Matičič UB, Šumak R, Omejec G, Salapura V, Snoj Ž. Ultrasound-guided injections in pelvic entrapment neuropathies. J Ultrason 2021; 21:e139-e146. [PMID: 34258039 PMCID: PMC8264816 DOI: 10.15557/jou.2021.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
Pelvic entrapment neuropathies represent a group of chronic pain syndromes that significantly impede the quality of life. Peripheral nerve entrapment occurs at specific anatomic locations. There are several causes of pelvic entrapment neuropathies, such as intrinsic nerve abnormality or inflammation with scarring of surrounding tissues, and surgical interventions in the abdomen, pelvis and the lower limbs. Entrapment neuropathies in the pelvic region are not widely recognized, and still tend to be underdiagnosed due to numerous differential diagnoses with overlapping symptoms. However, it is important that entrapment neuropathies are correctly diagnosed, as they can be successfully treated. The lateral femoral cutaneous nerve, ischiadic nerve, genitofemoral nerve, pudendal nerve, ilioinguinal nerve and obturator nerve are the nerves most frequently causing entrapment neuropathies in the pelvic region. Understanding the anatomy as well as nerve motor and sensory functions is essential in recognizing and locating nerve entrapment. The cornerstone of the diagnostic work-up is careful physical examination. Different imaging modalities play an important role in the diagnostic process. Ultrasound is a key modality in the diagnostic work-up of pelvic entraptment neuropathies, and its use has become increasingly widespread in therapeutic procedures. In the article, the authors describe the background of pelvic entrapment neuropathies with special focus on ultrasound-guided injections.
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Affiliation(s)
- Urša Burica Matičič
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
| | - Rok Šumak
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Gregor Omejec
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Zaloška 7, Ljubljana, Slovenia
| | - Vladka Salapura
- Radiology Institute, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, Slovenia
| | - Žiga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, Slovenia
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23
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Chang KV, Wu WT, Yang YC, Özçakar L. Dynamic Ultrasound Imaging of the Brachial Plexus for Diagnosis of Thoracic Outlet Syndrome. Pain Pract 2021; 21:604-605. [PMID: 33340235 DOI: 10.1111/papr.12988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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24
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Lee MG, Jung WS, Go DY, Choi SU, Shin HW, Choi YS, Shin HJ. Efficacy of a single injection compared with triple injections using a costoclavicular approach for infraclavicular brachial plexus block during forearm and hand surgery: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e22739. [PMID: 33120774 PMCID: PMC7581144 DOI: 10.1097/md.0000000000022739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES It was recently proposed that a costoclavicular (CC) approach can be used in ultrasound (US)-guided infraclavicular brachial plexus block (BPB). In this study, we hypothesized that triple injections in each of the 3 cords in the CC space would result in a greater spread in the 4 major terminal nerves of the brachial plexus than a single injection in the CC space without increasing the local anesthetic (LA) volume. METHODS Sixty-eight patients who underwent upper extremity surgery randomly received either a single injection (SI group, n = 34) or a triple injection (TI group, n = 34) using the CC approach. Ten milliliters of 2% lidocaine, 10 mL of 0.75% ropivacaine, and 5 mL of normal saline were used for BPB in each group (total 25 mL). Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at 5 minutes intervals for 30 minutes immediately after LA administration. RESULTS Thirty minutes after the block, the blockage rate of all 4 nerves was significantly higher in the TI group than in the SI group (52.9% in the SI group vs 85.3% in the TI group, P = .004). But there was no significant difference in the anesthesia grade between the 2 groups (P = .262). The performance time was similar in the 2 groups (3.0 ± 0.9 minutes in the SI group vs 3.2 ± 1.2 minutes in the TI group, respectively; P = .54). DISCUSSION The TI of CC approach increased the consistency of US-guided infraclavicular BPB in terms of the rate of blocking all 4 nerves without increasing the procedure time despite administering the same volume of the LA.
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Affiliation(s)
- Mi Geum Lee
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon
| | - Wol Seon Jung
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon
| | - Doo Yeon Go
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Anam Hospital, Seoul
| | - Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Anam Hospital, Seoul
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Anam Hospital, Seoul
| | - Yun Suk Choi
- Department of Anesthesiology and Pain Medicine, JeJu National University College of Medicine, Jeju Hospital, Jeju, Republic of Korea
| | - Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Anam Hospital, Seoul
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25
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Siddiq MAB, Clegg D, Hasan SA, Rasker JJ. Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain 2020; 33:305-317. [PMID: 32989195 PMCID: PMC7532296 DOI: 10.3344/kjp.2020.33.4.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
Not all sciatica-like manifestations are of lumbar spine origin. Some of them are caused at points along the extra-spinal course of the sciatic nerve, making diagnosis difficult for the treating physician and delaying adequate treatment. While evaluating a patient with sciatica, straightforward diagnostic conclusions are impossible without first excluding sciatica mimics. Examples of benign extra-spinal sciatica are: piriformis syndrome, walletosis, quadratus lumborum myofascial pain syndrome, cluneal nerve disorder, and osteitis condensans ilii. In some cases, extra-spinal sciatica may have a catastrophic course when the sciatic nerve is involved in cyclical sciatica, or the piriformis muscle in piriformis pyomyositis. In addition to cases of sciatica with clear spinal or extra-spinal origin, some cases can be a product of both origins; the same could be true for pseudo-sciatica or sciatica mimics, we simply don’t know how prevalent extra-spinal sciatica is among total sciatica cases. As treatment regimens differ for spinal, extra-spinal sciatica, and sciatica-mimics, their precise diagnosis will help physicians to make a targeted treatment plan. As published works regarding extra-spinal sciatica and sciatica mimics include only a few case reports and case series, and systematic reviews addressing them are hardly feasible at this stage, a scoping review in the field can be an eye-opener for the scientific community to do larger-scale prospective research.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Physical Medicine and Rehabilitation Department, Brahmanbaria Medical College, Brahmanbaria, Bangladesh.,School of Health Sport and Professional Practice, University of South Wales, Pontypridd, United Kingdom
| | - Danny Clegg
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Suzon Al Hasan
- Physical Medicine and Rehabilitation Department, Rajshahai Medical College, Rajshahai, Bangladesh
| | - Johannes J Rasker
- Faculty of Behavioral Management and Social Sciences, Psychology Health and Technology, University of Twente, Enschede, The Netherlands
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26
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Ultrasound Imaging of the Paraspinal Muscles for Interscapular Pain After Back Massage. J Sport Rehabil 2020; 29:830-832. [DOI: 10.1123/jsr.2018-0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022]
Abstract
Muscle injuries are very common in sports medicine, but involvement of the paraspinal muscles is relatively rare. The diagnosis is usually clinical, but diagnostic imaging modalities (ie, ultrasound and magnetic resonance) identify, in detail, the anatomical site and extension of the lesion helping the physician plan a specific rehabilitation program. Likewise, the authors present an unusual case of a amateur volleyball player who suffered injury of the paraspinal muscles after a session of manual therapy with deep massage. The authors also highlight the potential role of ultrasound imaging in detecting muscle injuries not only in the limbs but also at the level of paraspinal region for prompt management and return to play.
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Gupta S, Clendenen S, Ferreira-Dos-Santos G, Hurdle MF. Ultrasound-Guided Intercostal Peripheral Nerve Stimulator Implantation: Technique Report and Feasibility Study in a Cadaver. PAIN MEDICINE 2020; 21:S32-S37. [PMID: 32804225 DOI: 10.1093/pm/pnaa012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to describe and validate a novel ultrasound-guided intercostal peripheral nerve stimulator implantation technique. METHODS The fifth to tenth ribs on both sides of an unembalmed cadaveric specimen were localized using a 15-6-MHz linear array transducer, counting distally from T-1 bilaterally. A single interventionist then implanted 12 peripheral nerve stimulators on the fifth through tenth ribs, six MicroLeads on the left side and six StimRouters on the right side, using an in-plane lateral to medial approach to the inferior border of the corresponding rib. After all the stimulators were implanted, their location was confirmed using fluoroscopy. Gross anatomic dissection was later performed for each of the stimulators placed, and the distance of the lead from the intercostal nerve and pleura was noted. RESULTS All leads were noted in an accurate position in the plane between the inner and innermost intercostal muscle, without any intrapleural placement. The distance of the leads from the intercostal nerves was on average 2.3 mm and 1.1 mm for MicroLead and StimRouter, respectively. CONCLUSIONS To our knowledge, this study is the first to determine the feasibility of ultrasound-guided peripheral nerve stimulator placement in close proximity to the pleura. All the stimulator leads were accurately placed using our ultrasound-guided technique and were within 0.5-3 mm from the intercostal nerve. Although this technique might prove technically challenging, the use of ultrasound for intercostal peripheral nerve stimulator implantation appears feasible and warrants further investigation to establish this as an acceptable technique for patients.
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Affiliation(s)
- Sahil Gupta
- Department of Pain Medicine, Southern Illinois Healthcare, Carbondale, Illinois
| | - Steven Clendenen
- Department of Pain Medicine, Southern Illinois Healthcare, Carbondale, Illinois
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Hsu PC, Chang KV, Mezian K, Naňka O, Wu WT, Yang YC, Meng S, Ricci V, Özçakar L. Sonographic Pearls for Imaging the Brachial Plexus and Its Pathologies. Diagnostics (Basel) 2020; 10:diagnostics10050324. [PMID: 32443708 PMCID: PMC7277999 DOI: 10.3390/diagnostics10050324] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 01/14/2023] Open
Abstract
The brachial plexus (BP) is a complicated neural network, which may be affected by trauma, irradiation, neoplasm, infection, and autoimmune inflammatory diseases. Magnetic Resonance Imaging is the preferred diagnostic modality; however, it has the limitations of high cost and lack of portability. High-resolution ultrasound has recently emerged as an unparalleled diagnostic tool for diagnosing postganglionic lesions of the BP. Existing literature describes the technical skills needed for prompt ultrasound imaging and guided injections for the BP. However, it remains particularly challenging for beginners to navigate easily while scanning its different parts. To address this, we share several “clinical pearls” for the sonographic examination of the BP as well as its common pathologies.
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Affiliation(s)
- Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.)
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Correspondence:
| | - Kamal Mezian
- Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine and General University Hospital in Prague, 12800 Prague, Czech Republic;
| | - Ondřej Naňka
- Institute of Anatomy, Charles University, First Faculty of Medicine, 12800 Prague, Czech Republic;
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11221, Taiwan;
| | - Stefan Meng
- Center for Anatomy and Cell Biology, Medical University of Vienna and Radiology, Hanusch Hospital, 1090 Vienna, Austria;
| | - Vincenzo Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico Rizzoli Orthopedic Institute, 40136 Bologna, Italy;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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Wu TJ, Hung CY, Lee CW, Lam S, Clark TB, Chang KV. Ultrasound-Guided Lumbar Intradiscal Injection for Discogenic Pain: Technical Innovation and Presentation of Two Cases. J Pain Res 2020; 13:1103-1107. [PMID: 32547174 PMCID: PMC7245455 DOI: 10.2147/jpr.s253047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/01/2020] [Indexed: 01/17/2023] Open
Abstract
We described two cases and the techniques for using the ultrasound (US) to guide lumbar intradiscal injection with platelet-rich plasma (PRP). The two cases suffered from chronic low back pain. Magnetic resonance imaging revealed posterior annular tear of the L5/S1 intervertebral disc (IVD) in the first case and L4/5 and L5/S1 IVDs in the second case. For the US-guided lumbar intradiscal injection, the patient was placed in a prone position. By placing the transducer in the axial plane at the interlaminar space, the needle was directed toward the center of the aimed IVD. The needle tip was ensured inside the IVD by using the end-feel of sudden reduction of resistance and the poking technique with the transducer oriented in the paramedian sagittal oblique plane. At the follow-up, both patients had significant improvement after the intradiscal PRP injections (visual analogue scale from 7.5 to 1.5 on average). The report indicated US-guided lumbar intradiscal PRP injection to be a feasible approach for treatments of low back pain. Familiarization of the anatomy and sonoanatomy of the lumbar spine is fundamental to achieve the success of intradiscal injection.
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Affiliation(s)
- Tsung-Ju Wu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.,Department of Physical Medicine and Rehabilitation, Yuanlin Christian Hospital, Changhua, Taiwan
| | - Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Chih-Wei Lee
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Stanley Lam
- Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Thomas B Clark
- Private Practice Ultrasonographic Training, Vista, CA, USA
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
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30
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Wang W, Wang Q. Sonographic measurements of normal C5-C8 nerve roots in children. Muscle Nerve 2020; 61:649-653. [PMID: 32012293 PMCID: PMC7216925 DOI: 10.1002/mus.26826] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
Introduction The aim of this study was to use ultrasound to measure the cervical nerve roots in normal children to determine normal reference values. Methods A total of 441 children of different ages at the Children's Hospital of Chongqing Medical University were examined by ultrasound. The diameter, circumference, and cross‐sectional area of the nerve roots were measured. Results Ultrasonographic measurements were consistent with the ranking C5 < C6 < C7. The C8 nerve root was thicker than C7 in 60% of the participants. The nerve root measurements increased with increasing age, height, weight, and body surface area. Discussion Normal reference ranges of the cervical nerve roots in children of different ages were established, and can serve as the basis for measurement in future studies.
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Affiliation(s)
- Wenying Wang
- Department of Ultrasound, West China Longquan Hospital Sichuan University, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Qiao Wang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Abstract
This review describes techniques for sonographic evaluation of the brachial plexus and multiple regional nerve branches in the neck, essential for successful implementation of neurosonology in the neck. High-frequency ultrasound transducers have the ability to produce superior, high-resolution images, allowing for superb depiction of nerve fascicular anatomy. Sonographic appearances of normal nerve anatomy and nerve-specific pathology are reviewed. Benefits and limitations of ultrasound nerve imaging compared with magnetic resonance imaging are discussed.
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Cho H, Kang S, Won HS, Yang M, Kim YD. New insights into pathways of the dorsal scapular nerve and artery for selective dorsal scapular nerve blockade. Korean J Pain 2019; 32:307-312. [PMID: 31569924 PMCID: PMC6813903 DOI: 10.3344/kjp.2019.32.4.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/02/2019] [Accepted: 08/23/2019] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this study was to clarify the topographical relationships between the dorsal scapular nerve (DSN) and the dorsal scapular artery (DSA) in the interscapular region to identify safe and convenient injection points related to DSN blockade. Methods Thirty shoulders of embalmed Korean cadavers and 50 live subjects were used for dissection and ultrasound (US) analysis. Results The running patterns of the DSA and DSN in the interscapular region were classified into 3 types. Type I was defined as nerves that were medial to the artery and parallel without changing location (80.0% of specimens). In type II (13.3%), the nerve and artery traversed one another only one time over their entire length. In type III (6.7%), the nerve and artery traversed one another, resembling a twist. Above the level of the scapular spine, the nerve was always medial to the artery. Below the scapular spine, the number of arteries was obviously decreased. Most of the arteries were lateral to the medial border of the scapula, except at the level of the superior angle of the scapula artery (SA). The positional tendency of the DSN toward the medial or lateral sides from the medial border of the scapula was similar. In US imaging of live subjects, the DSA was most observed at the level of the SA (94.0%). Conclusions Results of this study enhance the current knowledge regarding the pathway of the DSN and DSA and provide helpful information for selective diagnostic nerve blocks in the interscapular region.
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Affiliation(s)
- Hyunho Cho
- Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea.,Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Seungwoo Kang
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
| | - Hyung-Sun Won
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea.,Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
| | - Miyoung Yang
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea.,Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
| | - Yeon-Dong Kim
- Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea.,Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea.,Wonkwang Institute of Science, Wonkwang University School of Medicine, Iksan, Korea
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Wu WT, Chang KV, Han DS, Özçakar L. Musculoskeletal ultrasound workshops in postgraduate physician training: a pre- and post-workshop survey of 156 participants. BMC MEDICAL EDUCATION 2019; 19:362. [PMID: 31547816 PMCID: PMC6755693 DOI: 10.1186/s12909-019-1769-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/27/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Use of ultrasonography has revolutionized diagnosis of musculoskeletal disorders. Until now, few studies have investigated usefulness of a short-period workshop for musculoskeletal ultrasound (MSKUS) education. In this research, we attempted to explore (1) whether the physicians felt it useful to attend this type of courses for improving knowledge of sonoanatomy and scanning skills, (2) if the attendees' perceived confidence in musculoskeletal diagnoses by using ultrasound increased following the program and (3) whether differences existed in perceived usefulness and confidence regrading different sessions of the course. METHODS The target participants of the courses were postgraduate physicians without limitation of their specialties. The attendees' responses to questionnaires before and after the course were reviewed. The workshop contained didactic and practical sessions on 6 major joints in accordance with the scanning protocols of EURO-MUSCULUS/USPRM. The course usefulness and perceived confidence in MSKUS examination were evaluated using a 5-point Likert scale. Data relevant to participants' pre-workshop confidence levels were also analyzed. If any participant attended the course for more than 1 time, only their first survey was used for analysis. RESULTS The study included 156 participants. The average rating for the course usefulness ranged between 4 (useful) to 5 (very useful). There was no difference in perceived usefulness between the didactic and hands-on practical sessions. Participants' perceived confidence significantly increased after the workshop but appeared to be lowest for evaluation on the hip joint. Previous experience in performing MSKUS (in years) was consistently associated with the level of pre-workshop confidence. CONCLUSION A short period ultrasound workshop might be useful regarding making musculoskeletal diagnoses by using ultrasound based on an increase in post-workshop confidence in MSKUS examinations. The perceived confidence of hip scanning was lower than that of other joints after the course, indicating inadequacy of education in hip sonoanatomy and intensity of hand-on practice in the present program. An increase in the faculty-to-student ratio or length of practice in the hip section should be implemented in the future course.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Ricci V, Özçakar L. Ultrasound-guided injection of the erector spinae enthesis for iliac crest pain syndrome. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:69. [PMID: 31523255 PMCID: PMC6734669 DOI: 10.4103/jrms.jrms_1034_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vincenzo Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Ultrasound Imaging and Rehabilitation of Muscle Disorders: Part 1. Traumatic Injuries. Am J Phys Med Rehabil 2019; 98:1133-1141. [PMID: 31469682 DOI: 10.1097/phm.0000000000001307] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ultrasound imaging has several advantages that include the absence of radiation, portability, excellent resolution of neuromuscular structures, and the ability to perform dynamic examinations. Traumatic muscle injury can be comprehensively evaluated using static, dynamic, and Doppler ultrasound imaging. In the present review, we briefly discuss mechanisms of traumatic muscle injury, present ultrasound images of normal muscles, focus on ultrasound assessment of injured muscles, and concisely discuss treatment and rehabilitation options for muscle injuries.
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Chang KV, Wu WT. Is it possible to exactly visualize the superior cluneal nerve using ultrasound imaging? Reg Anesth Pain Med 2019:rapm-2019-100731. [PMID: 31473664 DOI: 10.1136/rapm-2019-100731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
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Ricci V, Özçakar L. Don't Be NervoUS! You Can Even See the PlexUS…. PM R 2019; 11:902-903. [PMID: 30688028 DOI: 10.1002/pmrj.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 01/23/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Vincenzo Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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38
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Sonoanatomy of Muscles Attaching to the Medial Scapular Border (Levator Scapulae, Rhomboid Minor, and Serratus Anterior) Revisited. Am J Phys Med Rehabil 2019; 98:e79-e80. [PMID: 30640725 DOI: 10.1097/phm.0000000000001136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Cassai A, Bonvicini D, Ruol M, Correale C, Furnari M. Erector spinae plane block combined with a novel technique for selective brachial plexus block in breast cancer surgery -a case report. Korean J Anesthesiol 2018; 72:270-274. [PMID: 30481947 PMCID: PMC6547240 DOI: 10.4097/kja.d.18.00266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022] Open
Abstract
Background The breast is innervated by the intercostal nerves and the brachial plexus. We propose a technique to perform breast surgery without general anesthesia using the erector spinae plane (ESP) block and selective block of four nerves that arise from the brachial plexus innervate the breast and the axilla (SBP block). Case A 77-year-old man with breast cancer was scheduled for radical mastectomy and axillary clearance. He had a previous history of myocardial infarction with dilated cardiomyopathy and severely impaired ejection fraction. The surgery was performed under regional anesthesia with combined ESP and SBP block. The patient did not require opioids or other supplemental analgesics intra- or postoperatively and was discharged uneventfully. Conclusions SBP is a novel block that selectively blocks branches of the brachial plexus that innervate the breast.
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Affiliation(s)
- Alessandro De Cassai
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Italy
| | - Daniele Bonvicini
- Department of Urgency and Emergency, Anesthesiology and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Michele Ruol
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Italy
| | - Christelle Correale
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Italy
| | - Maurizio Furnari
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Italy
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Chang KV, Mezian K, Naňka O, Wu WT, Lou YM, Wang JC, Martinoli C, Özçakar L. Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications. J Clin Med 2018; 7:E457. [PMID: 30469370 PMCID: PMC6262579 DOI: 10.3390/jcm7110457] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022] Open
Abstract
Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan.
| | - Kamal Mezian
- Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, 12800 Prague, Czech Republic.
| | - Ondřej Naňka
- Institute of Anatomy, Charles University, First Faculty of Medicine, 12800 Prague, Czech Republic.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan.
| | - Yueh-Ming Lou
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan.
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey.
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Ye L, Wen C, Liu H. Ultrasound-guided versus low dose computed tomography scanning guidance for lumbar facet joint injections: same accuracy and efficiency. BMC Anesthesiol 2018; 18:160. [PMID: 30404599 PMCID: PMC6223004 DOI: 10.1186/s12871-018-0620-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/17/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the feasibility, accuracy and efficiency of the facet joint injections in the lumbar spine by ultrasound guided versus lose dose computed tomography (CT) guidance. METHODS First the examination on the joint space of the facet joints of the lumbar spine was obtained by the ultrasound in 10 patients. Second forty patients were randomized assigned into two groups: ultrasound group and low dose CT group. Comparison was made in the clinical efficiency between the ultrasound-guided group and CT group. The feasibility, accuracy and efficiency of the ultrasound-guided lumbar facet joint injections were also evaluated. RESULTS A total of 88 lumbar facet joints from L1 to S1 were clearly visualized in the 10 patients. Both the ultrasound and the CT measurements showed the same average depth and lateral distance to the reference point (P > 0.05). And 86.5% of the facet joint injections (64/74) were correctly performed under the ultrasound guidance in the first time. The exact placement of the needle tips was evaluated by CT. After the lumbar facet joint injections, the clinical efficiency was almost the same in the ultrasound-guided group as in the CT group. CONCLUSIONS The lumbar facet joint space can be accurately demonstrated by ultrasound. The ultrasound-guided facet joint injection in the lumbar spine obtained almost the same satisfactory feasibility, accuracy and clinical efficiency compared with low dose CT. Ultrasound technique could provide the real-time monitoring. TRIAL REGISTRATION This study was registered on Chinese Clinical Trial Registry ( ChiCTR1800018819 , retrospective registered on 11/10/2018).
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Affiliation(s)
- Ling Ye
- Department of Pain management, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041 People’s Republic of China
| | - Chuanbing Wen
- Department of Pain Management, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province 610072 People’s Republic of China
| | - Hui Liu
- Department of Pain management, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041 People’s Republic of China
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Ricci V, Özçakar L. Ultrasound imaging of the superior cluneal nerve: Sonoanatomy of the osteo-fibrous tunnel revisited. Clin Anat 2018; 32:466-467. [PMID: 30281166 DOI: 10.1002/ca.23287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/11/2018] [Accepted: 09/28/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Vincenzo Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Yurdakul OV, Rezvani A. Can ultrasound be an assessment tool for sagittal spine mobility and chest expansion in patients with ankylosing spondylitis? Medicine (Baltimore) 2018; 97:e12609. [PMID: 30278577 PMCID: PMC6181605 DOI: 10.1097/md.0000000000012609] [Citation(s) in RCA: 2] [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
We aimed to examine whether ultrasound (US) is useful for evaluating spinal mobility and chest expansion in ankylosing spondylitis (AS) patients and determine a cutoff value to identify reduced sagittal lumbar mobility.Our cross-sectional study included 50 AS patients and 50 controls. Metric measurements and Bath AS indices were measured in AS patients. The distance between C6-C7, T11-T12, and L4-L5 vertebrae was measured, and the difference and percentage of difference between erect position and maximal cervical and lumbar flexion was calculated (T11-T12dif, T11-T12%, L4-L5dif, L4-L5%, T+L dif, T+L%). Intercostal divergence was measured 1.5 cm away on the left from the sternocostal space during maximum inhalation and maximum exhalation, and the difference and percentage of difference between them was calculated (ICdif, IC%).All metric measurements were lower in the AS group except for tragus-to-wall distance. T11-T12dif, T11-T12%, L4-L5dif, T+L dif, and T+L% values were higher in the control group, while other US measurements did not differ between the groups. All US measurements except ICdif and IC% correlated with the Bath AS Metrology Index.Thus, US may be used for assessing spinal mobility in patients with AS. T11-T12dif <0.79 cm may show decreased lumbar sagittal mobility.
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Affiliation(s)
| | - Aylin Rezvani
- Medipol University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
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