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Yen YS, Lin CH, Chiang CH, Wu CY. Ultrasound-Guided Sciatic Nerve Hydrodissection Can Improve the Clinical Outcomes of Patients with Deep Gluteal Syndrome: A Case-Series Study. Diagnostics (Basel) 2024; 14:757. [PMID: 38611670 PMCID: PMC11011499 DOI: 10.3390/diagnostics14070757] [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: 02/26/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Deep gluteal syndrome (DGS) is caused by sciatic nerve entrapment. Because fascial entrapment neuropathies may occur in multiple locations, ultrasound-guided nerve hydrodissection is a key component of DGS treatment. In this study, we examined the clinical outcomes of patients with DGS undergoing ultrasound-guided sciatic nerve hydrodissection. A 10 mL mixture consisting of 5% dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve hydrodissection. Clinical outcomes were evaluated using Numeric Rating Scale (NRS) scores of pain, the proportion of patients with favorable outcomes (reduction of ≥50% in pain), the duration for which patients exhibited favorable outcomes (percentage of follow-up duration), and the occurrence of major complications and minor side effects. A total of 53 patients were consecutively included and followed up for 3 to 19 months. After the initial injection, the NRS scores significantly improved at 1 week, 1 month, 3 months, and the final follow-up. Specifically, 73.6%, 71.7%, 64.2%, and 62.3% of the patients exhibited favorable outcomes at 1 week, 1 month, 3 months, and the final follow-up, respectively. The median duration for which the patients exhibited favorable outcomes was 84.7% of the follow-up period. Three patients (5.7%) experienced transient dizziness and vomiting, which resolved without further treatment. No vessel or nerve puncture was observed. Overall, ultrasound-guided sciatic nerve hydrodissection is a safe procedure that mitigates the pain associated with DGS. To achieve favorable outcomes, three consecutive injections 3 weeks apart are required.
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Affiliation(s)
- Yun-Shan Yen
- Department of Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600, Taiwan;
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600, Taiwan; (C.-H.L.); (C.-H.C.)
| | - Chen-Hao Chiang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600, Taiwan; (C.-H.L.); (C.-H.C.)
| | - Cheng-Yi Wu
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600, Taiwan; (C.-H.L.); (C.-H.C.)
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Sveva V, Farì G, Fai A, Savina A, Viva MG, Agostini F, Ranieri M, Megna M, Mangone M, Paoloni M, Bernetti A. Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review. J Pers Med 2024; 14:154. [PMID: 38392587 PMCID: PMC10890373 DOI: 10.3390/jpm14020154] [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: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Ultrasound-guided perineural hydrodissection (HD) is a novel technique that has been found to be effective in providing mechanical release of perineural adhesions and decompression of the nerve, reducing inflammation and edema and restoring its physiological function. It has a significant impact on chronic neuropathic pain (20 ± 4 weeks with VAS < 5 or VAS diminished by 2 points after the procedure). Carpal tunnel syndrome (CTS) is a common entrapment mononeuropathy, and its distribution is typically innervated by the median nerve. Patients with mild or moderate CTS may benefit from nonsurgical treatments or conservative therapies. This review was conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Four investigators assessed each title, abstract, and full-text article for eligibility, with disagreements being resolved by consensus with two experienced investigators. The qualitative assessment of the studies was carried out using the modified Oxford quality scoring system, also known as the modified Jadad score. Furthermore, risk of possible biases was assessed using the Cochrane collaboration tool. The results of this review suggest that US-guided HD is an innovative, effective, well-tolerated, and safe technique (11 out of 923 patients had collateral or side effects after the procedure). However, further studies comparing all drugs and with a larger sample population are required to determine the most effective substance.
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Affiliation(s)
- Valerio Sveva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Giacomo Farì
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy
| | - Annatonia Fai
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Alessio Savina
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Mattia Giuseppe Viva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy
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Zhou T, Wu Z, Gou X, Xia H, Ding J, Ai S. Local injection therapy for carpal tunnel syndrome: a network meta-analysis of randomized controlled trial. Front Pharmacol 2023; 14:1140410. [PMID: 37693911 PMCID: PMC10484596 DOI: 10.3389/fphar.2023.1140410] [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: 01/10/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Objective: Clinical research has shown that local injections for carpal tunnel syndrome reduce the symptoms of patients and enhance their quality of life considerably. However, there are several therapy options, and the optimal choice of regimen remains uncertain. Therefore, we comprehensively evaluated the variations in clinical efficacy and safety of several medications for treating carpal tunnel syndrome. Methods: Computer searches of Embase, PubMed, Cochrane Library, and Web of Science databases were used to collect articles of randomized controlled trials on local injections for treating carpal tunnel syndrome from database creation till 10 June 2023. Two researchers independently screened the literature, extracted information, evaluated the risk of bias in the included studies, and performed network Meta-analysis using Stata 17.0 software. Drug efficacy was assessed using symptom severity/function and pain intensity. Surface under the cumulative ranking curve (SUCRA) ranking was used to determine the advantage of each therapy. Results: We included 26 randomized controlled trials with 1896 wrists involving 12 interventions, such as local injections of corticosteroids, platelet-rich plasma, 5% dextrose, progesterone, and hyaluronidase. The results of the network meta-analysis showed the following: (i) symptom severity: at the 3-month follow-up, D5W combined with splinting (SUCRA = 95%) ranked first, and hyaluronidase (SUCRA = 89.6%) at 6 months; (ii) functional severity: either at the 3-month follow-up (SUCRA = 89.5%) or 6 months (SUCRA = 83.6%), iii) pain intensity: 5% dextrose in water combined with splinting was the most effective at the 3-month (SUCRA = 85%) and 6-month (SUCRA = 87.6%) follow-up. Conclusion: Considering the combination of symptoms/function and pain intensity, combining 5% dextrose in water with splinting is probably the treatment of choice for patients with carpal tunnel syndrome. It is more effective than glucocorticoids and no adverse effects have been observed. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022370525.
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Affiliation(s)
- TianQi Zhou
- College of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - ZhuoRao Wu
- College of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - XingYun Gou
- College of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - HaiSha Xia
- College of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - JiLin Ding
- Department of Rehabilitation Medicine, Mianyang Hospital, Chengdu University of Traditional Chinese Medicine, Mianyang, China
| | - ShuangChun Ai
- College of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Rehabilitation Medicine, Mianyang Hospital, Chengdu University of Traditional Chinese Medicine, Mianyang, China
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Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AES, Peng PWH. Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses. Diagnostics (Basel) 2023; 13:diagnostics13061138. [PMID: 36980446 PMCID: PMC10046938 DOI: 10.3390/diagnostics13061138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.
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Affiliation(s)
- King Hei Stanley Lam
- The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Faculty of Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: ; Tel.: +852-23720888
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Kenneth Dean Reeves
- Private Practice PM&R and Pain Management, 4840 El Monte, Roeland Park, KS 66205, USA
| | - Felice Galluccio
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Fisiotech Lab. Studio, Rheumatology and Pain Management, 50136 Firenze, Italy
- Morphological Madrid Research Center (MoMaRC), 10107 Madrid, Spain
| | - Abdallah El-Sayed Allam
- Morphological Madrid Research Center (MoMaRC), 10107 Madrid, Spain
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Clinical Neurophysiology Fellowship, Arab Board of Health Specializations, Ministry of Health, Baghdad 61298, Iraq
| | - Philip W. H. Peng
- Department of Anesthesiology and Pain Medicine, The University of Toronto, Toronto, ON M5T 2S8, Canada
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Ferreira-Silva N, Galacho J, Ferreira-Dos-Santos G, Clendenen SR, Hurdle MFB. Ultrasound-guided hydrodissection of the superficial peroneal nerve for chronic neuropathic pain: a war veteran's story. Pain Manag 2022; 12:579-586. [PMID: 35416721 DOI: 10.2217/pmt-2022-0014] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: This case report presents the application of ultrasound-guided hydrodissection of the superficial peroneal nerve to treat chronic refractory neuropathic pain, rated by the patient with an average intensity of 6/10 on the numerical rating scale. Materials & methods: Under ultrasound guidance, the nerve was identified compressed by a herniation of the peroneus brevis. An in-plane hydrodissection was performed using a solution of 10 ml of ropivacaine and methylprednisolone until the epineurium was entirely separated from the surrounding tissue. Results: At the 2-month follow-up, the patient reported a decrease of pain, which he rated a 2/10 on the numerical rating scale. At this point, night-time episodes of moderate pain persisted. The procedure was repeated and at the 6-month follow-up, the patient remained pain free. Conclusion: This case report suggests that consecutive ultrasound-guided hydrodissection techniques might be a valuable option in the treatment of superficial peroneal nerve entrapment neuropathy.
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Affiliation(s)
- Nuno Ferreira-Silva
- Department of Physical Medicine & Rehabilitation, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - João Galacho
- Department of Anesthesiology, Chronic Pain Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Guilherme Ferreira-Dos-Santos
- Department of Anesthesiology & Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Steven R Clendenen
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
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Wang JC, Hsu PC, Wang KA, Chang KV. Response: "Commentary: Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial". Front Med (Lausanne) 2022; 9:841609. [PMID: 35350579 PMCID: PMC8957874 DOI: 10.3389/fmed.2022.841609] [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: 12/22/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, National Yang Ming University, Taipei, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, National Yang Ming University, Taipei, Taiwan
| | - Kevin A Wang
- Division of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.,Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Lumbar zygapophyseal joints injections under ultrasound guidance an alternative to fluoroscopy guidance in the management of low back pain. Sci Rep 2022; 12:3615. [PMID: 35256701 PMCID: PMC8901759 DOI: 10.1038/s41598-022-07695-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/21/2022] [Indexed: 01/15/2023] Open
Abstract
AbstractUltrasound-guided injections are an alternative to evaluate in the management of low back pain associated with osteoarthritis of the lumbar facet joints: it eliminates the risk of ionizing radiation for both the patient and the practitioner. This study aims to compare the short-term clinical efficacy of lumbar facet joints injections between ultrasound-guided injections and fluoroscopy-guided injections. Observational, retrospective, single-center study. Patients received one or two lumbar zygapophyseal joints injections under fluoroscopy or ultrasound and a follow-up consultation at one month. Data from 54 patients was collected. The median of the evolution of VAS at one month was − 30 mm [−50.0; −20.0] in the ultrasound group and – 29.5 mm [−47.0; −15.0] (p < 0.001) in the fluoroscopy group with no statistically significant difference between the two groups (p = 0.835). There were no injection-related complications in either group during the follow-up. The percentage of patients who stopped NSAIDs was not statistically significant between the two groups (p = 1.00). Injections of corticosteroids of lumbar facet joints under ultrasound guidance significantly reduced pain after one month, with no difference found between the two techniques. Ultrasound-guided injections are reliable, accessible and a safe alternative that should be preferred over those under fluoroscopy.
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Lam KHS, Lai WW, Ngai HY, Wu WKR, Wu YT. Commentary: Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial. Front Med (Lausanne) 2022; 8:833862. [PMID: 35096917 PMCID: PMC8793904 DOI: 10.3389/fmed.2021.833862] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Kwoloon, Hong Kong SAR, China.,Department of Family Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Department of Family Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.,Taiwan Association of Prolotherapy and Regenerative Medicine, Taichung, Taiwan.,Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wai Wah Lai
- The Hong Kong Institute of Musculoskeletal Medicine, Kwoloon, Hong Kong SAR, China.,Department of Family Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ho Yin Ngai
- The Hong Kong Institute of Musculoskeletal Medicine, Kwoloon, Hong Kong SAR, China.,Department of Family Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wing Keung Ricky Wu
- The Hong Kong Institute of Musculoskeletal Medicine, Kwoloon, Hong Kong SAR, China.,Department of Family Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Department of Family Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Research and Development, School of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
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Chang KV, Wu WT. Authors' Response to the Letter to the Editor on "Ultrasonography in Pronator Teres Syndrome: Dynamic Examination and Guided Hydrodissection". PAIN MEDICINE 2021; 23:223-224. [PMID: 34668545 DOI: 10.1093/pm/pnab309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/12/2022]
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.,Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, 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
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