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Sun X, Shi R, Shen Y, Qiu Z, Jia Y, Zhou Q, Shi C, Li Y, Zhang W, Li S, Chen Z. Safety and efficacy of ultrasound-guided percutaneous flexor retinaculum release of the ankle: an anatomical study. Quant Imaging Med Surg 2024; 14:3875-3886. [PMID: 38846301 PMCID: PMC11151242 DOI: 10.21037/qims-24-81] [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: 01/31/2024] [Accepted: 03/22/2024] [Indexed: 06/09/2024]
Abstract
Background Tarsal tunnel syndrome (TTS) is a condition in which the tibial nerve (TN) (or its terminal branches) is compressed by the flexor retinaculum (FR) and the deep fascia of the abductor hallucis muscle at the tarsal tunnel, causing symptoms that negatively impact the patient's quality of life, including numbness, a sensation of a foreign object, coldness, and pain. FR release via microtrauma using needle-knife has proven to be effective in China and is widely used by clinicians. The traditional acupotomy, however, is the "blind knife" treatment, which cannot guarantee patient safety due to risk of injury to important structures, particularly the neurovascular bundle. Compared with the conventional treatments, ultrasound-guided percutaneous FR release possesses noteworthy advantages including high efficacy and safety. Methods Percutaneous release of the FR was performed on 51 formalin-fixed specimens. The specimens were divided into two groups: an ultrasound-guided acupotomy pushing group comprising 20 legs (group U) and a nonultrasound-guided acupotomy pushing group comprising 31 legs (group N). After high-frequency ultrasound exploration, those with clear vascular imaging were included in group U; otherwise, they were included in group N. The FR was released percutaneously, soft tissue was dissected layer by layer, and anatomical data were recorded. Results There no cases of injury in group U (0%) and four in group N (12.9%). Among the different intervention methods, there were no significant differences in tissue injury types (χ2=2.80; P=0.09). The percentage of released FR in group U was 80.00% while that in group N was 61.29% (χ2=1.977; P=0.16), which did not represent a significant difference between the two groups. However, group U had a significantly greater release length than that in the group N (t=3.359; P=0.002), indicating that the flexor release length guided by ultrasound is significantly greater than the unguided one. Conclusions Ultrasound-guided percutaneous release of the FR using a needle-knife can provide greater length and percentage of released FR while maintaining a comparable safety rate to the unguided procedure.
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Affiliation(s)
- Xiaojie Sun
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- Department of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Rongxing Shi
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, China
| | - Yifeng Shen
- Department of Traditional Chinese Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zuyun Qiu
- Department of Traditional Chinese Medicine Bone-Setting, Beijing Jishuitan Hospital, Beijing, China
| | - Yan Jia
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Qiaoyin Zhou
- Chinese Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Chong Shi
- Department of Traditional Chinese medicine, Aerospace Center Hospital, Beijing, China
| | - Yunnan Li
- Chinese Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Weiguang Zhang
- Department of Human Anatomy, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Shiliang Li
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, China
| | - Zhaojun Chen
- Department of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
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Lu SW, Lang BX, Liu JN, Ma XX, Li TT, Du X, Zhang ML. Comparative Efficacy of Micro-Needle-Knife Therapy and Acupuncture in Acute Ankle Sprains: A Randomized Controlled Trial. Med Sci Monit 2024; 30:e944157. [PMID: 38794788 PMCID: PMC11135136 DOI: 10.12659/msm.944157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/24/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Micro-needle knife (MNK) therapy releases the superficial fascia to alleviate pain and improve joint function in patients with acute ankle sprains (AAS). We aimed to evaluate the efficacy and safety of MNK therapy vs that of acupuncture. MATERIAL AND METHODS This blinded assessor, randomized controlled trial allocated 80 patients with AAS to 2 parallel groups in a 1: 1 ratio. The experimental group received MNK therapy; the control group underwent conventional acupuncture treatment at specified acupoints. Clinical efficacy differences between the 2 groups before (time-point 1 [TP1]) and after treatment (TP2) were evaluated using the visual analogue scale (VAS) and Kofoed ankle score. Safety records and evaluations of adverse events were documented. One-month follow-up after treatment (TP3) was conducted to assess the intervention scheme's reliability. RESULTS VAS and Kofoed ankle scores significantly improved in both groups. No patients dropped due to adverse events. At TP1, there were no significant differences between the 2 groups in terms of VAS and Kofoed scores (P>0.05). However, at TP2, efficacy of MNK therapy in releasing the superficial fascia was significantly superior to that of acupuncture treatment (P<0.001). At TP3, no significant differences in scores existed between the groups (P>0.05). CONCLUSIONS This study demonstrates that 6 sessions of MNK therapy to release the superficial fascia safely and effectively alleviated pain and enhanced ankle joint function in patients with AAS, surpassing the efficacy of conventional acupuncture treatment. Future studies should increase the sample size and introduce additional control groups to further validate the superior clinical efficacy of this intervention.
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Affiliation(s)
- Sen-wei Lu
- Department of Orthopedics, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR
China
| | - Bo-xu Lang
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang, PR
China
| | - Jia-na Liu
- Department of Orthopedics, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR
China
| | - Xiao-xiao Ma
- Department of Orthopedics, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR
China
| | - Tang-tang Li
- Department of Orthopedics, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR
China
| | - Xin Du
- Department of Orthopedics, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR
China
| | - Mao-liang Zhang
- Department of Orthopedics, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR
China
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Amro S, Kashbour M, Shaaban Abdelgalil M, Qafesha RM, Eldeeb H. Efficacy of Ultrasound-Guided Tendon Release for Trigger Finger Compared With Open Surgery: A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:657-669. [PMID: 38205616 DOI: 10.1002/jum.16408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Trigger finger (also known as stenosing tenosynovitis) is a chronic inflammatory disorder that affects the fingers and causes discomfort and functional impairment. It is estimated to affect 2-3.6% of the population and is more common in manual laborers and individuals engaged in repetitive hand activities. This study comprehensively compares the efficacy of ultrasound-guided release versus traditional open surgery in treating trigger fingers. MATERIALS We systematically searched PubMed, Scopus, EMBASE, and the Cochrane Library to identify relevant studies. Inclusion criteria were studies evaluating ultrasound-guided release of trigger finger (grade 2 and higher) compared with open surgical release. A meta-analysis was performed by Revman software 5.4.1 to assess efficacy, utilizing appropriate statistical methods to address heterogeneity. Primary outcome measures included "Quick Disability of Arm, Shoulder, and Hand" (QDASH) scores, Grip strength, and the Visual Analogue Scale (VAS). Secondary outcome measures included Days of stopping analgesia, full-digit flexion and extension, days to return to normal activities, pinch strength, Quinnell grading score, and bow strengthening. RESULTS Out of the initial pool of 820 studies, five met the inclusion criteria, including 275 patients with 283 trigger digits. The analysis revealed significant differences favoring the ultrasound-guided release group over the surgical group for improvement in Quick Disability of Arm, Shoulder, and Hand score in the first month (MD -0.48, 95% CI: 0.75 to -0.2, P = .0007, I2 = 20%). The difference was not statistically significant in the 3-month follow-up period (MD -2.25, 95% CI: -0.54 to 0.05, P = .1, I2 = 0%). Additionally, there is a significant difference in the days required for return to normal activities in favor of the ultrasound release approach (MD -13.78, 95% CI: -16.68 to 10.89, P = .00001, I2 = 68%). The data displayed heterogeneity, which was resolved through sensitivity analysis that also favored the ultrasound-guided group. In terms of grip strength, full-digit flexion and extension, VAS, and days of stopping analgesia no significant differences were observed. CONCLUSIONS Ultrasound-guided release showed advantages over open surgical release, resulting in improved QDASH score and quicker return to normal activities. This offers a minimally invasive, successful alternative to open surgery, reducing associated risks. Further studies with long-term follow-up are recommended.
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Affiliation(s)
- Sarah Amro
- Specialized Arab Hospital, Nablus, Palestine
| | - Muataz Kashbour
- Diagnostic Radiology Department, National Cancer Institute, Misrata, Libya
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
| | | | | | - Hatem Eldeeb
- Faculty of Medicine, Alazhar University, Cairo, Egypt
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Margenfeld F, Zendehdel A, Tamborrini G, Müller-Gerbl M. The advantages of utilizing different ultrasound imaging techniques on joints of human cadavers in the teaching of anatomy - A scoping review. Ann Anat 2024; 251:152179. [PMID: 37879500 DOI: 10.1016/j.aanat.2023.152179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/05/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND A common approach to define sonoanatomy is a reciprocal exchange of macroscopic and microscopic information in ultrasound imaging. High-resolution ultrasound has been long established and is crucial as an inexpensive and adaptable tool, not just in clinical settings but also while teaching anatomy. Early application of ultrasonography provides medical students with a couple of benefits: they acquire an improved understanding of anatomy and learn how to use it. METHODS A comprehensive literature review has been carried out, with relevant studies discovered in the following databases: MEDLINE, EMBASE, CENTRAL, BIOSIS Previews and Web of Science Core Collection. Gray literature was also considered in two different ways: (1) Regarding grey literature databases: National Gray Literature Collection. (2) For PhD theses and dissertations, the databases EThOS and Open Access Theses and Dissertations were screened for relevant studies by combining the keywords used in the search string. The reference lists of all relevant papers were scanned. Search process was performed on January 3rd, 2023. The search string was developed with the aid of and finally checked by a professional librarian. Only ultrasound studies on human cadavers were included, not animals or phantoms. If the studied subject was a joint, the article was included. Only B-Mode ultrasound was included, whereas Elastosonography, Doppler sonography and quantitative approaches including among others sound speed, backscatter attenuation were excluded. Intravascular, intraosseous, intraarticular, and three-dimensional or four-dimensional ultrasonography were also eliminated from the analysis. All appropriate information comprising articles, PhD theses, dissertations and chapters in textbooks were considered. There were solely English and German studies covered. There was no additional restriction on the publishing year. The included studies' general characteristics and ultrasound techniques were taken from them and examined. Using VOS viewer, a keyword analysis was also carried out. RESULTS 142 of the 8899 results that were returned by the search satisfied the requirements. With a quarter of the included studies, the knee joint was the most extensively studied joint, followed by the elbow joint (10.6%) and the shoulder joint (9.2%). The methodological analysis includes 125 studies. Both the sample size and the ultrasonographer's qualifications were diverse. The probe position and the ultrasound method were precisely documented so that a reader could duplicate them in about three-quarters of the included studies (72.8%). CONCLUSION The current study, in our perspective, is the first scoping review to screen ultrasound studies on human cadaver joints. A heterogeneous field was shown by the methodological investigation. We suggest using a uniform method for conducting and presenting ultrasound examinations in future studies.
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Affiliation(s)
- Felix Margenfeld
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland.
| | - Adib Zendehdel
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland
| | - Giorgio Tamborrini
- Swiss Ultrasound Center UZR and Institute for Rheumatology, Aeschenvorstadt 68, Basel 4051, Switzerland; Rheumatology Clinic, University Hospital of Basel, Basel 4001 Switzerland
| | - Magdalena Müller-Gerbl
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland
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Lee DC, Lee KJ, Lee H, Koh SH, Kim JS, Roh SY. Serious Complications of the Percutaneous A1 Pulley Release: Case Reports and Literature Review. Arch Plast Surg 2024; 51:110-117. [PMID: 38425861 PMCID: PMC10901604 DOI: 10.1055/a-2179-3911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/19/2023] [Indexed: 03/02/2024] Open
Abstract
Percutaneous first annular pulley (A1 pulley) release, which has been increasingly used to treat trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley release. In this study, however, we report cases of patients who developed complications after undergoing percutaneous A1 pulley release at local clinics. A total of six patients visited our hospital for infectious complications after percutaneous A1 pulley release. Various sequelae such as damage to normal structures, insufficient procedure, and tissue necrosis were observed during the exploration. A retrospective study was conducted to identify the cause and trend of the observed complications by instruments (HAKI knife or needle). In the HAKI knife group, there was a tendency for damage to normal structures, while in the needle group, an insufficient release or serious soft tissue necrosis was observed. Based on these cases, our findings confirm the existence and characteristics of infectious complications following the percutaneous A1 pulley release. We further identify that the type of instrument used predicts the nature of complications. Thus, reliable and skilled performance of the procedure by experts is essential for safe treatment.
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Affiliation(s)
- Dong Chul Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Kyung Jin Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Hohyung Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Sung Hoon Koh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Jin Soo Kim
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Si Young Roh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
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Sun J, Zou X, Fu Q, Wu J, Yuan S, Alhaskawi A, Dong Y, Zhou H, Abdalbary SA, Lu H. Case report: Ultrasound-guided needle knife technique for carpal ligament release in carpal tunnel syndrome treatment. Front Neurol 2023; 14:1291702. [PMID: 38020668 PMCID: PMC10665483 DOI: 10.3389/fneur.2023.1291702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common peripheral neuropathy of the hand, mainly manifesting as sensory disturbances, motor dysfunctions, and pain in the fingers and hand. The pathogenesis of the disease is associated with fibrosis of the transverse carpal ligament in the carpal tunnel, which compresses median nerve. In our case, we demonstrate an ultrasound-guided needle knife technique to treat CTS. We guided the patient to a supine position on the examination table. The skin of the wrist area was sterilized for the procedure. After the skin was dry, we positioned sterile drapes, located the median nerve and compression, and marked the compression point. Local anesthesia was administered. An ultrasound-guided needle knife was inserted. The needle knife was advanced under ultrasound guidance. The carpal ligament was incised. A gradual release of pressure on the median nerve was observed on the ultrasound monitor. After treatment, the patient's finger sensation and motor function can significantly improve, and pain symptoms are markedly reduced, this case demonstrates that small needle-knife treatment can serve as a safe and effective minimally invasive therapeutic method.
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Affiliation(s)
- Jianjun Sun
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Xiaodi Zou
- Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qinyun Fu
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Jianhua Wu
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Shuaishuai Yuan
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Ahmad Alhaskawi
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanzhao Dong
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Hui Lu
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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