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Dias AC, Jureidini RAG, Araujo-Filho JAB, Camerin GR, Zattar LC, Sernik RA, Malhotra A, Cerri LMO, Cerri GG. Advanced US of the Skin, Nerves, and Muscles of the Neck: Pearls and Pitfalls with Use of High-Frequency Transducers. Radiographics 2024; 44:e240029. [PMID: 39298354 DOI: 10.1148/rg.240029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
High-frequency US provides excellent visualization of superficial structures and lesions, is a preferred diagnostic modality for anatomic characterization of neck abnormalities, and has a central role in clinical decision making. Recent technological advancements have led to the development of transducers that surpass 20 MHz, elevating high-frequency US to a highly valuable diagnostic tool with broader clinical use and enabling greater spatial resolution in the assessment of skin and superficial nerves and muscles. The authors focus on evolving applications of high-frequency US in neck imaging, emphasizing practical insights and strategies in skin and neuromuscular applications. ©RSNA, 2024 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Alex C Dias
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
| | - Regiany A G Jureidini
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
| | - Jose A B Araujo-Filho
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
| | - Gabriela R Camerin
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
| | - Luciana C Zattar
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
| | - Renato A Sernik
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
| | - Ajay Malhotra
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
| | - Luciana M O Cerri
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
| | - Giovanni G Cerri
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, São Paulo, SP 01308-050, Brazil (A.C.D., R.A.G.J., J.A.B.A.F., G.R.C., L.C.Z., R.A.S., L.M.O.C., G.G.C.); and Department of Diagnostic Radiology, Yale University School of Medicine. Yale New Haven Hospital, New Haven, Conn (A.M.)
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Kim E, Choi CH, Lim JA, Lee SY, Choi E, Kim J. Eighth Cervical Nerve Root Block During Interscalene Brachial Plexus Block Decreases Pain Caused by Posterior Portal Placement but Increases Horner Syndrome in Patients Undergoing Arthroscopic Shoulder Surgery: A Randomized Controlled Trial. Arthroscopy 2024; 40:217-228.e4. [PMID: 37355189 DOI: 10.1016/j.arthro.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/07/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To compare the intensity of pain on posterior portal placement between a C5-C7 root block (conventional interscalene brachial plexus block [ISBPB]) and a C5-C8 root block in patients undergoing arthroscopic shoulder surgery. METHODS In this prospective, single-blinded, parallel-group randomized controlled trial, patients were randomized to receive either a C5-C7 root block (C5-C7 group, n = 37) or a C5-C8 root block (C5-C8 group, n = 36) with 25 mL of 0.75% ropivacaine. The primary outcome was the pain intensity on posterior portal placement, which was graded as 0 (no pain), 1 (mild pain), or 2 (severe pain). The secondary outcomes were the bilateral pupil diameters measured 30 minutes after ISBPB placement; the incidence of Horner syndrome, defined as a difference in pupil diameter (ipsilateral - contralateral) of less than -0.5 mm; the onset of postoperative pain; and the postoperative numerical rating pain score, where 0 and 10 represent no pain and the worst pain imaginable, respectively. RESULTS Fewer patients reported mild or severe pain on posterior portal placement in the C5-C8 group than in the C5-C7 group (9 of 36 [25.0%] vs 24 of 37 [64.9%], P = .003). Less pain on posterior portal placement was reported in the C5-C8 group than in the C5-C7 group (median [interquartile range], 0 [0-0.75] vs 1 [0-1]; median difference [95% confidence interval], 1 [0-1]; P = .001). The incidence of Horner syndrome was higher in the C5-C8 group than in the C5-C7 group (33 of 36 [91.7%] vs 22 of 37 [59.5%], P = .001). No significant differences in postoperative numerical rating pain scores and onset of postoperative pain were found between the 2 groups. CONCLUSIONS A C5-C8 root block during an ISBPB reduces the pain intensity on posterior portal placement. However, it increases the incidence of Horner syndrome with no improvement in postoperative pain compared with the conventional ISBPB (C5-C7 root block). LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Eugene Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang Hyuk Choi
- Department of Orthopedic Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jung A Lim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - So Young Lee
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jonghae Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea.
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Wu WT, Chang KV, Mezian K, Ricci V, Özçakar L. Ultrasound assessment of a supraclavicular lipoma entrapping the brachial plexus: a diagnostic insight. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:58-60. [PMID: 38155552 PMCID: PMC10834269 DOI: 10.12701/jyms.2023.01284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 12/30/2023]
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
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, 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, Bologna, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Valera-Calero JA, Gómez-Sánchez S, Fernández-de-Las-Peñas C, Plaza-Manzano G, Sánchez-Jorge S, Navarro-Santana MJ. A Procedure for Measuring Anterior Scalene Morphology and Quality with Ultrasound Imaging: An Intra- and Inter-rater Reliability Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1817-1823. [PMID: 37188569 DOI: 10.1016/j.ultrasmedbio.2023.04.005] [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: 01/18/2023] [Revised: 03/20/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Ultrasound (US) imaging is an essential tool for clinicians because of its cost-effectiveness and accessibility for assessing multiple muscle metrics including muscle quality, size and shape. Although previous studies highlighted the importance of the anterior scalene muscle (AS) in patients with neck pain, studies analyzing the reliability of US measurements for this muscle are lacking. This study aimed to develop a protocol for assessing AS muscle shape and quality measured with US and investigating its intra- and inter-examiner reliability. METHODS Through use of a linear transducer, B-mode images of the anterolateral neck region at the C7 level were acquired in 28 healthy volunteers by two examiners (one experienced and one novel). Cross-sectional area, perimeter, shape descriptors and mean echo-intensity were measured twice by each examiner in randomized order. Intra-class correlation coefficients (ICCs), standard errors of measurement and minimal detectable changes were calculated. RESULTS Results indicated no muscle side-to-side asymmetries (p > 0.05). Gender differences were found for muscle size (p < 0.01), but muscle shape and brightness were comparable (p > 0.05). Intra-examiner reliability was good to excellent for all metrics for the experienced and (ICC >0.846) and novel (ICC >780) examiners. Although inter-examiner reliability was good for most of the metrics (ICC >0.709), the estimates for assessing solidity and circularity were unacceptable (ICC <0.70). CONCLUSION This study found that the described ultrasound procedure for locating and measuring anterior scalene muscle morphology and quality is highly reliable in asymptomatic individuals.
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Affiliation(s)
- Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain; Grupo In Physio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain; Grupo In Physio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Sandra Sánchez-Jorge
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain; Grupo In Physio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Pruidze P, Rossmann T, Weninger JT, Didava G, Seyedian Moghaddam A, Weninger WJ, Meng S. Ultrasound Detection of the Axillary Arch as a Cause of Thoracic Outlet Syndrome: A Prospective Dissection-Controlled Cadaver Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:946-950. [PMID: 36621389 DOI: 10.1016/j.ultrasmedbio.2022.11.016] [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: 10/26/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Ultrasound as a diagnostic tool in thoracic outlet syndrome (TOS) is becoming increasingly important. The aim of this study was to investigate the diagnostic value of ultrasound in detecting the axillary arch, an ancillary muscle potentially causing TOS. Two hundred upper limbs of 100 fresh, non-frozen, non-embalmed body donors were screened for axillary arches. Sonographic findings were validated by anatomic dissection. Twelve axillary arches were found in 200 upper extremities, corresponding to a prevalence of 8.0% per individual and 6.0% per upper extremity investigated. Ultrasound had low diagnostic performance in identifying axillary arches, with a sensitivity of 66.7% and specificity of 95.7%. There was a tendency to identify more easily arches consisting of purely muscle tissue. Axillary arch thickness, its cross-sectional area and the predominant tissue type were associated with compression of the neurovascular bundle during shoulder elevation. Ultrasound seems to have limited potential to identify axillary arches. However, arches consisting predominantly of muscle tissue may be identified more easily and were associated with compression of neurovascular structures, thus potentially causing symptoms. Further clinical trials are needed to clarify the true value of ultrasound in patients with symptoms of TOS.
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Affiliation(s)
- Paata Pruidze
- Division of Anatomy, Medical University of Vienna, Vienna, Austria
| | - Tobias Rossmann
- Division of Anatomy, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | | | - Giorgi Didava
- Division of Anatomy, Medical University of Vienna, Vienna, Austria
| | | | | | - Stefan Meng
- Division of Anatomy, Medical University of Vienna, Vienna, Austria; Department of Radiology, Hanusch Hospital, Vienna, Austria.
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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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Liu A, Jia X, Zhang L, Huang X, Chen W, Chen L. Diagnostic performance of preoperative ultrasound for traumatic brachial plexus root injury: A comparison study with an electrophysiology study. Front Neurol 2023; 13:1077830. [PMID: 36686523 PMCID: PMC9852902 DOI: 10.3389/fneur.2022.1077830] [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: 10/23/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose Accurate preoperative assessment for traumatic brachial plexus injury (BPI) is critical for clinicians to establish a treatment plan. The objective of this study was to investigate the diagnostic performance of preoperative ultrasound (US) through comparison with an electrophysiology study (EPS) in the assessment of traumatic brachial plexus (BP) root injury. Materials and methods We performed a retrospective study in patients with traumatic BPI who had preoperative US and EPS, excluding obstetric palsy and other nontraumatic neuropathies. US examination was performed on an EPIQ 5 color Doppler equipment. EPS was performed on a Keypoint 9033A07 Electromyograph/Evoked Potentials Equipment, testing electromyography (EMG), nerve conduction studies (NCS), and somatosensory evoked potentials (SEP). Each BP root of all patients was assessed by US and EPS as completely injured or incompletely injured, respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated based on the correlation with intraoperative findings. The accuracy of US and EPS were compared using the McNemar test. The added benefit of US was evaluated by comparing the sensitivity and specificity between the combined tests with EPS using the McNemar test. Results This study included 49 patients with traumatic BPI who underwent BP surgeries from October 2018 to September 2022. Surgical exploration confirmed 89 completely injured BP roots in 28 patients. US correctly detected 80 completely injured BP roots (sensitivity, 0.899; specificity, 0.981; PPV, 0.964; NPV, 0.944; accuracy, 0.951). EPS correctly detected 75 completely injured BP roots (sensitivity, 0.843; specificity, 0.929; PPV, 0.872; NPV, 0.912; accuracy, 0.898). US showed significantly higher accuracy than EPS (p = 0.03). When combining US and EPS for completely injured BP root detection, the sensitivity of the inclusive combination (0.966) was significantly higher than EPS alone (p = 0.000977), and the specificity of the exclusive combination (1.000) was significantly higher than EPS alone (p = 0.000977). Conclusion Preoperative US is an effective diagnostic tool in the assessment of traumatic BP root injury. US had higher accuracy than EPS in this study. Sensitivity and specificity were significantly higher than EPS when US was combined with EPS.
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Affiliation(s)
- Ailin Liu
- Department of Medical Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaotian Jia
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Zhang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyun Huang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Weimin Chen
- Department of Medical Ultrasound, Huashan Hospital, Fudan University, Shanghai, China,*Correspondence: Weimin Chen ✉
| | - Lin Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China,Lin Chen ✉
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Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12123097. [PMID: 36553104 PMCID: PMC9776939 DOI: 10.3390/diagnostics12123097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Shoulder disorders are very common in clinical practice. Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible patterns of migration. In this paper, we have illustrated how and where these calcium depositions can migrate from the rotator cuff tendons to the peri-articular soft tissues. We have also tried to discuss the issue from the clinical side, i.e., how these particular conditions might impact the specific diagnosis, appropriate rehabilitation plan or interventional approach for optimal functional recovery.
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Artificial intelligence using deep neural network learning for automatic location of the interscalene brachial plexus in ultrasound images. Eur J Anaesthesiol 2022; 39:758-765. [PMID: 35919026 DOI: 10.1097/eja.0000000000001720] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Identifying the interscalene brachial plexus can be challenging during ultrasound-guided interscalene block. OBJECTIVE We hypothesised that an algorithm based on deep learning could locate the interscalene brachial plexus in ultrasound images better than a nonexpert anaesthesiologist, thus possessing the potential to aid anaesthesiologists. DESIGN Observational study. SETTING A tertiary hospital in Shanghai, China. PATIENTS Patients undergoing elective surgery. INTERVENTIONS Ultrasound images at the interscalene level were collected from patients. Two independent image datasets were prepared to train and evaluate the deep learning model. Three senior anaesthesiologists who were experts in regional anaesthesia annotated the images. A deep convolutional neural network was developed, trained and optimised to locate the interscalene brachial plexus in the ultrasound images. Expert annotations on the datasets were regarded as an accurate baseline (ground truth). The test dataset was also annotated by five nonexpert anaesthesiologists. MAIN OUTCOME MEASURES The primary outcome of the research was the distance between the lateral midpoints of the nerve sheath contours of the model predictions and ground truth. RESULTS The data set was obtained from 1126 patients. The training dataset comprised 11 392 images from 1076 patients. The test dataset constituted 100 images from 50 patients. In the test dataset, the median [IQR] distance between the lateral midpoints of the nerve sheath contours of the model predictions and ground truth was 0.8 [0.4 to 2.9] mm: this was significantly shorter than that between nonexpert predictions and ground truth (3.4 mm [2.1 to 4.5] mm; P < 0.001). CONCLUSION The proposed model was able to locate the interscalene brachial plexus in ultrasound images more accurately than nonexperts. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov) identifier: NCT04183972.
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Wu WT, Chang KV, Chang HC, Kuan CH, Chen LR, Mezian K, Ricci V, Özçakar L. Ultrasound Imaging of Facial Vascular Neural Structures and Relevance to Aesthetic Injections: A Pictorial Essay. Diagnostics (Basel) 2022; 12:diagnostics12071766. [PMID: 35885669 PMCID: PMC9317469 DOI: 10.3390/diagnostics12071766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
The facial and submental regions are supplied by complicated neurovascular networks; therefore, facial aesthetic injections may be associated with serious adverse events such as skin necrosis and blindness. Pre-injection localization of neurovascular structures using high-resolution ultrasound can theoretically prevent unexpected complications. Therefore, a systematic protocol that focuses on these facial neurovascular structures is warranted. In this pictorial essay, we discuss the sonoanatomy of facial and submental neurovascular structures and its relevance to aesthetic injections. Moreover, we have highlighted the mechanisms underlying potential neurovascular injuries during aesthetic injections.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.)
- 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; (W.-T.W.); (L.-R.C.)
- 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
- Correspondence: ; Tel.: +886-2-2371-7101-5309
| | - Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Chen-Hsiang Kuan
- Department of Surgery, Division of Plastic Surgery, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Lan-Rong Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.)
| | - Kamal Mezian
- Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine and General University Hospital in Prague, 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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Chuang CH, Huang CY, Ho SW, Chen CC. Rapid Detecting Brachial Plexus Injury by Point-of-Care Ultrasonography. J Med Ultrasound 2022; 30:303-305. [PMID: 36844780 PMCID: PMC9944823 DOI: 10.4103/jmu.jmu_185_21] [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: 09/29/2021] [Revised: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022] Open
Abstract
Brachial plexus injury (BPI) is regarded as one of the most devastating injuries of the upper extremity. Brachial plexus neuropathy can have a high morbidity by seriously affecting the motor function and sensation of upper limbs with loss of activities of daily living. The use of computed tomography myelogram and/or magnetic resonance imaging (MRI) assessing brachial plexus offers valuable details including the location, morphology, and severity of preganglionic and postganglionic injuries during the preoperative period. High-field-strength MRI with specific coil and specialized MRI sequences might be not available in every emergency setting and is time-consuming. Point-of-care ultrasonography (POCUS) comes in handy and offers good image resolution of muscles and nerves that makes early detection of neuromuscular injury possible. Here, we present a case report of BPI that POCUS provides indirect evidence of cervical root injury and expedite time to MRI.
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Affiliation(s)
- Cheng-Hsun Chuang
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Yen Huang
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sai-Wai Ho
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Ching Chen
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan,Address for correspondence: Dr. Chia-Ching Chen, Department of Emergency Medicine, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Rd., South Dist., Taichung City 402, Taiwan. E-mail:
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12
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Mezian K, Jačisko J, Kaiser R, Machač S, Steyerová P, Sobotová K, Angerová Y, Naňka O. Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment. Front Neurol 2021; 12:661441. [PMID: 34054704 PMCID: PMC8160369 DOI: 10.3389/fneur.2021.661441] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/23/2021] [Indexed: 01/01/2023] Open
Abstract
Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. It results from either static or dynamic compression of the ulnar nerve. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. In the operative treatment description, an emphasis is put on two commonly used approaches-in situ decompression and anterior transpositions.
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Affiliation(s)
- Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Jakub Jačisko
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czechia
| | - Stanislav Machač
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Petra Steyerová
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Karolína Sobotová
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Yvona Angerová
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czechia
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13
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Chang KV, Wu WT. Authors' Response to the Letter to the Editor on "Dynamic Ultrasound Imaging of the Brachial Plexus for Diagnosis of Thoracic Outlet Syndrome". Pain Pract 2021; 21:730. [PMID: 33471426 DOI: 10.1111/papr.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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
| | - 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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14
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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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Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory. Diagnostics (Basel) 2020; 10:diagnostics10110887. [PMID: 33143188 PMCID: PMC7693958 DOI: 10.3390/diagnostics10110887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.
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Bordoni B. The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 2. Cureus 2020; 12:e8713. [PMID: 32699708 PMCID: PMC7372241 DOI: 10.7759/cureus.8713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023] Open
Abstract
The main objective of the osteopath and that of osteopathic manipulative medicine (OMM) is to create space between the different tissues. The sliding capacity of the various tissue layers and between the different body components, up to the possibility of movement between cells is the salutogenic stimulus to allow the circulation of fluids, the biochemical exchange, and the adequate management of the multiple internal and external stimuli that perturb the body living. Movement is allowed by space and space is life. In this second part, the exposure of the anatomical neurological relationships of the five diaphragms continues, highlighting the relationships of the thoracic outlet, the respiratory diaphragm, and the pelvic floor. Finally, there will be clinical reflections to further corroborate the existence of the anatomical continuum and to lay the scientific foundations for an OMM approach to body diaphragms.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
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