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Varela-Margolles D, Milani A, Kamel SI. Percutaneous Interventions for Injuries in Athletes: Implications on Return to Play. Semin Musculoskelet Radiol 2024; 28:146-153. [PMID: 38484767 DOI: 10.1055/s-0043-1778026] [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: 03/19/2024]
Abstract
For nonsurgical musculoskeletal (MSK) injuries in athletes, image-guided percutaneous intervention may aid in recovery and decrease return to play (RTP) time. These interventions fall into two major categories: to reduce inflammation (and therefore alleviate pain) or to promote healing. This review describes the risks and benefits of the various percutaneous interventions in MSK athletic injury and surveys the literature regarding the implication of these interventions on RTP.
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Affiliation(s)
- Diana Varela-Margolles
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ava Milani
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah I Kamel
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Lazarescu AE, Hogea BG, Andor BC, Totorean A, Cojocaru DG, Negru M, Bolintineanu LA, Patrascu Jnr JM, Misca LC, Sandesc MA, Patrascu Snr JM. Using a Double Syringe Sterile System for MSK Aspiration/Injection Procedures Eliminates Risk of Iatrogenic Infection. Ther Clin Risk Manag 2022; 18:1029-1036. [PMID: 36339728 PMCID: PMC9628697 DOI: 10.2147/tcrm.s372676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Diverse musculo-skeletal pathology can be treated conservatively by different types of injections and in most cases, results are significantly better if the existing inflammatory fluid is aspirated prior to injection of medication solutions. The present study analyses an original technique which uses infusion therapy accessories to create two types of closed sterile double syringe systems, and compares the benefits of using such a system in aspiration/injection procedures to classic aspiration injection technique that implies changing and connecting multiple syringes to the same needle, thus increasing the risk for septic complications. The aim of the present study is to minimize therapeutic risk of iatrogenic septic complications during aspiration/injection procedures. Methods 1024 patients underwent aspiration/injection procedures in our clinic using the double syringe system between 2015 and 2020. During the early stages of the study, the second type of assembly was rendered impractical so the study continued with analyzing a single type of double syringe system using a three way infusion therapy device which is readily available, and allows the assembly of a closed sterile system with a single, two-step procedure technique. Iatrogenic local septic complications were followed by means of a six week clinical follow-up evaluation with additional investigations only if necessary. Results In 1024 procedures we report 0% incidence of iatrogenic septic complications, or other types of complications and recommend this technique in a vast array of rheumatic, orthopedic or traumatic conditions that require aspiration/injection procedures. Discussion The double syringe system is practical, easy to use, it completely eliminates the risk of iatrogenic infection due to manipulation errors, and significantly simplifies the technique for sonography guided aspiration/injection procedures for musculo-skeletal pathology.
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Affiliation(s)
- Adrian Emil Lazarescu
- Department of Anatomy and Embriology, University of Medicine and Pharmacy “victor Babes” Timișoara, Timisoara, Romania
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Bogdan Gheorghe Hogea
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Correspondence: Bogdan Gheorghe Hogea, Tel +40744363188, Email
| | - Bogdan Corneliu Andor
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Alina Totorean
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Department of Medical Recovery, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Dan Grigore Cojocaru
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Marius Negru
- Department of Pediatric Surgery, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Laura A Bolintineanu
- Department of Pathophysiology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Jenel Marian Patrascu Jnr
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Liviu C Misca
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Mihai A Sandesc
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Jenel Marian Patrascu Snr
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
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Jana M, Mittal D, Bagri N, Yadav R, Parihar V, Bagri NK. Role of Imaging in Childhood Arthritis. J Clin Rheumatol 2022; 28:e539-e544. [PMID: 33843776 DOI: 10.1097/rhu.0000000000001735] [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: 11/27/2022]
Abstract
ABSTRACT Imaging plays a pivotal role in the management of various childhood arthritis. Conventional radiography is the most commonly ordered imaging modality for the evaluation of arthritis. Owing to their higher sensitivity for detecting synovitis, magnetic resonance imaging and ultrasonography are increasingly being used to guide clinical management of various forms of arthritis, especially juvenile idiopathic arthritis. Magnetic resonance imaging is a preferred modality for evaluating more complex sites such as the sacroiliac joint. In this review, we have discussed the rational use and the characteristic imaging features of common childhood arthritis.
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Affiliation(s)
- Manisha Jana
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Disha Mittal
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Neha Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
| | - Richa Yadav
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Vivek Parihar
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
| | - Narendra Kumar Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
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Perineural Local Anesthetic Treatments for Osteoarthritic Pain. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2021; 7:262-282. [DOI: 10.1007/s40883-021-00223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Krishna Prasad BP, Joy B, Raghavendra VA, Toms A, George D, Ray B. Ultrasound-guided peripheral nerve interventions for common pain disorders. Indian J Radiol Imaging 2021; 28:85-92. [PMID: 29692534 PMCID: PMC5894327 DOI: 10.4103/ijri.ijri_108_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There are a number of common pain disorders that can be managed effectively by injections around or ablation of peripheral nerves. Ultrasound is a universally available imaging tool, is safe, cost-effective, and is excellent in imaging many peripheral nerves and guiding needles to the site of the nerves. This article aims to present an overview of indications and techniques of such procedures that can be effectively performed by a radiologist.
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Affiliation(s)
| | - Binu Joy
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | | | - Ajith Toms
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Danny George
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Brijesh Ray
- Department of Imaging and Interventional Radiology, Aster Medcity Hospital, Cheranelloor, Ernakulam, Kerala, India
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Amatto MD, Rambaransingh B, Yu JC. An Evaluation of Musculoskeletal Interventional Ultrasound Training in Canadian Physical Medicine and Rehabilitation Residency Programs. PM R 2020; 13:1148-1156. [PMID: 33247549 DOI: 10.1002/pmrj.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Ultrasound is a rapidly evolving field of medicine with strong utility in musculoskeletal practices. In Canadian physical medicine and rehabilitation (PM&R) residency programs there are no national standards for objectives of training in this area. This possible disconnection between demand and availability could lead to gaps in education. OBJECTIVE (1) To determine the current state of interventional musculoskeletal ultrasound (MSUS) training in Canadian PM&R residency programs, as perceived by both residents and program directors; (2) to evaluate the perspectives of experts in the field on current and future MSUS curriculum inclusion. DESIGN This study was a cross-sectional cohort study using an explanatory sequential mixed methods design. SETTING This project included anonymous online surveys and targeted telephone/in-person semistructured interviews. PARTICIPANTS Participants were Canadian PM&R residents or clinicians. Survey responses included 71 residents and nine program directors. Interviews were conducted with nine MSUS experts. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Outcome measures included residents' level of interest, amount of exposure, and barriers to training. Themes regarding resident exposure and future directions for MSUS training were obtained based on expert interviews. RESULTS The vast majority (97%) of current PM&R residents are interested in using ultrasound clinically, with 73% reporting having had "none" to "limited exposure" in MSUS. Expert interviews revealed four major themes: (1) appropriate training is dependent on access, (2) MSUS represents an emerging standard of care, (3) a minimal baseline level of competence should be expected, and (4) various strategies may be used to integrate basic MSUS into existing residency curriculums. CONCLUSIONS The use of ultrasound as a clinical tool is rapidly increasing. Current PM&R residents have a desire to incorporate this skill into their future practices. Although barriers exist to implementing this training on a national level, the future looks promising with multiple strategies outlined to assist the process.
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Affiliation(s)
- Michael D Amatto
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brian Rambaransingh
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jaime C Yu
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Ultrasound-guided injections in musculo-skeletal system - An overview. J Clin Orthop Trauma 2019; 10:669-673. [PMID: 31316237 PMCID: PMC6611943 DOI: 10.1016/j.jcot.2019.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022] Open
Abstract
Ultrasound guided musculoskeletal injection has a wide range of indication in joint, muscle, tendon, nerve, ganglion and bursa pathologies. These are less invasive procedures and provide desirable results in short duration. Local anesthetics and corticosteroids are the most commonly injected pharmaceuticals. Platelet rich plasma and autologus blood injections have gained popularity in recent past and provide acceptable results. In this article we aim to review the general consideration, indications, technique and pharmaceuticals used in common therapeutic musculoskeletal injections.
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Comparison between Collagen and Lidocaine Intramuscular Injections in Terms of Their Efficiency in Decreasing Myofascial Pain within Masseter Muscles: A Randomized, Single-Blind Controlled Trial. Pain Res Manag 2018; 2018:8261090. [PMID: 29973970 PMCID: PMC6008702 DOI: 10.1155/2018/8261090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/05/2018] [Accepted: 05/15/2018] [Indexed: 12/22/2022]
Abstract
Background and Objective A novel option for myofascial pain (MFP) management and muscle regeneration is intramuscular collagen injections. The aim of the study was to evaluate the efficiency of intramuscular injections of collagen and lidocaine in decreasing MFP within masseter muscles. Methods Myofascial pain within masseter muscles was diagnosed on the basis of the Diagnostic Criteria for Temporomandibular Disorders (II.1.A. 2 and 3). A total of 43 patients with diagnosed MFP within masseter muscles were enrolled to the study (17 male and 26 female, 40 ± 3.8 years old) and randomly divided into three groups. The first group received injections using 2 ml of collagen MD Muscle (Guna), the second group received 2 ml of 2% lidocaine without a vasoconstrictor, and the third group 2 ml of saline as a control (0.9% NaCl). All patients received repeated injections at one-week intervals (days 0 and 7). The visual analogue scale was used to determine pain intensity changes during each follow-up visit (days 0, 7, and 14) in each group. The masseter muscle activity was measured on each visit (days 0, 7, and 14) with surface electromyography (sEMG) (Neurobit Optima 4, Neurobit Systems). Results We found that sEMG masseter muscle activity was significantly decreased in Group I (59.2%), less in Group II (39.3%), and least in Group III (14%). Pain intensity reduction was 53.75% in Group I, 25% in Group II, and 20.1% in Group III. Conclusions The study confirmed that intramuscular injection of collagen is a more efficient method for reducing myofascial pain within masseter muscles than intramuscular injection of lidocaine.
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Abstract
This article is a comprehensive review of the current utilizations of ultrasound in the treatment of orthopedic conditions of the foot and ankle. It reviews the diagnostic and interventional applications to commonly encountered lower-extremity ailments, including plantar fasciosis, tendinosis, and peripheral nerve disorders. It also outlines minimally invasive ultrasound-guided procedures and emerging therapies as alternatives to current treatments. These emerging therapies can be used to assist surgeons and provide options for patients needing intervention. Techniques such as hydrodissection, injection, aspiration, tenotomy, and fasciotomy are discussed, giving readers insight into different treatment modalities and options to help manage their patients.
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Affiliation(s)
- Nahum Michael Beard
- Department of Family Medicine, University of Tennessee Health Science Center, Saint Francis Family Medicine, 1301 Primacy Parkway, Memphis, TN 38119, USA; Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue Suite 520, Memphis, TN 38104.
| | - Robert Patrick Gousse
- Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue Suite 520, Memphis, TN 38104
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Walter WR, Burke CJ, Adler RS. Ultrasound-guided therapeutic injections for neural pathology about the foot and ankle: a 4 year retrospective review. Skeletal Radiol 2017; 46:795-803. [PMID: 28303298 DOI: 10.1007/s00256-017-2624-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe a 4-year clinical experience with ultrasound-guided therapeutic perineural injections of peripheral nerves about the foot and ankle. MATERIALS AND METHODS Retrospective analysis of foot and ankle perineural injections performed between January 2012 and August 2016. Demographics, clinical indications, presence of structural pathology, immediate and interval pain relief, as well as complications were recorded. RESULTS Fifty-nine therapeutic injections were performed among 46 patients, accounting for multiple injections in a single visit or multiple visits [mean age = 43 years (range 18-75), 31 female (67%) and 15 male (33%)]. Most commonly, perineural injections involved the hallux branch of the medial plantar nerve (n = 17, 22%). Least commonly, perineural injections involved the saphenous nerve (n = 3, 4%). Other injections in our series include sural (10), superficial (11) and deep (7) peroneal, medial (5) and lateral (3) plantar nerves, and the posterior tibial nerve (3). Ultrasound evaluation revealed structural abnormality associated with the nerve in 30 cases (51%)-most commonly thickening with perineural scarring (n = 14). Of 45 injections with complete documentation, immediate relief of symptoms was reported in 43 (96%) cases. Interval symptom relief was achieved in 23 injections [short term (n = 12), intermediate (n = 6), and long term (n = 5)] out of 38 for which follow-up was available (61%). Complications are rare, occurring in only one case. CONCLUSION Ultrasound-guided perineural injections about the foot and ankle are safe and provide lasting symptomatic relief for many indications. Concomitant sonographic evaluation identifies structural abnormalities that may contribute to neuropathic symptoms, allowing targeting of injection or clinical therapy.
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Affiliation(s)
- William R Walter
- Hospital for Joint Diseases, New York University Langone Medical Center, 301 E 17th St, New York, NY, 10003, USA.
| | - Christopher J Burke
- Hospital for Joint Diseases, New York University Langone Medical Center, 301 E 17th St, New York, NY, 10003, USA
| | - Ronald S Adler
- Center for Musculoskeletal Care, New York University Langone Medical Center, New York, NY, USA
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