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Hilbig-Vlatten L, Grauberger JN, Engmann TF, Stadelmeier LF, Dunn RM, Mandeville R, Ko JH, D'Hemecourt P, Dowlatshahi S. Soleal Sling Syndrome: A Narrative Review. J Peripher Nerv Syst 2025; 30:e70032. [PMID: 40391847 DOI: 10.1111/jns.70032] [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: 10/15/2024] [Revised: 05/05/2025] [Accepted: 05/10/2025] [Indexed: 05/22/2025]
Abstract
Soleal sling syndrome is a rare cause of lower extremity neuropathy due to compression of the proximal tibial nerve under the fibromuscular arch of the soleus muscle. It presents with plantar numbness/paresthesias, calf pain, and tenderness over the proximal calf. Chronic compression can lead to toe flexor weakness. This study reviews the clinical presentation, diagnostic workup, and treatment options for soleal sling syndrome. A query of the PubMed database up until August 30, 2022, was conducted to gather relevant clinical, anatomic, and radiographic findings. The literature review identified key features of soleal sling syndrome, highlighting the importance of considering it in patients with calf pain/tenderness and plantar foot neurosensory changes. Diagnosis typically relies on history and physical examination, often with a positive Tinel's sign, though imaging modalities show inconsistent utility. Soleal sling syndrome is underrecognized and overlaps with other syndromes. Radiological imaging modalities can rule out secondary causes of proximal tibial nerve compression but lack consistency for diagnosing idiopathic cases. Surgical decompression of the nerve, via a medial or posterior approach, is the definitive treatment for all causes of tibial nerve compression.
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Affiliation(s)
- Laura Hilbig-Vlatten
- Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer N Grauberger
- Division of Plastic Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Toni F Engmann
- Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lilly F Stadelmeier
- Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond M Dunn
- Division of Plastic Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason H Ko
- Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pierre D'Hemecourt
- Orthopedics and Sports Medicine Department, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sammy Dowlatshahi
- Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Sabbineni M, Ajmera P, Wang B, Varma V, Mbuagbaw L, Choudur HN. Exploring the therapeutic potential of ultrasound-guided nerve hydrodissection: a comprehensive retrospective analysis. Clin Radiol 2025; 85:106863. [PMID: 40203607 DOI: 10.1016/j.crad.2025.106863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 02/20/2025] [Accepted: 02/25/2025] [Indexed: 04/11/2025]
Abstract
AIM To determine the efficacy of ultrasound-guided nerve hydrodissection for the clinical improvement of commonly entrapped peripheral nerves. MATERIALS AND METHODS A retrospective review of patient information was conducted for the period of Jan 2015-Dec 2020. Potential patients were identified using a keyword search for 'hydrodissection' and/or 'perineural injection' from radiology reports. Data included patient age, sex, intervention date, target peripheral nerve, pre-intervention clinical presentation, electromyography (EMG) data and patient outcomes at 3 weeks, 3 months and 6 months post-procedure. Outcomes included pain (as rated on the visual analog scale, 1-10), numbness, tingling, paraesthesias, mobility and others. The data were used to assess intervention efficacy based on each peripheral nerve as well as total peripheral nerves. RESULTS Data were collected for 204 patients for various peripheral nerves. At the 3-week follow-up, 48% demonstrated minimal improvement, 18% demonstrated moderate improvement and 34% demonstrated significant improvement. At the 3-month follow-up, 52% demonstrated minimal improvement, 20% demonstrated moderate improvement and 28% demonstrated significant improvement. Finally, at the 6-month follow-up, 56% demonstrated minimal improvement, 14% demonstrated moderate improvement and 30% demonstrated significant improvement. CONCLUSION Moderate to significant clinical improvement was noted in half of the patients and minimal improvement in the remaining half of the patients who had undergone ultrasound-guided nerve hydrodissection. To date, there are few studies assessing the effectiveness of ultrasound-guided hydrodissection. These results therefore have implications for the use of this dynamic, percutaneous, ultrasound-guided intervention using steroid and local anaesthetic for multiple peripheral nerves.
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Affiliation(s)
- M Sabbineni
- McMaster University, 1280 Main St. West Hamilton, ON, L8S4L8, Canada.
| | - P Ajmera
- Department of Radiology, The University of North Carolina at Chapel Hill, USA.
| | - B Wang
- Department of Radiology, McMaster University, 1280 Main St. West Hamilton, ON, L8S4L8, Canada.
| | - V Varma
- Department of Radiology, McMaster University, 1280 Main St. West Hamilton, ON, L8S4L8, Canada.
| | - L Mbuagbaw
- Biostatistics Unit/The Research Institute, St Joseph's Healthcare-Hamilton, 50 Charlton Avenue East, Hamilton L8N 4A6, ON, Canada.
| | - H N Choudur
- Department of Radiology, McMaster University, Hamilton General Hospital, 237 Barton St. East, Hamilton, L8L2X2, ON, Canada.
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Serrano IP, Wang D, Saratan RAA, Peña MI, de Castro JC. Dextrose-based Lyftogt perineural injection therapy on facial muscle strength in a Bell's palsy patient - a case report. Pain Manag 2025; 15:245-250. [PMID: 40298143 DOI: 10.1080/17581869.2025.2494975] [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: 01/30/2025] [Accepted: 04/15/2025] [Indexed: 04/30/2025] Open
Abstract
Bell's palsy, a unilateral peripheral facial nerve palsy, is one of the most common acute mononeuropathies. Chronic cases persisting beyond one year present significant challenges to conventional treatment methods. Standard treatment includes steroids and antiviral medications in the acute phase, and physical therapy, various supplements such as vitamin B12 and folic acid supplementation, and injections for chronic therapy. This case report describes the effect of a unique treatment, dextrose-based Lyftogt perineural injection therapy (LPIT), in a 22-year-old Filipino male with left-sided peripheral facial nerve palsy. His condition had persisted for a duration of 13 months and was refractory to standard management. LPIT was delivered at chronic constriction points and endpoints of the facial nerve in ten different sessions. The mechanism of LPIT involves addressing glycopenia in affected nerves, reducing neurogenic inflammation, and facilitating nerve repair by enhancing the flow of nerve growth factors. Following treatment, marked improvement was observed in the functional muscle strength of the left occipitofrontalis, zygomaticus, and buccinator muscles, progressing from weak functional to functional. This case underscores LPIT's potential as an adjunct therapy for chronic Bell's palsy, adding to the limited but a growing body of evidence supporting its role in managing neuropathic conditions.
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Affiliation(s)
- Isabel Patricia Serrano
- Department of Physical Medicine and Rehabilitation, The Medical City Ortigas, Pasig, Philippines
| | - Daniel Wang
- Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Physical Medicine & Rehabilitation, University of Miami Health System, Miami, FL, USA
| | | | - Melecio Iii Peña
- Department of Physical Medicine and Rehabilitation, The Medical City Ortigas, Pasig, Philippines
- Department of Physical Medicine and Rehabilitation, The Medical City Clark, Mabalacat, Pampanga, Philippines
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Nwawka OK, Adriaensen M, Andreisek G, Drakonaki EE, Lee KS, Lutz AM, Martinoli C, Nacey N, Symanski JS. Imaging of Peripheral Nerves: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2025; 224:e2431064. [PMID: 38775432 DOI: 10.2214/ajr.24.31064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2025]
Abstract
Peripheral nerve imaging provides information that can be critical to the diagnosis, staging, and management of peripheral neuropathies. MRI and ultrasound are the imaging modalities of choice for clinical evaluation of the peripheral nerves given their high soft-tissue contrast and high resolution, respectively. This AJR Expert Panel Narrative Review describes MRI- and ultrasound-based techniques for peripheral nerve imaging; highlights considerations for imaging in the settings of trauma, entrapment syndromes, diffuse inflammatory neuropathies, and tumor; and discusses image-guided nerve interventions, focusing on nerve blocks and ablation.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Gustav Andreisek
- Institute of Radiology, Cantonal Hospital Munsterlingen, Munsterlingen, Switzerland
- Institute of Diagnostic and Interventional Radiology, University of Zurich, Zurich, Switzerland
| | - Elena E Drakonaki
- Department of Anatomy, University of Crete School of Medicine, Heraklion, Greece
- Department of MSK Imaging, Diagnostic and Interventional Ultrasound Practice, Heraklion, Greece
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin, Madison, WI
| | - Amelie M Lutz
- Institute of Radiology, Cantonal Hospital Munsterlingen, Munsterlingen, Switzerland
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Carlo Martinoli
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Nicholas Nacey
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - John S Symanski
- Department of Radiology, University of Wisconsin, Madison, WI
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Chen CH, Lu YJ, Wu MT, Wu TJ. Minimizing Risks in Anterior Endoscopic Cervical Discectomy Using Ultrasound-Guided Hydrodissection: A Technical Report. Cureus 2025; 17:e81309. [PMID: 40291228 PMCID: PMC12033070 DOI: 10.7759/cureus.81309] [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] [Accepted: 03/26/2025] [Indexed: 04/30/2025] Open
Abstract
Anterior endoscopic cervical discectomy (AECD) is a minimally invasive alternative to anterior cervical discectomy and fusion (ACDF) for treating cervical disc herniation. Despite its advantages, AECD poses risks to delicate anatomical structures, including the esophagus, recurrent laryngeal nerve, inferior thyroid artery, and carotid artery. This report introduces a novel ultrasound-guided hydrodissection technique designed to enhance the safety of AECD by improving visualization and reducing iatrogenic injury. By employing ultrasound imaging, key structures can be identified in real time, while hydrodissection creates a protective space, minimizing tissue trauma when advancing the needle. This technique allows precise needle placement and facilitates a safer surgical approach. The integration of ultrasound guidance with the hydrodissection technique has the potential to reduce complications and improve procedural accuracy, making it a valuable adjunct to AECD.
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Affiliation(s)
- Chien-Hua Chen
- Neurosurgery, Clive Chen Clinic, Taichung, TWN
- Neurosurgery, Yuan Rung Hospital, Yuanlin, TWN
| | - Yu-Jen Lu
- Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, TWN
- College of Medicine, Chang Gung University, Taoyuan, TWN
| | - Meng-Ting Wu
- Neurosurgery, Cheng-Hsin General Hospital, Taipei, TWN
| | - Tsung-Ju Wu
- Regenerative Medicine, Reboot Clinics, Changhua, TWN
- Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, TWN
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Chatha PK, Drakonaki E, Rao PM, Botchu R, Sharma GK. Spectrum of abdominal anterior cutaneous nerve entrapment syndrome (ACNES) with successful management: a case report. J Ultrasound 2025; 28:223-226. [PMID: 38904734 PMCID: PMC11947326 DOI: 10.1007/s40477-024-00881-0] [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: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 06/22/2024] Open
Abstract
Abdominal pain is a common symptom with a spectrum of causes. Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked and underdiagnosed cause for anterior abdominal pain. Among the patients of chronic abdominal wall pain, the incidence of ACNES is 10-30% and the most common cause is nerve entrapment at the lateral border of the rectus muscle. We describe two cases covering varied location of entrapment, one at the medial border of rectus and another at lateral border explaining the need of ultrasound for successful management of both. This case report illustrates the difficulty of making this diagnosis, utility of ultrasound and a brief review of literature.
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Affiliation(s)
- Prableen Kaur Chatha
- Jaipur Institute of Pain and Sports Injuries (JIPSI), A-22, Anita Colony, Bajajnagar, Jaipur, Rajasthan, India
| | - Elena Drakonaki
- Anatomy Medical School, University of Crete, Rethymno, Greece
| | - Perumandla Mohan Rao
- Department of Radiodiagnosis, MGM Hospital, Kakatiya Medical College, Warangal, Telangana, India
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Gaurav Kant Sharma
- Jaipur Institute of Pain and Sports Injuries (JIPSI), A-22, Anita Colony, Bajajnagar, Jaipur, Rajasthan, India.
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Dmytriiev D, Liu W, Barsa M, Khomenko A, Strokan A, Pasquina PF, Cohen SP. Perineuromal hydrodissection for acute postamputation pain? An observational study in a time of war. Reg Anesth Pain Med 2025:rapm-2024-106307. [PMID: 39971386 DOI: 10.1136/rapm-2024-106307] [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: 12/10/2024] [Accepted: 01/22/2025] [Indexed: 02/21/2025]
Abstract
INTRODUCTION This exploratory study investigates the potential of perineuromal hydrodissection as an adjunct to opioid therapy for postamputation pain, specifically focusing on residual limb and phantom limb pain (PLP). Given the correlations between acute pain and the development of chronic pain, the primary aims were to estimate the effect size of early hydrodissection of scar tissue around residual limb neuroma(s) and to identify the best time frame for treatment. METHODS Seventy-four patients with war-related limb amputations and painful neuromas were included in this observational analysis. Thirty-eight Ukrainian patients with war-related limb amputation and a painful neuroma(s) who underwent hydrodissection and opioid therapy within 6 months of amputation were compared with 36 patients who received opioids alone. Co-primary outcome measures were median reduction from baseline in average residual limb and PLP at 12 weeks. The composite positive outcome was designated as a ≥2-point decrease or 30% reduction in average residual limb and PLP, satisfaction with treatment, and not requiring an increase in analgesics. RESULTS Hydrodissection as an add-on to opioids resulted in a greater reduction in average residual limb pain at 12 weeks (-2.00±1.00 vs -1.00±1.00; p<0.001) and earlier time periods, but PLP only through 4 weeks. At 12 weeks, Hospital Anxiety and Depression Scale anxiety (10.00±2.00 vs 11.00±1.00; p<0.001) but not depression score was lower in the hydrodissection group. Opioid use in the hydrodissection group significantly declined from 41.32±9.63 to 33.42±8.78 morphine equivalents per day (p=0.001) over the study, but not in the opioid-only group (p=0.20). Differences in 12-week satisfaction rates were not significant. CONCLUSIONS This exploratory study suggests perineuromal hydrodissection may improve residual limb pain and to a lesser degree phantom limb pain, particularly when implemented early in the course of postamputation pain. The study provides preliminary effect size estimates and identifies acute pain as a potential characteristic of patients who may respond more favorably to this intervention. Randomized controlled trials are needed to confirm these findings and control for the confounding variables identified.
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Affiliation(s)
- Dmytro Dmytriiev
- Anesthesiology and pain medicine, Vinnitskij Natsionalnij Medichnij Universitet, Vinnitsiya, Ukraine
| | - Winnie Liu
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Maksym Barsa
- Department of Anesthesiology, Semenyuk Rivne Regional Clinical Hospital, Rivne, Ukraine
- Dept of Anesthesiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Andreii Khomenko
- Dept of Anesthesiology and Intensive Care, Feofaniya Clinical Hospital of the State Management of Affairs of Ukraine, Kyiv, Ukraine
| | - Andreii Strokan
- Dept of Anesthesiology and Intensive Care, Feofaniya Clinical Hospital of the State Management of Affairs of Ukraine, Kyiv, Ukraine
- Department of Anesthesiology, Intensive Care Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Paul F Pasquina
- Dept of Physical Medical & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Steven P Cohen
- Dept of Physical Medical & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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8
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Su DCJ, Yeh MC, Lam KHS. Novel Ultrasound Examination and Guided Intervention of Peri-Oral Musculature and Fascia in Wind Players with Embouchure Problems: Technical Note. Diagnostics (Basel) 2025; 15:514. [PMID: 40075762 PMCID: PMC11898922 DOI: 10.3390/diagnostics15050514] [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: 01/12/2025] [Revised: 02/15/2025] [Accepted: 02/17/2025] [Indexed: 03/14/2025] Open
Abstract
Background: Embouchure problems in wind players can severely affect musical performance. The complexity of the embouchure involves peri-oral musculature, which is essential for controlling airflow and tone production but is prone to injuries from overuse or misuse. The current literature lacks guidance on utilizing ultrasound for diagnosing embouchure-related injuries. Methods: This technical note presents a scanning method for wind players that presented with embouchure problems, with common pathological sonographic findings and ultrasound-guided interventions. Results: A comprehensive overview of the sonoanatomy of the peri-oral musculature relevant to the embouchure and a scanning protocol for the embouchure in wind players are described. This technical note also highlights common pathological sonographic findings associated with embouchure problems and describes ultrasound-guided interventions addressing these issues. Conclusions: This technical note emphasizes the potential of ultrasound in diagnosing and treating embouchure problems, contributing to effective therapeutic strategies for wind players.
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Affiliation(s)
- Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan 710, Taiwan;
- A Tempo Regeneration Center for Musicians, Tainan 700, Taiwan
| | - Mei-Chen Yeh
- Department of Endocrinology, Chi Mei Medical Center, Tainan 710, Taiwan;
| | - King Hei Stanley Lam
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, China
- 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
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Choong JT, Suhaimi A, Su DCJ, Lam KHS. Perineural Injection Therapy for Hemiplegic Shoulder Pain: A Novel Management Approach. Cureus 2025; 17:e79332. [PMID: 40130090 PMCID: PMC11931588 DOI: 10.7759/cureus.79332] [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] [Accepted: 02/16/2025] [Indexed: 03/26/2025] Open
Abstract
Hemiplegic shoulder pain (HSP) significantly interferes with upper limb rehabilitation and reduces the function and quality of life in stroke patients. Perineural injection therapy (PIT) offers a regenerative approach by targeting potential pain-generating nerves utilizing dextrose. The effectiveness of PIT in HSP remains underexplored. This case series involved five stroke patients diagnosed with HSP during post-stroke inpatient rehabilitation. Their pain was not responding to analgesics and physical modalities, causing poor rehabilitation participation. All patients received the same PIT regime, whereby 1-5 ml of buffered 5% dextrose was administered subcutaneously to the lateral and intermediate supraclavicular nerve exiting point, quadrangular space, and triangular space. Pain levels, shoulder passive range of motion (PROM), and Fugl-Meyer Assessment for upper extremity (FMA-UE) scores were measured pre- and post-treatment. Standard rehabilitation care continued post-treatment. All patients reported significant pain reduction, with numerical rating scale (NRS) scores decreasing from an average of 7.3 to 1.0. Shoulder PROM improved by an average of 40 degrees in flexion and 37 degrees in abduction. FMA-UE scores increased from an average of 32.0 to 57.3, with all patients achieving the minimal clinically important difference of 12.4. No adverse effects were reported. In conclusion, a single-session PIT demonstrated effectiveness in reducing pain and improving function in patients with HSP, facilitating engagement in rehabilitation. This approach may be particularly valuable in facilities lacking ultrasound equipment.
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Affiliation(s)
- Jern Tung Choong
- Department of Rehabilitation Medicine, Cheras Rehabilitation Hospital, Kuala Lumpur, MYS
| | - Anwar Suhaimi
- Department of Rehabilitation Medicine, Universiti Malaya Medical Centre, Kuala Lumpur, MYS
- Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, TWN
| | - King Hei Stanley Lam
- Faculty of Medicine, The University of Hong Kong, Hong Kong, HKG
- Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, HKG
- Faculty of Medicine, The Chinese University of Hong Kong, New Territories, HKG
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Lee K, Park JM, Yoon SY, Kim MS, Kim YW, Shin JI, Lee SC. Ultrasound-Guided Nerve Hydrodissection for the Management of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis. Yonsei Med J 2025; 66:111-120. [PMID: 39894044 PMCID: PMC11790405 DOI: 10.3349/ymj.2024.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 02/04/2025] Open
Abstract
PURPOSE Ultrasound-guided nerve hydrodissection has emerged as a potential non-surgical treatment for carpal tunnel syndrome (CTS). The objective of this research was to offer suggestions for optimizing injectables utilized in hydrodissection for the treatment of CTS through a systematic review and network meta-analysis. MATERIALS AND METHODS PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were searched through April 25, 2024. Effect sizes were quantified using standard mean differences within a random-effects model. Effectiveness ranking for each treatment was expressed as the surface under the cumulative ranking curve (SUCRA). RESULTS Nine studies with 458 patients with CTS were included. According to SUCRA, 5% dextrose (DW) was the most effective option for the Boston Carpal Tunnel Questionnaire (BCTQ) function at 99.9, 89.8, and 88.8 at 4, 12, and 24 weeks, respectively; for BCTQ symptoms, 5% DW was the most effective option at 99.9 at 4 weeks and platelet-rich plasma at 95.7 and 93.9 at 12 and 24 weeks, respectively. In terms of both BCTQ symptoms and BCTQ function, the 5 cc injection was the most effective, with SUCRA values of 99.5 for both categories. However, the effectiveness of the electrodiagnostic assessment and ultrasound variables was dependent on the type and dose of medication. CONCLUSION Administration of 5% DW showed better results in terms of initial symptom relief and long-term functional recovery compared to other agents, while platelet-rich plasma showed greater long-term symptom improvement; an injection dose of 5 cc showed the greatest benefit. However, additional research is required to establish precise protocols based on disease severity.
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Affiliation(s)
- KunWook Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Mi Park
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seo Yeon Yoon
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Seo Kim
- Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- The Center for Medical Education Training and Professional Development in Yonsei-Donggok Medical Education Institute, Seoul, Korea
- Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Korea.
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
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11
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Hooper NR, Sussman WI, Bowers R, Williams C. Ulnar Neuropathy Hydrodissection With Platelet Lysate and Prolotherapy: A Case Series and Review of the Literature. Cureus 2025; 17:e79791. [PMID: 40161197 PMCID: PMC11954682 DOI: 10.7759/cureus.79791] [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] [Accepted: 02/27/2025] [Indexed: 04/02/2025] Open
Abstract
This case series highlights both pain and function outcomes of three patients who underwent hydrodissection of the ulnar nerve with platelet lysate and prolotherapy for symptomatic ulnar nerve entrapment of the elbow. All patients reported significant long-term symptom improvement, which reached more than 75% regarding pain and function and greater than 80% Single Assessment Numeric Evaluation (SANE) evaluation at the follow-up. The outcomes of this case series suggest that hydrodissection with platelet lysate and dextrose neuroprolotherapy may provide an alternative viable non-surgical treatment option for patients with ulnar neuropathy.
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Affiliation(s)
- Nicholas R Hooper
- Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, USA
| | - Walter I Sussman
- Physical Medicine and Rehabilitation, Tufts Medical Center, Wellesley, USA
| | - Robert Bowers
- Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, USA
| | - Christopher Williams
- Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, USA
- Physical Medicine and Rehabilitation, Interventional Orthopedics of Atlanta, Atlanta, USA
- Physical Medicine and Rehabilitation, Regenexx Cayman, Cayman Islands, CYM
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12
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Ikuta F, Matsuzaki M, Kajitani K. Effectiveness of non-invasive ultrasound-guided electrical stimulation of genicular nerves for chronic knee pain: A case report. Medicine (Baltimore) 2025; 104:e41286. [PMID: 39833050 PMCID: PMC11749737 DOI: 10.1097/md.0000000000041286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 01/03/2025] [Indexed: 01/22/2025] Open
Abstract
RATIONALE Chronic knee pain is a common health issue that requires effective and noninvasive treatment. We devised a novel noninvasive approach using ultrasound-guided electrical nerve reactivation (ENR) in which ultrasound is used to identify the genicular nerve (GN). Then, transcutaneous low-frequency stimulation is applied for 10 seconds. The aim of this study was to clarify the pain-relieving effects of ENR on the GN innervating the knee joint. PATIENT CONCERNS Patients had visited our hospital with the complaint of knee joint pain. DIAGNOSES This study included 21 osteoarthritic knees from 16 patients with a mean age of 78.3 ± 8.5 years. INTERVENTIONS Baseline measurements included the range of motion of the knee joint, Visual Analogue Scale (VAS) scores for pain, and maximum knee flexion angle during squatting. A therapist conducted an interview to locate the painful area of the knee and then performed ultrasound-guided ENR by targeting the GN. OUTCOMES The preintervention VAS score was 49.3 (95% confidence interval: 41.0, 57.5). Postintervention VAS scores showed significant reductions: 27.0 (19.0, 35.1) immediately after the intervention (P < .0001), 27.7 (22.6, 32.8) at 1-day postintervention (P = .002), and 29.0 (22.9, 35.1) at 1-week postintervention (P = .001). The knee flexion angle during squatting significantly improved from 108.1° (101.6, 114.5) preintervention to 121.9° (115.1, 128.7) postintervention (P < .001). There was a significant increase in flexion angle preintervention and postintervention (P = .02); however, no significant change was observed in the extension angle. In addition, no adverse events were reported. LESSONS This study is the first to demonstrate the effects of ultrasound-guided low-frequency stimulation of the GN for knee osteoarthritis. Although the exact mechanism of pain relief is unclear, we hypothesize that alterations in neurotransmission, with or without endorphin release, may play a role. Moreover, ENR may improve nerve entrapment by causing contraction of surrounding muscles.This study demonstrated that ultrasound-guided ENR targets the GN and effectively reduces pain without complications. This treatment addresses the limitations of invasive methods, such as hydrorelease and radiofrequency ablation. Furthermore, ultrasound-guided ENR has diverse applications in diagnostics, physical therapy, and pre-exercise pain management and will greatly benefit patients and healthcare professionals.
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Affiliation(s)
- Futoshi Ikuta
- School of Health Sciences, Tokyo International University, Kawagoe, Saitama, Japan
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13
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Zhu M, Labagnara K, Loloi J, Babar M, Harandi AA, Salami A, Bernstein A, Davila J, Davuluri M, Chalouhy C, Maria P. Pudendal nerve block decreases narcotic requirements and time spent in post-anesthesia care units in patients undergoing primary inflatable penile prosthesis implantation. Int J Impot Res 2025; 37:55-60. [PMID: 38760570 PMCID: PMC11706770 DOI: 10.1038/s41443-024-00870-1] [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: 01/02/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 05/19/2024]
Abstract
Efforts to minimize narcotic usage following inflatable penile prosthesis (IPP) implantation are vital, considering the current opioid epidemic in the United States. We aimed to determine whether pudendal nerve block (PNB) utilization in a multiethnic population undergoing primary IPP implantation can decrease rates of post-operative opiate usage. A single-institution, retrospective study was conducted on patients who underwent primary IPP implantation between December 2015 and June 2022. PNB usage and intra- and post-operative outcomes were analyzed using multivariate binary logistic regression. 449 patients were included, with 373 (83.1%) in the PNB group. Median time (minutes) spent in the post-anesthesia care unit (PACU) (1499 [119-198] vs. 235 [169-322], p < 0.001) was significantly lower in the PNB group. There were no significant differences in intra-operative and PACU morphine milligram equivalents or post-operative safety outcomes between groups. However, fewer patients in the PNB group called for pain medications post-operatively (10.2% vs 19.7%, p = 0.019). Multivariate analysis revealed a significantly decreased operative time (B -6.23; 95%CI -11.28, -1.17; p = 0.016) and decreased time in recovery (B: -81.62; 95%CI: -106.49, -56.76, p < 0.001) in the PNB group. PNB decreases post-operative opioid analgesic requirements and time spent in PACU in patients undergoing a primary IPP implantation and thus may represent an attractive, non-opioid adjunct.
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Affiliation(s)
- Michael Zhu
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Justin Loloi
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Ari Bernstein
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Jonathan Davila
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Meenakshi Davuluri
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charbel Chalouhy
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pedro Maria
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
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14
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Jiang Y, Liu X, Jiang Z. From Morphology to Therapeutic Strategies: Exploring New Applications of Ultrasound for Diabetic Peripheral Neuropathy Diagnosis and Management. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:2231-2245. [PMID: 39239831 DOI: 10.1002/jum.16573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/24/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes that can result in severe lower limb pain and amputation. Early detection and treatment of DPN are vital, but this condition is often missed due to a lack of symptoms and the insensitivity of testing methods. This article reviews various ultrasound imaging modalities in the direct and indirect evaluation of peripheral neuropathy. Moreover, how ultrasound-related therapeutic strategies are playing a role in clinical treatment is discussed. Finally, the application of innovative methodologies in the diagnosis of DPN, including ultrasound attenuation, photoacoustic imaging, and artificial intelligence, is described.
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Affiliation(s)
- Yanfeng Jiang
- Department of Ultrasound, The First Affiliated Hospital of Shaoxing University, Shaoxing, China
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Xiatian Liu
- Department of Ultrasound, The First Affiliated Hospital of Shaoxing University, Shaoxing, China
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Zhenzhen Jiang
- Department of Ultrasound, The First Affiliated Hospital of Shaoxing University, Shaoxing, China
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
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15
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Fuchs J, Rose G. Alternative treatment of carpal tunnel syndrome with ultrasound-guided median nerve hydrodissection in the emergency department. Am J Emerg Med 2024; 84:189.e5-189.e7. [PMID: 39079806 DOI: 10.1016/j.ajem.2024.07.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 09/13/2024] Open
Abstract
Hydrodissection is becoming increasingly recognized as a treatment for nerve entrapment syndromes in the orthopedic and rehabilitation world. Carpal Tunnel Syndrome (CTS) is the most prevalent nerve entrapment neuropathy, characterized by compression of the median nerve as it passes through the carpal tunnel. Initial management includes NSAIDs and wrist splints, but surgical intervention is often necessary when these measures fail. Ultrasound-guided hydrodissection of the median nerve is both safe and effective and presents a minimally invasive option when first-line treatments fail to provide adequate symptom relief. This case report demonstrates the potential for an alternative approach to analgesia in the Emergency Department (ED) for patients presenting with pain related to CTS. Here we discuss a case of a 26-year-old female presenting with CTS symptoms and her successful treatment with ultrasound-guided hydrodissection in the ED.
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Affiliation(s)
- Joshua Fuchs
- Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, United States of America
| | - Gabriel Rose
- Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, United States of America.
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Hsu CY, Hsu T, Lin YN, Cheng YH. Additional Effect of Interfascial Hydrodissection With Dextrose on Shoulder and Neck Function in Patients With Myofascial Pain Syndrome: A Randomized Control Trial. Am J Phys Med Rehabil 2024; 103:827-834. [PMID: 38320240 DOI: 10.1097/phm.0000000000002442] [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: 02/08/2024]
Abstract
OBJECTIVE The aim of the study is to evaluate whether the application of an interfascial injection with dextrose water could result in reduced pain and improved shoulder function and range of motion. DESIGN This is a double-blind randomized controlled trial. Thirty-five patients with chronic shoulder pain were randomly assigned to receive either an interfascial injection of 10 mL of 10% dextrose water guided by ultrasound or a sham injection of 0.5 mL of 10% dextrose water into the subcutaneous layer. All patients received education on a home program of self-massage and self-stretching. Shoulder pain, shoulder range of motion, and neck and shoulder function were measured before injection and at 4 and 12 wks after injection. RESULTS Both groups showed significant improvements in visual analog scale scores at 12-wk follow-up. The interfascial injection group exhibited a significant pain reduction compared with the sham group at the 12-wks follow-up. No between-group differences were observed in shoulder range of motion, pain threshold, and neck and shoulder function. CONCLUSIONS Interfascial injection is effective in decreasing pain in patients with myofascial pain syndrome.
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Affiliation(s)
- Chih Yang Hsu
- From the Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan (CYH, TH, Y-NL, Y-HC); and Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan (Y-NL)
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17
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Saito Y, Takeuchi H, Tokumine J, Sawada R, Watanabe K, Yorozu T. Ultrasound-guided peripheral nerve blocks for anterior cutaneous nerve entrapment syndrome after robot-assisted gastrectomy: A case report. World J Gastrointest Surg 2024; 16:2719-2723. [PMID: 39220055 PMCID: PMC11362933 DOI: 10.4240/wjgs.v16.i8.2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Anterior cutaneous nerve entrapment syndrome (ACNES) is a condition manifesting with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves. This case report aims to provide new insight into the selection of peripheral nerve blocks for the ACNES treatment. CASE SUMMARY A 66-year-old woman manifested ACNES after a robot-assisted distal gastrectomy. An ultrasound-guided rectal sheath block was effective for pain triggered by the port scar. However, the sudden severe pain, which radiated laterally from the previous site, remained. A transversus abdominis plane block was performed for the remaining pain and effectively relieved it. CONCLUSION In this case, the trocar port was inserted between the rectus and transverse abdominis muscles. The intercostal nerves might have been entrapped on both sides of the rectus and transversus abdominis muscles. Hence, rectus sheath and transverse abdominis plane blocks were required to achieve complete pain relief. To the best of our knowledge, this is the first report on use of a combination of rectus sheath and transverse abdominis plane blocks for pain relief in ACNES.
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Affiliation(s)
- Yukiko Saito
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Hirohisa Takeuchi
- Department of Surgery, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Ryuji Sawada
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Kunitaro Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
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18
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Torosis M, Fullerton M, Kaefer D, Nitti V, Ackerman AL, Grisales T. Pudendal Block at the Time of Transvaginal Prolapse Repair: A Randomized Controlled Trial. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:706-713. [PMID: 38640500 DOI: 10.1097/spv.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
IMPORTANCE The utility of pudendal nerve blocks (PNBs) at the time of transvaginal surgery is mixed in the literature. No published study has evaluated the efficacy of PNB since the widespread adoption of Enhanced Recovery After Surgery (ERAS) pathways. OBJECTIVE This study aimed to determine if PNB, in addition to ERAS measures, at the time of vaginal reconstructive surgery reduces opioid use in the immediate postoperative period. STUDY DESIGN In this randomized, blinded, controlled trial, women scheduled for transvaginal multicompartment prolapse repair were randomized to bilateral PNB before incision with 20 mL of 0.5% bupivacaine versus usual care. Primary outcome was opioid use in morphine milligram equivalents (MME) for the first 24 hours. The study was powered to detect a 5.57-MME difference in opioid use in the first 24 hours between groups. RESULTS Forty-four patients were randomized from January 2020 to April 2022. The PNB and control groups were well matched in demographic and surgical data. There was no difference in opioid use in first 24 hours between the control and PNB groups (8 [0-20] vs 6.7 [0-15]; P = 0.8). Median pain scores at 24 and 48 hours did not differ between groups (4 ± 2 vs 3 ± 3; P = 0.44) and 90% of participants were satisfied with pain control across both groups. Time to return to normal activities (median, 10 days) was also not different between the groups. CONCLUSIONS Because pain satisfaction after transvaginal surgery in the era of ERAS is high, with overall low opioid requirements, PNB provides no additional benefit.
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Affiliation(s)
- Michele Torosis
- From the Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA
| | - Morgan Fullerton
- Department of Obstetrics and Gynecology, Kaiser Permanente, Panorama City, CA
| | | | | | | | - Tamara Grisales
- From the Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA
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Lam KHS, Su DCJ, Wu YT, Varrassi G, Suryadi T, Reeves KD. A Novel Ultrasound-Guided Bilateral Vagal Nerve Hydrodissection With 5% Dextrose Without Local Anesthetic for Recalcitrant Chronic Multisite Pain and Autonomic Dysfunction. Cureus 2024; 16:e63609. [PMID: 38957517 PMCID: PMC11218924 DOI: 10.7759/cureus.63609] [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: 06/09/2024] [Accepted: 06/30/2024] [Indexed: 07/04/2024] Open
Abstract
Chronic pain is a complex condition that often poses diagnostic and management challenges due to its multifactorial etiology. This case report describes a 49-year-old pastor who presented with a three-year history of chronic pain affecting multiple sites, including the neck, bilateral shoulders, thoracic region, lower back, and bilateral knees. Additionally, he experienced shortness of breath on mild exertion, which adversely affected his ability to converse and speak publicly. The patient had a rapid resting heart rate of 100-120 beats per minute, occasional palpitations, and a 24-hour electrocardiogram that confirmed 15% premature ventricular complexes with bigeminy and trigeminy. He complained of limited appetite with early satiety, intermittent nausea, and regurgitation. Despite consultations with multiple specialists, no underlying causes were identified in the cardiac, respiratory, gastrointestinal, or psychological domains. Ultrasound-guided bilateral vagus nerve hydrodissection using 5% dextrose without local anesthetics was administered three times at monthly intervals, resulting in remarkable pain relief within three months and the effects persisted at the nine-month follow-up. Tachycardia was no longer perceived, resting heart rate slowed to 70-80 beats per minute, shortness of breath improved, and public speaking ability was restored. The patient's early satiety, nausea, and reflux complaints were resolved. This case report highlights the potential effectiveness of this novel intervention for chronic pain. Further research is warranted to validate these findings and explore the mechanism of action.
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Affiliation(s)
- King Hei Stanley Lam
- Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, HKG
- Faculty of Medicine, The Chinese University of Hong Kong, New Territories, HKG
- Faculty of Medicine, The University of Hong Kong, Hong Kong, HKG
| | | | - Yung-Tsan Wu
- Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei, TWN
| | | | - Teinny Suryadi
- Physical Medicine and Rehabilitation, Synergy Clinic, Jakarta, IDN
- Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, Jakarta, IDN
| | - K Dean Reeves
- Rehabilitation Medicine, Private Practice, Kansas City, USA
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Faridi S, Vandewint A, Matz J. Hydrodissection Facilitates Open Resection of Morton's Neuroma Through a Plantar Approach: Technique Tip. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241274778. [PMID: 39224235 PMCID: PMC11367692 DOI: 10.1177/24730114241274778] [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] [Indexed: 09/04/2024] Open
Abstract
Visual AbstractThis is a visual representation of the abstract.
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Affiliation(s)
- Sufyan Faridi
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Canada East Foot & Ankle, Saint John, NB, Canada
| | - Amanda Vandewint
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Canada East Foot & Ankle, Saint John, NB, Canada
| | - Jacob Matz
- Canada East Foot & Ankle, Saint John, NB, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University/DMNB, Saint John, NB, Canada
- Horizon Health Network, Saint John, NB, Canada
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21
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Omodani T. Ultrasound-Guided Hydrodissection of the Thoracodorsal Nerve and Axillary Nerve in a Gymnast With Shoulder Pain Associated With Superior Labral Anterior-Posterior Lesions: A Case Report. Cureus 2024; 16:e60157. [PMID: 38864056 PMCID: PMC11165443 DOI: 10.7759/cureus.60157] [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] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
A 20-year-old male national-level gymnast presented with left shoulder pain attributed to a superior labral anterior-posterior (SLAP) lesion. Physical examination revealed pain in the anterosuperior area at maximum shoulder elevation, with a positive combined abduction test and horizontal flexion test indicating a restriction in glenohumeral joint motion. Rather than directly addressing the SLAP lesion, ultrasound-guided hydrodissections of the thoracodorsal and axillary nerves were performed, leading to immediate alleviation of pain and mobility constraints. This innovative approach, emphasizing shoulder function, offers a novel therapeutic strategy for SLAP-associated shoulder pain in athletes.
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Affiliation(s)
- Toru Omodani
- Orthopaedics, Tokyo Advanced Orthopaedics, Tokyo, JPN
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22
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Omodani T. Hydrodissection of the Eighth Cervical Nerve Root for Scapular Girdle Pain Associated With Nonunion of the First Rib Stress Fracture: A Case Report. Cureus 2024; 16:e60156. [PMID: 38864062 PMCID: PMC11166477 DOI: 10.7759/cureus.60156] [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] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
The first rib stress fracture is a rare overuse injury, with nonunion posing challenges to athletic performance. We report an 18-year-old international-level gymnast diagnosed with the nonunion of the first rib stress fracture, experiencing pain extending to the medial scapular area. Traditional treatments provided no relief, with tests suggesting C8 nerve root involvement. This study introduces a novel approach targeting the C8 nerve root using hydrodissection, which alleviates the pain. Post-procedure, the patient resumed competition without recurrence of pain after a year. This case suggests that pain due to first rib stress fracture nonunion might be associated with the C8 nerve root, and hydrodissection could be a potentially effective treatment.
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Affiliation(s)
- Toru Omodani
- Orthopaedics, Tokyo Advanced Orthopaedics, Tokyo, JPN
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Liu K, Russo M, Ellis JS, Capua JD, Wu D, Smolinski-Zhao S, Kalva S, Arellano RS, Irani Z, Uppot R, Linderman SW, Gupta R, Aizenberg J, Srinivasan S, Som A. Transient, Image-Guided Gel-Dissection for Percutaneous Thermal Ablation. Adv Healthc Mater 2024:e2400272. [PMID: 38678431 DOI: 10.1002/adhm.202400272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/02/2024] [Indexed: 04/30/2024]
Abstract
Image-guided tumor ablative therapies are mainstay cancer treatment options but often require intra-procedural protective tissue displacement to reduce the risk of collateral damage to neighboring organs. Standard of care strategies, such as hydrodissection (fluidic injection), are limited by rapid diffusion of fluid and poor retention time, risking injury to adjacent organs, increasing cancer recurrence rates from incomplete tumor ablations, and limiting patient qualification. Herein, a "gel-dissection" technique is developed, leveraging injectable hydrogels for longer-lasting, shapeable, and transient tissue separation to empower clinicans with improved ablation operation windows and greater control. A rheological model is designed to understand and tune gel-dissection parameters. In swine models, gel-dissection achieves 24 times longer-lasting tissue separation dynamics compared to saline, with 40% less injected volume. Gel-dissection achieves anti-dependent dissection between free-floating organs in the peritoneal cavity and clinically significant thermal protection, with the potential to expand minimally invasive therapeutic techniques, especially across locoregional therapies including radiation, cryoablation, endoscopy, and surgery.
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Affiliation(s)
- Kathy Liu
- Materials Science & Mechanical Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, 02138, USA
| | - Mario Russo
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joshua S Ellis
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - John Di Capua
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Dufan Wu
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Sara Smolinski-Zhao
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Sanjeeva Kalva
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ronald S Arellano
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Zubin Irani
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Raul Uppot
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Stephen W Linderman
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Rajiv Gupta
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joanna Aizenberg
- Materials Science & Mechanical Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, 02138, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, 02138, USA
| | - Shriya Srinivasan
- Materials Science & Mechanical Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, 02138, USA
| | - Avik Som
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, 02114, USA
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24
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Bordoni B, Escher AR, Duczyński M. Proposal for Manual Osteopathic Treatment of the Phrenic Nerve. Cureus 2024; 16:e58012. [PMID: 38606024 PMCID: PMC11007451 DOI: 10.7759/cureus.58012] [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] [Accepted: 04/11/2024] [Indexed: 04/13/2024] Open
Abstract
The article reviews the anatomical path of the phrenic nerve and its anastomoses, with the most up-to-date knowledge reported in the literature. We have briefly reviewed the possible phrenic dysfunctions, with the final aim of presenting an osteopathic manual approach for the treatment of the most superficial portion of the nerve, using a gentle technique. The approach we propose is, therefore, a theory based on clinical experience and the rationale that we can extrapolate from the literature. We hope that the article will be a stimulus for further experimental investigations using the technique illustrated in the article. To the authors' knowledge, this is the first article that takes into consideration the hypothesis of an osteopathic treatment with gentle techniques for the phrenic nerve.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Don Carlo Gnocchi Foundation, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
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25
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Pietramaggiori G, Ricci F, L'Erario S, Bassetto F, Scherer S. Minimally invasive scar release by autologous adipose tissue transfer for post-traumatic neuropathic pain. Regen Ther 2024; 25:302-307. [PMID: 38327717 PMCID: PMC10847010 DOI: 10.1016/j.reth.2023.12.017] [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: 12/10/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction Addressing post traumatic lower limb neuropathic pain is challenging across medical specialties. To address this potentially devastating condition, several invasive and non-invasive approaches have been proposed with inconsistent results. Adipose fat transfer (AFT), also known as fat grafting, is a regenerative medicine technique in which a patient's own fat is harvested from one area of the body (usually through liposuction) and then injected into another area for various purposes, such as aesthetic contour enhancement or reconstruction and regeneration of scarred tissues. Methods We analyze the effects of fat grafting for neuropathic pain combined with neuroma excision (hybrid technique, hAFT) or alone (AFT). A retrospective review was conducted on 22 patients with neuropathic lower limb pain, after trauma or orthopedic surgery treated with hAFT (n = 9) or AFT (n = 13). Results Reduction in VAS scale more than 50 % was observed in 6 patients (66 %) treated with hybrid technique and in eleven patients (85 %) treated with AFT alone. Among these, complete pain reduction (>91 %) was achieved in 33.3 % of hAFT and 54 % of AFT technique. A 3.2 points reduction in VAS was found in the hAFT group versus 5.8 points in the AFT group (p = 0.035). Conclusion This pioneering use of AFT emerges as a minimally invasive breakthrough, promising significant improvement in reconstructing scarred subcutaneous tissue and managing neuropathic pain.
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Affiliation(s)
- Giorgio Pietramaggiori
- Global Medical Institute, Division of Aesthetic and Migraine Surgery, Avenue Jomini 8, 1004 Lausanne, Switzerland
- University of Padua, Department of Neurosciences, Division of Plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Federico Ricci
- University of Padua, Department of Neurosciences, Division of Plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Stefano L'Erario
- University of Padua, Department of Neurosciences, Division of Plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Franco Bassetto
- University of Padua, Department of Neurosciences, Division of Plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Saja Scherer
- Global Medical Institute, Division of Aesthetic and Migraine Surgery, Avenue Jomini 8, 1004 Lausanne, Switzerland
- University of Padua, Department of Neurosciences, Division of Plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
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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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Huang CY, Lai CY, Reeves KD, Lam KHS, Li TY, Cheng CI, Wu YT. Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome: A Prospective, Randomized, and Single-Blind Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:161-169. [PMID: 37873682 DOI: 10.1002/jum.16349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES This study compared ultrasound-guided nerve hydrodissection (HD) outcomes using two commonly used injectate volumes (10 and 5 mL) of normal saline to explore if there is a volume effect of HD for patients with moderate carpal tunnel syndrome (CTS). METHODS Twenty-four participants were randomly assigned to treatment with HD using ultrasound-guidance and either 10 mL or 5 mL of normal saline (HD-10 and HD-5 groups respectively). Our primary outcome measures were the change scores of the two subscales of the Boston Carpal Tunnel Syndrome Questionnaire: The Symptom Severity Scale (SSS) and Functional Status Scale (FSS). We conducted a one-way repeated analysis of variance for 3 time points (4, 12, and 24 weeks) for both SSS and FSS, respectively, for change scores from time 0, and percentage change from time 0. RESULTS All participants (n = 12 per group) completed the study. From 0 to 24 weeks the HD-10 group outperformed the HD-5 group for improvement in SSS (median ± IQR; -0.8 ± 0.4 versus -0.5 ± 0.5; P = .024) and FSS scores (mean ± SD; -0.8 ± 0.2 versus -0.5 ± 0.5; P = .011). The HD-10 group improvement in FSS subtest significantly exceeded the MCID percentage-change-based threshold of 27% (34%; P = .039). CONCLUSIONS Despite the limitations of small study size, a largely inert injectate, and a single injection approach, these findings in favor of the 10 mL group suggest that the volume used for ultrasound-guided HD in moderate CTS matters, and a higher volume is more effective.
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Affiliation(s)
- Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
| | - Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
| | | | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
- Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI, USA
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, 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, Taipei, Taiwan
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Żyluk A, Żyluk A. Effectiveness of non-operative methods of treatment of carpal tunnel syndrome: a narrative review. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:2536-2545. [PMID: 39874341 DOI: 10.36740/wlek/196561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Abstract
Carpal tunnel syndrome (CTS) can be treated with several methods, including surgical and non-surgical techniques. Non-surgical methods include wrist splinting, systemic pharmacotherapy, intracarpal injections of steroids hydrodissection, acupuncture, nerve and tendon mobilization, osteopathy, taping, topical application of ointments, laser, ultrasound and shock-wave therapies. These treatments are generally less effective than surgery, and provide only short-lived effect, but it may be quite sufficient for a certain category of patients, particularly those suffering from mild symptoms. Over the last years, these techniques have attracted increasing popularity, because they offer non-invasive option for surgical treatment what can be attractive for some patients. However, although these methods were shown in the literature, their actual effectiveness has not been scientifically verified. The objective of this study was a review of the effectiveness of non-operative methods of treatment of CTS. A review of the published literature from PubMed and Medline databases on the effectiveness of CTS non-operative treatments of was done. The review indicates that each of the presented methods is effective in reduction of symptoms and improvement of hand function in CTS patients, but their effect is only short-lived. None of these treatments provides a permanent cure, like does surgical treatment. In spite of numerous non-operative treatments of CTS, surgery is the only method that provides permanent recovery.
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Affiliation(s)
- Andrzej Żyluk
- DEPATRMENT OF GENERAL AND HAND SURGERY, POMERANIAN MEDICAL UNIVERSITY, SZCZECIN, POLAND
| | - Alicja Żyluk
- DEPARTAMENT OF GENERAL NAD HAND SURGERY, STUDENT'S SCIENTIFIC CIRCLE, POMERANIAN MEDICAL UNIVERSITY, SZCZECIN, POLAND
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29
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Ueda Y, Nakamata O, Kakizaki F, Natsuyama Y, Kawata S, Yakura T, Li ZL, Qu N, Itoh M. Relationship between scapular elevation exercises with different alignments and activity of the trapezius and levator scapulae muscles. J Phys Ther Sci 2023; 35:751-756. [PMID: 37915451 PMCID: PMC10618018 DOI: 10.1589/jpts.35.751] [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: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 11/03/2023] Open
Abstract
[Purpose] This study aimed to examine whether scapular elevation exercises in sitting positions with different alignments lead to contractions of the trapezius and levator scapulae muscles. [Participants and Methods] The participants were 25 males, measured in four sitting positions with different alignments. Spine alignment was assessed by measuring the head protrusion, upper thoracic spine tilt, and pelvic tilt angles. Upper limb alignment was evaluated using the scapula tilt angle, scapula rotation angle, and distance between scapular spinous processes. Scapular elevation exercises were measured, and the thickness of the trapezius and levator scapulae muscles were measured in resting and elevated positions, with changes in muscle thickness. [Results] The trapezius muscle thickness was greater in the sitting position with less thoracic spine tilt and scapula tilt angles. Conversely, the levator scapulae muscle thickness was greater in the sitting position with more thoracic spine tilt and scapula tilt angles. [Conclusion] Scapular elevation exercises induce separate contractions of the trapezius and levator scapulae muscles by modifying the alignment of the spine and upper limbs.
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Affiliation(s)
- Yasuhisa Ueda
- Department of Anatomy, Tokyo Medical University,
Japan
- Department of Physical Therapy, Faculty of Health Science
Technology, Bunkyo Gakuin University: 1196 Kamekubo, Fujimino, Saitama 356-8533,
Japan
| | - Osamu Nakamata
- Department of Physical Therapy, Faculty of Health Science
Technology, Bunkyo Gakuin University: 1196 Kamekubo, Fujimino, Saitama 356-8533,
Japan
| | - Fujiyasu Kakizaki
- Department of Physical Therapy, Faculty of Health Science
Technology, Bunkyo Gakuin University: 1196 Kamekubo, Fujimino, Saitama 356-8533,
Japan
| | | | | | - Tomiko Yakura
- Department of Anatomy, Tokyo Medical University,
Japan
| | | | - Ning Qu
- Department of Anatomy, Tokyo Medical University,
Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University,
Japan
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Omodani T, Takahashi K. Ultrasound-Guided Hydrodissection for Sural Neuropathy After Calcaneus Fracture Surgery: A Case Report. Cureus 2023; 15:e47749. [PMID: 38022034 PMCID: PMC10676283 DOI: 10.7759/cureus.47749] [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] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
We present a case study of a 61-year-old man who experienced sural neuropathy following calcaneus fracture surgery, which was effectively treated using ultrasound-guided hydrodissection. Postoperatively, while the patient exhibited good bony fusion, he reported pain on the lateral side of the calcaneus. Ultrasound findings did not suggest any nerve discontinuity, but localized tenderness around the sural nerve was observed. After hydrodissection using 0.09% lidocaine, the patient's pain significantly decreased. Although hydrodissection alleviated the pain, complete resolution was achieved only post plate removal and neurolysis. This study represents the first report on the efficacy of hydrodissection for postoperative sural neuropathy, suggesting its potential as an effective treatment option.
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Affiliation(s)
- Toru Omodani
- Orthopaedics, Tokyo Advanced Orthopaedics, Tokyo, JPN
| | - Kenji Takahashi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, JPN
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Walter WR, Burke CJ, Adler RS. Tips and tricks in ultrasound-guided musculoskeletal interventional procedures. J Ultrason 2023; 23:e347-e357. [PMID: 38020507 PMCID: PMC10668939 DOI: 10.15557/jou.2023.0039] [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: 06/05/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023] Open
Abstract
Ultrasound visualization affords proceduralists versatile and accurate guidance for a variety of percutaneous, minimally invasive procedures in the musculoskeletal system including joint (intra-articular) injections or aspirations, intra-bursal injections, peritendinous, and perineural injections. A variety of percutaneous procedures are traditionally performed blindly, but may be more easily or more accurately performed with the real-time assistance of ultrasound guidance. Other procedures are only possible utilizing image-guidance, due to the required precision of the injection because of delicate local anatomy or depth of the injection; ultrasound is a safe, portable, and widespread modality that can be used to assist the proceduralist in localizing the needle tip in such cases, to ensure safe and accurate delivery of the medication, most frequently a solution of steroid and anesthetic. This review aims to provide a foundational approach to ultrasound-guided procedures in the musculoskeletal system, offering tips and tricks that can be employed in many different procedures including intra-articular, juxta-articular, and perineural injections for a multitude of clinical scenarios. Technical considerations regarding ultrasound transducer selection, sonographic technique, as well as common indications, contraindications, and complications of these procedures, are presented. Additionally, a variety of pharmacologic considerations for proceduralists contemplating ultrasound-guided injections are discussed.
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32
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Covey CJ, Knobloch AC, Kim AR. Hip Pain in an Athlete. Curr Sports Med Rep 2023; 22:313-319. [PMID: 37678350 DOI: 10.1249/jsr.0000000000001098] [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: 09/09/2023]
Abstract
ABSTRACT Hip pain is a common complaint in sports, and narrowing the differential diagnosis can be difficult. Many etiologies are secondary to overuse and respond well to nonsurgical treatment. The increased use of point-of-care ultrasound has helped provide timely and accurate diagnoses and some guided treatments. The hip is in close proximity to the abdomen and pelvis, and clinicians should be familiar with nonmusculoskeletal pain generators. This article is a comprehensive review of hip pain etiologies in athletes.
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Affiliation(s)
- Carlton J Covey
- Uniformed Services University, Family and Sports Medicine, Travis AFB, CA
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Shojaie P, Botchu R, Iyengar K, Drakonaki E, Sharma GK. Ultrasound-guided median nerve hydrodissection of pronator teres syndrome: a case report and a literature review. J Ultrason 2023; 23:e165-e169. [PMID: 37701054 PMCID: PMC10494808 DOI: 10.15557/jou.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 09/14/2023] Open
Abstract
Aim of the study To describe the sonographic appearance of pronator teres syndrome and the role of ultrasound-guided hydrodissection for its management. Case description Pronator teres syndrome is a well-known compressive neuropathy of the median nerve between the two heads of pronator teres. However, the clinical presentation of this syndrome can be indolent with vague pain at the proximal volar forearm leading to a delay in diagnosis. We describe our experience in the management of pronator teres syndrome in a healthy young badminton player with ultrasound-guided median nerve hydrodissection. We highlight the clinical presentation, the role of dynamic Ultrasound scan (USS) in the diagnosis and effective treatment of pronator teres syndrome. Conclusions In conclusion, managing PTS can be challenging, and this case highlights the importance of ultrasound-guided hydrodissection, when conservative measures have failed to improve the symptoms. Further studies are required to assess and compare the long-term outcomes of these interventions.
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Affiliation(s)
- Parham Shojaie
- Medical School, Aston Medical School, Aston, United Kingdom
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, United Kingdom
| | - Karthikeyan Iyengar
- Department of Orthopaedics, South Port and Ormskirk Hospital NHS Trust, Southport, United Kingdom
| | - Elena Drakonaki
- Department of Anatomy, Clinical Radiologist University of Crete, Crete, Greece
| | - Gaurav Kant Sharma
- Department of Musculoskeletal Radiology, Jaipur Institute of Pain & Sports Injuries (JIPSI), Jaipur, India
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Lin CH, Yen YS, Wu CY. Ultrasound-guided nerve hydrodissection of cervical nerve roots for cervical radicular pain in patients with mild and moderate to severe stenosis: a retrospective cohort study. Sci Rep 2023; 13:13817. [PMID: 37620404 PMCID: PMC10449834 DOI: 10.1038/s41598-023-40376-2] [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: 11/15/2022] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Because fascial entrapment neuropathy can occur in multiple locations, ultrasound-guided nerve hydrodissection has become a key component of the treatment of cervical radicular pain. In this paper, we propose a combination of injectates used for nerve hydrodissection of the cervical nerve roots and compare the clinical outcomes of this treatment among patients with different severities of stenosis. This is a retrospective cohort study designed to compare outcomes between patients with mild stenosis and moderate to severe stenosis. Forty-four patients with mild cervical stenosis and 30 patients with moderate to severe cervical stenosis were consecutively enrolled into two groups. A 10-mL mixture in a single level consisting of 5% in Dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve roots hydrodissection. The two groups were compared with regard to their numeric rating scales (NRS) of pain, proportion of patients who exhibited a favorable outcome (a reduction of pain ≥ 50%), duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects. The follow-up period ranged from 3 to 20 months. The NRS of both groups improved significantly by 1 week, 1 month, 3 months, and final follow-up after the initial injection. Differences in the groups' NRS, proportion of patients who exhibited a favorable outcome, duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects were nonsignificant. There were 4 patients (5.4%) experienced dizziness in that resolved without further treatment. Ultrasound-guided nerve hydrodissection of cervical nerve roots is a safe procedure that reduces pain associated with cervical radicular pain, even in patients with moderate to severe stenosis.
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Affiliation(s)
- Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yun-Shan Yen
- Department of Rehabilitation Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Cheng-Yi Wu
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
- Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chiayi, Taiwan.
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Kersschot J. Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study. Arch Phys Med Rehabil 2023; 104:1154-1155. [PMID: 36990375 DOI: 10.1016/j.apmr.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/30/2023]
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Shojaie P, Afzali M, Iyengar KP, Sharma GK, Arora V, Botchu R. Kiloh-Nevin syndrome: an unusual cause of forearm pain. J Ultrasound 2023:10.1007/s40477-023-00794-4. [PMID: 37318745 DOI: 10.1007/s40477-023-00794-4] [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: 03/23/2023] [Accepted: 04/26/2023] [Indexed: 06/16/2023] Open
Abstract
The popularity of weight training, bodybuilding and general physical conditioning has led to an increased rate of musculoskeletal injuries, such as nerve compression caused by muscle hypertrophy and, stretching of nerves peripherally. We present a case of anterior interosseous nerve (AIN) entrapment syndrome/neuropathy otherwise known as Kiloh-Nevin syndrome in a 22-year-old weightlifter. Knowledge of this injury is paramount for practitioners to increase awareness among athletes and bodybuilders.
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Affiliation(s)
- P Shojaie
- Aston Medical School, Aston, Birmingham, UK
| | - M Afzali
- Aston Medical School, Aston, Birmingham, UK
| | - K P Iyengar
- Department of Orthopedics, Southport and Ormskirk NHS Trust, Southport, UK
| | | | - V Arora
- Jeevan Rekha Superspeciality Hospital, Jaipur, India
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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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: 16] [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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Silver D, Esener D, Rose G. Ultrasound guided transgluteal sciatic nerve hydrodissection for the treatment of acute sciatica in the emergency department. Am J Emerg Med 2023:S0735-6757(23)00095-5. [PMID: 36933988 DOI: 10.1016/j.ajem.2023.02.026] [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: 01/14/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
Radicular pain due to sciatica is a common occurrence with a lifetime incidence of up to 40%. Typical approaches to treatment vary and may include topical and oral analgesics, such as opioids, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs); however, these medications may be contraindicated in some or result in untoward effects in others. The use of ultrasound-guided regional anesthesia is an important component of multimodal analgesia in the emergency department. Transgluteal sciatic nerve block has been described as an effective method to treat patients with sciatica but carries risk of injury and falls due to its resultant loss of motor function and potential for systemic toxicity when higher volumes are used. Ultrasound-guided peripheral nerve hydrodissection with D5W has been shown to be an effective treatment of various compressive neuropathies in the outpatient setting. Here we present 4 cases of patients who presented to the emergency department with severe acute sciatica and were treated successfully using an ultrasound guided transgluteal sciatic nerve hydrodissection (TSNH). This technique may offer a safe and effective approach to treating patients with sciatica, but more studies are needed to assess its utility on a larger scale.
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Affiliation(s)
- Drew Silver
- Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, USA
| | - Dasia Esener
- Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, USA
| | - Gabriel Rose
- Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, USA.
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Analgesic Effect of Perineural Injection of BoNT/A on Neuropathic Pain Induced by Chronic Constriction Injury of Sciatic Nerve in Rats. Neurochem Res 2023; 48:2161-2174. [PMID: 36828984 DOI: 10.1007/s11064-023-03893-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/26/2023]
Abstract
This study was designed to investigate the analgesic effect of perineural injection of BoNT/A on neuropathic pain induced by sciatic nerve chronic constriction injury (CCI) and possible mechanisms. SD rats were randomly divided into Sham group, CCI group and BoNT/A group. Paw mechanical withdrawal threshold (pMWT) and paw thermal withdrawal latency (pTWL) of each group were detected at different time points after surgery. The expression of myelin markers, autophagy markers and NLRP3 inflammasome-related molecules in injured sciatic nerves were examined at 12 days after surgery. Moreover, C-fiber evoked potential in spinal dorsal horn was recorded. The expression of SNAP-25, neuroinflammation and synaptic plasticity in spinal dorsal horn of each group were examined. Then rats treated with BoNT/A were randomly divided into DMSO group and Wnt agonist group to further explore the regulatory effect of BoNT/A on Wnt pathway. We found that pMWT and pTWL of ipsilateral paw were significantly decreased in CCI group compared with Sham group, which could be improved by perineural injection of BoNT/A at days 7, 9 and 12 after surgery. The peripheral analgesic mechanisms of perineural injection of BoNT/A might be related to the protective effect on myelin sheath by inhibiting NLRP3 inflammasome and promoting autophagy flow, while the central analgesic mechanisms might be associated with inhibition of neuroinflammation and synaptic plasticity in spinal dorsal horn due to inhibiting SNAP-25 and Wnt pathway. As a new route of administration, perineural injection of BoNT/A can relieve CCI induced neuropathic pain probably via both peripheral and central analgesic mechanisms.
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Lam KHS, Wu YT, Reeves KD, Hadzic A, Perez MF, Fu SN. A novel infrapatellar approach of ultrasound-guided intra-articular injection of the knee from both lateral and medial side: a case series. Ther Adv Musculoskelet Dis 2023; 15:1759720X221149954. [PMID: 36793993 PMCID: PMC9923012 DOI: 10.1177/1759720x221149954] [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: 08/05/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023] Open
Abstract
Knee osteoarthritis (OA) is common. Ultrasound-guided intra-articular injection (UGIAI) using the superolateral approach is currently the gold standard for treating knee OA, but it is not 100% accurate, especially in patients with no knee effusion. Herein, we present a case series of chronic knee OA treated with a novel infrapatellar approach to UGIAI. Five patients with chronic grade 2-3 knee OA, who had failed on conservative treatments and had no effusion but presented with osteochondral lesions over the femoral condyle, were treated with UGIAI with different injectates using the novel infrapatellar approach. The first patient was initially treated using the traditional superolateral approach, but the injectate was not delivered intra-articularly and became trapped in the pre-femoral fat pad. The trapped injectate was aspirated in the same session due to interference with knee extension, and the injection was repeated using the novel infrapatellar approach. All patients who received the UGIAI using the infrapatellar approach had the injectates successfully delivered intra-articularly, as confirmed with dynamic ultrasound scanning. Their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function scores significantly improved 1 and 4 weeks post-injection. UGIAI of the knee using a novel infrapatellar approach is readily learned and may improve accuracy of UGIAI, even for patients with no effusion.
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Affiliation(s)
| | - Yung-Tsan Wu
- Department of Physical Medicine and
Rehabilitation, Tri-Service General Hospital, School of Medicine, National
Defense Medical Center, 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, Taipei, Taiwan
| | | | | | - Mario Fajardo Perez
- Ultradissection Group, Madrid, Spain,MOMARC, Madrid, Spain,Vithas Hospital, Madrid, Spain
| | - Sau Nga Fu
- Department of Family Medicine, The Chinese
University of Hong Kong, Shatin, Hong Kong,Department of Family Medicine, The University
of Hong Kong, Pokfulam, Hong Kong
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41
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Raum G, Schroeder A. The Perplexity of Posterior Pelvic Pain: A Clinical Vignette. Am J Phys Med Rehabil 2022; 101:e169-e172. [PMID: 35762856 DOI: 10.1097/phm.0000000000002069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- George Raum
- From the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Muacevic A, Adler JR. A Case Report on Abdominal Pain Treated With a New Technique of Ultrasound-Guided Transversus Abdominis Plane Hydrodissection Using a Low Concentration of Local Anesthetics. Cureus 2022; 14:e31966. [PMID: 36582553 PMCID: PMC9795083 DOI: 10.7759/cureus.31966] [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] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
Hydrodissection, a technique for performing morphological dissection between the target tissues via injection, has attracted attention in recent years. However, high-quality evidence is available only for a few entrapment neuropathies, such as carpal tunnel syndrome, and further case studies are needed for other diseases. This case report presents the first case of hydrodissection of the ventral ramus of the spinal nerve, which innervates the abdominal wall, to improve abdominal pain. A 59-year-old Japanese man with a history of cerebral infarction and dyslipidemia presented to the emergency department with the chief complaint of left upper abdominal pain that began two days earlier. The pain radiated to the left side of the back and left axilla. The abdomen was flat and soft with no tenderness on examination, and the pinch test was negative. However, Carnett's sign was observed in the left upper abdomen, and the location of the left upper abdominal pain and that of the radiating pain were consistent with the ninth thoracic vertebra (Th9) dermatome; thus, the cause of the left upper abdominal pain was determined to be the ventral ramus of the spinal nerve of Th9. Two weeks of physical therapy and lifestyle guidance were ineffective; therefore, hydrodissection of the transversus abdominis plane (TAP) between the myofascia of the internal oblique muscle and that of the transversus abdominis at the Th9 level using a 23G 60 mm needle under ultrasound guidance was planned. The abdominal pain immediately improved after hydrodissection, and the patient was able to work without pain. Thus, ultrasound-guided TAP hydrodissection with a low-concentration local anesthetic is effective in the treatment of abdominal pain caused by the entrapment of the ventral ramus of the spinal nerve due to adhesions between the myofascia of the internal oblique muscle and that of the transversus abdominis. This condition should be termed ventral ramus of spinal nerve entrapment syndrome (VERNES), and this concept and TAP hydrodissection must be made known to the public.
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Kersschot J, Karavani I. Isotonic Glucose Injections for Postherpetic Neuralgia in the Elderly. Cureus 2022; 14:e29740. [PMID: 36324341 PMCID: PMC9617511 DOI: 10.7759/cureus.29740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
Postherpetic neuralgia (PHN) is a painful condition which is difficult to treat, especially among the elderly. This clinical case describes the treatment of an 88-year-old patient with PHN who continued to suffer from pain for several months despite oral and transdermal pain treatment. Multiple intradermal glucose 5% injections allowed her to discontinue her pain medication regimen after four sessions. The improvement was sustained at the four-month follow-up after the last procedure. A fifth session was performed because of a flaring up of the pain.
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Gill B, Rahman R, Khadavi M. Ultrasound-Guided Hydrodissection Provides Complete Symptom Resolution in Radial Tunnel Syndrome: A Case Series and Scoping Review on Hydrodissection for Radial Nerve Pathology. Curr Sports Med Rep 2022; 21:328-335. [PMID: 36083708 DOI: 10.1249/jsr.0000000000000991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This study analyzes the effectiveness of ultrasound-guided hydrodissection (HD) perineural as a treatment for radial tunnel syndrome (RTS). A literature search was performed along with retrospective analysis of local cases to assess outcomes and safety of this procedure. In the case series, surgical candidates, defined as cases with over 80% but temporary relief after diagnostic injection, were treated with ultrasound-guided HD. Of 22 patients who received ultrasound-guided diagnostic injections, 11 proceeded to HD. All HD patients experienced complete and lasting symptom resolution for a minimum of 2 years, and none required surgery. Thorough literature review provided seven studies, which fulfilled inclusion criteria. Sixty-one patients are represented in the literature. All studies reported significant benefit to pain symptoms with HD of radial nerve, with five specifying over 90% improvement. No adverse effects from HD were noted in any study. Ultrasound-guided HD of the radial tunnel has potential to be a surgery sparing treatment for RTS.
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Affiliation(s)
- Benjamin Gill
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO
| | - Rafid Rahman
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO
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A Review of Current Concepts in Ultrasound Evaluation and Management of Ulnar Nerve Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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46
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Lam KHS, Hung CY, Wu TJ, Chen WH, Ng TKT, Lin JA, Wu YT, Lai WW. Novel Ultrasound-Guided Cervical Intervertebral Disc Injection of Platelet-Rich Plasma for Cervicodiscogenic Pain: A Case Report and Technical Note. Healthcare (Basel) 2022; 10:healthcare10081427. [PMID: 36011084 PMCID: PMC9408075 DOI: 10.3390/healthcare10081427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Ultrasound-guided needle placement into the cervical intervertebral discs using a lateral-to-medial approach is reportedly possible. Clinically, however, patients commonly present with very high uncovertebral joints or narrowed intervertebral spaces, making the method difficult or impossible. This report presents a novel ultrasound-guided needle placement technique to the cervical intervertebral discs using a more medial approach between the trachea/thyroid gland and the carotid sheath. A patient presented with neck pain radiating to the right shoulder and right-sided interscapular regions that affected his sleep and daily functioning. Physiotherapy, selective nerve root block, and percutaneous endoscopic right C7 laminotomy did not sufficiently improve his condition, which progressed to bilateral interscapular and bilateral shoulder pain. Provocative discography was performed with injection of leukocyte-poor and red blood cell-poor platelet-rich plasma to provoke the discogenic pain, which was treated with platelet-rich plasma mixed with lidocaine. The patient recovered well. A month later, there was a significant decrease in the neck disability index score from the initial 28/50 to 14, and there was a further decrease to 5 after 2 months. In conclusion, this medial approach of ultrasound-guided cervical disc needle placement is feasible, even in patients where disc access by previously described approaches is impossible.
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Affiliation(s)
- King Hei Stanley Lam
- The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, China;
- The Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The Department of Family Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan; (T.K.T.N.); (J.-A.L.)
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: ; Tel.: +852-2372088
| | - Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Tsung-Ju Wu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung 40402, Taiwan;
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua City 50006, Taiwan
| | - Wei-Hung Chen
- Department of Anesthesiology, E-Da Hospital, Kaohsiung City 82445, Taiwan;
| | - Tony Kwun Tung Ng
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan; (T.K.T.N.); (J.-A.L.)
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Pain Management Unit, Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital, Hong Kong, China
- Department of Anesthesiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Anesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Frankston Pain Management, Frankston, VIC 3199, Australia
| | - Jui-An Lin
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan; (T.K.T.N.); (J.-A.L.)
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Anesthesiology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Pain Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan;
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Wai Wah Lai
- The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, China;
- The Department of Family Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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47
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Castro JCD, Wang D, Chien GCC. Regenerative medicine for neuropathic pain: physiology, ultrasound and therapies with a focus on alpha-2-macroglobulin. Pain Manag 2022; 12:779-793. [PMID: 35762220 DOI: 10.2217/pmt-2022-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The currently available drugs to treat neuropathic pain do not provide adequate pain management. As such, other treatments including stem cells, platelet-rich plasma and plasma-derived molecules such as alpha-2 macroglobulin (A2M) are being explored because they show promising potential for neuropathic pain. The various mechanisms and immunomodulatory effects could be a desirable approach in targeting neuropathic pain. This review indicates that A2M can be highly efficacious due to its conformational change during activation and specificity of action on various cytokines. Its ability to reduce neuropathic pain can further the future of neuropathic intervention. However, there is a lack of robust clinical studies and thus further research is needed to verify and expand the understanding of its therapeutic effects.
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Affiliation(s)
- Jeimylo C de Castro
- Department of Physical Medicine & Rehabilitation, The Medical City-South Luzon, Santa Rosa, Laguna, 4026, Philippines.,SMARTMD Center for Non-Surgical Pain Interventions, Makati, 1224, Philippines
| | - Daniel Wang
- Kansas City University, Kansas City, MO 64106, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA 93003, USA.,GCC Institute for Regenerative Medicine, Irvine, CA 92606, USA
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48
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Chao TC, Reeves KD, Lam KHS, Li TY, Wu YT. The Effectiveness of Hydrodissection with 5% Dextrose for Persistent and Recurrent Carpal Tunnel Syndrome: A Retrospective Study. J Clin Med 2022; 11:jcm11133705. [PMID: 35806998 PMCID: PMC9267718 DOI: 10.3390/jcm11133705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with failure of primary surgery for carpal tunnel syndrome (CTS) present a frustrating clinical problem because there are no relevant treatment guidelines, and the effect of current conservative management or revision surgery is unsatisfactory. Hydrodissection with 5% dextrose is emerging as an effective treatment for primary CTS and may be an effective alternative treatment method for persistent or recurrent post-surgical CTS. We retrospectively investigated the long-term effectiveness of hydrodissection with 5% dextrose for persistent or recurrent CTS. Thirty-six of forty consecutively-treated patients with either persistent or recurrent symptoms of CTS after surgery, who were treated with ultrasound-guided hydrodissection of the median nerve using 10 mL of 5% dextrose, were available to provide outcome data by a structured phone interview at least six months after treatment completion. Symptom relief ≥ 50% represented an effective outcome, while symptom relief < 50% was rated as a poor outcome. Nearly 2/3 (61.1%) of patients reported an effective outcome after a mean of 3.1 injections, with a post-injection follow-up mean of 33 (6−67) months. A non-significant trend toward a more frequently-effective outcome was observed in those with recurrent versus persistent symptoms following CTS (76.9% vs. 52.2%, p = 0.165). However, a significantly higher percentage of those with recurrent symptoms reported an excellent outcome, defined as a greater than 70% improvement (8/13 [61.6%] vs. 3/23 [13%], p = 0.006). The percentage of patients achieving an effective outcome was not significantly different between <2, 2−4, and >4 years of post-treatment follow-up (36.4% vs. 77.8% vs. 57.1%; p = 0.077). Hydrodissection with 5% dextrose may result in a clinically important and durable benefit in those experiencing persistent or recurrent CTS after surgery.
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Affiliation(s)
- Ta-Chung Chao
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
| | | | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong;
- Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
- 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
- Correspondence: ; Tel.: +886-2-87923311 (ext. 13342)
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Effect of Perineural Dextrose Injection on Ulnar Neuropathy at the Elbow: A Randomized, Controlled, Double-Blind Study. Arch Phys Med Rehabil 2022; 103:2085-2091. [PMID: 35690093 DOI: 10.1016/j.apmr.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare perineural dextrose injection efficacy in the treatment of ulnar neuropathy at the elbow with a control group. DESIGN Prospective, double-blind, randomized, control study. SETTINGS Training and Research Hospital Participants: The study was completed with 40 patients with ulnar neuropathy at the elbow Intervention: Normal saline (0.9% NaCl) was injected to the control group (n=20; mean age=38.1 ± 10.7 years; median duration of symptoms = 4.5 months), while 5% dextrose (D5W) was injected to the dextrose group (n=20; mean age=43.6 ±13.5 years; median duration of symptoms = 5 months), perineurally under ultrasound guidance twice at two-week intervals. US-guided perineural injection of 1 cc each was administered into the ulnar nerve, 2 cm and 4 cm distal to the medial epicondyle, at the level of the medial epicondyle, and 2 cm and 4 cm proximal to the medial epicondyle. Amount of total fluid injected was 5 cc. MAIN OUTCOME MEASURE(S) At baseline, weeks 2, 4, and 12, the patients were evaluated with the Visual Analog Scale for pain and the Disabilities of the Arm Shoulder and Hand (Quick-DASH) questionnaire for disability. Electrophysiological evaluation was performed with ulnar nerve conduction studies, and the ulnar nerve cross-sectional area (CSA) was measured on ultrasonography. RESULTS The improvements in pain, disability, ulnar motor nerve velocity and CSA in the dextrose group were superior to those in the control group, especially at weeks 4 and 12 (p<0.001, using independent-samples t-test). CONCLUSION Perineural D5W may be an effective alternative therapy for those with ulnar neuropathy at the elbow for up to the 12th week.
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50
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Mechanism of Glucose Water as a Neural Injection: A Perspective on Neuroinflammation. Life (Basel) 2022; 12:life12060832. [PMID: 35743863 PMCID: PMC9225069 DOI: 10.3390/life12060832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 12/19/2022] Open
Abstract
The entrapment of peripheral nerves is associated with chronic neuroinflammation and neuropathic pain, and perineural injection therapy with glucose is emerging as an effective treatment for peripheral entrapment neuropathy. However, the mechanism underlying the pharmacological effect of glucose on nerves remains unclear. One of the hypothesized mechanisms is that glucose reduces neurogenic inflammation. Therefore, we investigated the effects of high glucose concentrations on cytokine-induced neuroinflammation in vitro. Human SH-SY5Y neuronal cells were challenged with 10 ng/mL TNF-α for 16 h and subsequently treated with different glucose concentrations (0–25 mM) for 24 h. Cell viability was evaluated using the diphenyltetrazolium bromide assay, and proinflammatory cytokine levels were assessed using ELISA and quantitative PCR. In addition, mRNA levels of NF-κB and cyclooxygenase-2 were analyzed using quantitative PCR. Exposure to 10 ng/mL TNF-α resulted in decreased viability of SH-SY5Y cells and significant upregulation of IL-6, IL-1β, NF-κB, and cyclooxygenase-2. Subsequent exposure to high glucose levels (25 mM) markedly reduced the upregulation of IL-6, IL-1β, cyclooxygenase-2, and NF-κB, and restored the functional metabolism of SH-SY5Y cells, compared with that of the normal glucose control. Our findings suggest that high glucose concentrations can mitigate TNF-α-induced NF-κB activation, upregulation of proinflammatory cytokines, and metabolic dysfunction.
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