Adam M. Pourcho

Percutaneous Ultrasonic Fasciotomy for Refractory Plantar Fasciopathy After Failure of a Partial Endoscopic Release Procedure

Plantar fasciopathy is a painful, degenerative condition of the plantar fascia that affects 2 million people annually and has an estimated 10% lifetime prevalence. When both nonoperative and operative management fails, patients have limited therapeutic options. We present a case of an active 47‐year‐old male runner who was successfully treated with songraphically guided percutaneous ultrasonic fasciotomy after undergoing a prolonged course of nonoperative management and an endoscopic plantar fascia release procedure. Percutaneous ultrasonic fasciotomy may be considered in patients with chronic, refractory plantar fasciopathy, including those for whom a prior operative release procedure has failed.

Ultrasound Evaluation of the Lower Trapezius in Adolescent Baseball Pitchers.

Biomechanical studies have demonstrated that the lower trapezius (LT) facilitates normal shoulder function, and given its potential role in causing and/or perpetuating dysfunction, clinicians have begun to evaluate and rehabilitate the LT in the context of comprehensive shoulder rehabilitation programs. Although some studies have compared side‐to‐side differences in LT thickness among nonthrowers, no studies have been performed to examine the normal ultrasound appearance of the LT in the adolescent throwing population.

Optimal Elbow Angle for Sonographic Visualization of the Ulnar Collateral Ligament

To formally examine the sonographic appearance of the elbow ulnar collateral ligament (UCL) at 30° versus 70° of elbow flexion in asymptomatic baseball pitchers.

Percutaneous Ultrasonic Tenotomy for Refractory Common Extensor Tendinopathy After Failed Open Surgical Release: A Report of Two Cases

Common extensor tendinopathy (CET) is a common, painful overuse and degenerative condition of the lateral elbow, affecting an estimated 2 million patients per year. Although many cases resolve with conservative treatment, recalcitrant cases may progress to open surgical intervention. For patients who do not improve with surgical management, treatment options are extremely limited. In this article, we present 2 cases of recalcitrant surgically treated CET successfully treated with sonographically guided percutaneous ultrasonic tenotomy with 1‐year follow‐up. To our knowledge, this is the first publication demonstrating successful treatment of recalcitrant CET after open surgical repair, with the use of ultrasonic tenotomy.

Ultrasound-Guided Interventional Procedures About the Shoulder: Anatomy, Indications, and Techniques

Chronic and acute shoulder pain and dysfunction are common complaints among patients. Shoulder pain may be the result of abnormality involving the rotator cuff, subacromial-subdeltoid bursa, biceps tendon, glenoid labrum, glenohumeral joint, acromioclavicular joint, sternoclavicular joint, or glenohumeral joint capsule. Ultrasound-guided (USG) procedures of the shoulder are well established for interventional management. Ultrasound provides the advantages of excellent soft tissue resolution, injection accuracy, low cost, accessibility, portability, lack of ionizing radiation, and the ability to perform real-time image-guided procedures. The purpose of this article is to review common indications and effective techniques for USG injections about the shoulder.

Electrodiagnostically confirmed posttraumatic neuropathy and associated clinical exam findings with lisfranc injury.

Background: Patients with a Lisfranc injury often complain of persistent pain radiating from the Lisfranc joint up or down the first dorsal web space, accompanied by decreased sensation. We hypothesized that these symptoms were related to a posttraumatic neuropathy of the terminal medial branch of deep fibular (peroneal) nerve (MBDFN) and that by recognizing this symptom an earlier diagnosis of Lisfranc injury may be possible. Methods: Twelve patients with diagnosis of subtle unilateral Lisfranc injury, confirmed by standing X-ray, CT, or bone scan, were enrolled. Standardized antidromic sensory nerve conduction studies of MBDFN were performed bilaterally within 2 months postinjury and prior to surgical intervention. The contralateral, normal side was used as a control. All patients were tested for decreased 2-point discrimination in the first dorsal web space on both lower extremities. Results: Sensory nerve action potential of the MBDFN was absent, with decreased 2-point discrimination on the injured side in all patients. Conclusion: Lisfranc injuries were associated with a posttraumatic neuropathy of the MBDFN and decreased 2-point discrimination in the first dorsal web space. The finding of altered sensation in the first dorsal web space may help the practitioner to earlier diagnosis of a Lisfranc injury. Level of Evidence: Level III, case control study.

Ultrasound-Guided Interventional Procedures of the Wrist and Hand: Anatomy, Indications, and Techniques

Acute and chronic wrist and hand conditions are commonly seen by neuromuscular and musculoskeletal specialists. High-frequency diagnostic ultrasonography (US) has facilitated advances in the diagnosis and interventional management of wrist and hand disorders. US provides excellent soft tissue resolution, accessibility, portability, lack of ionizing radiation, and the ability to dynamically assess disorders and precisely guide interventional procedures. This article review the relevant anatomy, indications, and interventional techniques for common disorders of the wrist and hand, including radiocarpal joint arthritis, scaphotrapeziotrapezoidal joint arthritis, trapeziometacarpal joint arthritis, phalangeal joint arthritis, first dorsal compartment tenosynovitis, ganglion cysts, and stenosing tenosynovitis.

Atypical Coxa Saltans Due to Partial Proximal Hamstring Avulsion: A Case Presentation Highlighting the Role for Dynamic Sonography

Painful hip snapping can present as a rare sequela of proximal hamstring injury. We present a case of painful snapping of the conjoint tendon of the semitendinosus and biceps femoris over the ischial tuberosity in the setting of a partial proximal hamstring disruption. Dynamic ultrasonography identified the source of snapping and a persistent attachment of the conjoint tendon to the sacrotuberous ligament, which prevented retraction and allowed subluxation of the tendons across the ischial tuberosity. Following surgical transection of the persistent sacrotuberous ligament attachment to the conjoint tendon and tendon reattachment, the patients symptoms resolved with full return of function.

Sonographic Appearance of the Extensor Carpi Radialis Intermedius Tendon

Figure 1. Transducer positioning for sonographic short-axis (SAX) view of the second dorsal compartment (CPT) with correlative sonographic and magnetic resonance imaging (MRI) images. (A) Transducer (black rectangle) and patient positioning for the sonographic SAX view of the second dorsal CPT. (B) Sonographic correlative image of the second dorsal CPT at the level of the proximal intersection of the first dorsal CPT over the second dorsal CPT. The extensor carpi radialis intermedius tendon (white arrow) is shown in its typical location between and deep to the extensor carpi radialis longus (ECRL) (L) and extensor carpi radialis brevis (B) tendons. Note thickening and hypoechoic heterogeneity of the ECRL tendon consistent with tendinosis

Sonographic Changes After Ultrasound-Guided Release of the Transverse Carpal Ligament: A Case Report

Carpal tunnel syndrome is the most common entrapment neuropathy, resulting in 500,000 carpal tunnel release (CTR) surgeries and a total cost of more than 2 billion dollars annually in the United States. Although initially performed via a large (3‐5 cm) palmar incision, CTR techniques have continually evolved to reduce incision size, recovery times, postoperative pain, and improve cosmesis and clinical outcomes. More recently, multiple authors have reported excellent results after ultrasound‐guided carpal tunnel release (USCTR) using a variety of techniques, and one prospective randomized trial reported faster recovery after USCTR compared with traditional mini‐open CTR. However, there is a paucity of data with respect to changes in the median nerve after USCTR. This case report presents the functional outcomes and pre‐ and postprocedure ultrasound images of a patient after USCTR with 3‐month follow‐up.