David Spinner

Atlas of ultrasound guided musculoskeletal injections

Atlas of ultrasound guided musculoskeletal injections / , Atlas of ultrasound guided musculoskeletal injections / , کتابخانه دیجیتال جندی شاپور اهواز

Ultrasound‐Guided Cryoablation of a Traumatic Hip Disarticulation Neuroma

Traumatic amputation at the pelvic level is a rare procedure with few studies addressing long‐term complications. Painful neuroma formation may form at the site of nerve transection and cause significant impairments in daily living. Ultrasound‐guided cryoablation therapy has grown in popularity and should be considered in patients with painful neuromas. This is a case report of complete pain relief in a patient with rare traumatic hip disarticulation with neuroma formation, treated with ultrasound‐guided cryoablation. The patient gave consent for publication.

Ultrasound-Guided First Metatarsophalangeal Joint Injections Description of an In-plane, Gel Standoff Technique in a Cadaveric Study

Objective. To describe a longitudinal ultrasound-guided in-plane approach for injection into the first metatarsophalangeal (MTP) joint and assess its accuracy in a cadaveric model. Design. A prospective anatomical cadaver study model was used. A total of 10 first MTP joints using the described technique were injected with 0.5 mL of dye under ultrasound guidance. The joints were later dissected, and accuracy was classified as accurate, accurate with overflow, or inaccurate with no injectate in the target area. Results. Of the injections, 9 were classified as accurate injections, and 1 was classified accurate with overflow. Conclusion. This cadaveric study suggests that ultrasound-guided injections of the first MTP joint can be accurately and reproducibly performed with a gel standoff, long-axis in-plane approach. This technique attempts to minimize the collateral damage to the surrounding tissue, specifically the articular cartilage. Clinicians should consider using this technique when performing ultrasound-guided injections to the first MTP joint. Level of Evidence: Cadaveric, Level V

Ultrasound-Guided Superficial Trigeminal Nerve Blocks

Trigeminal neuralgia (TN) is a debilitating facial pain disorder characterized by severe paroxysmal facial pain that is usually unilateral and abrupt in onset and termination [1]. The pain is characterized as sharp and electric in quality. Patients often experience periods of remission and relapse [2, 3]. A trigger zone or area along part of the face may be triggered or stimulated by everyday activities such as brushing the teeth, applying cosmetics, or even speaking, eating, or feeling a breeze [2, 4]. These patients present with normal neurologic examinations.

Percutaneous Translaminar Facet Cyst Rupture and Epidural Access—Description of a Novel Technique

Synovial cysts of the lumbar zygapophysial joints can be treated by percutaneous injection of corticosteroids, with distension and rupture of the cyst. Some cysts can be difficult to access, particularly when they lie deep in relation to the lamina. This technical report describes a fluoroscopy-guided technique for accessing sublaminar pathology. Crucial to the safety of the technique is visualization of the ventral margin of the lamina using a contralateral oblique view, and controlling and limiting the insertion of the needle such that only its tip passes the lamina.

Filum Terminale Needle Placement During Caudal Epidural Steroid Injection

Objective Caudal epidural steroid injections (ESIs) are commonly used to treat lumbar radicular pain. Touhy needles are placed under live fluoroscopic guidance to ensure epidural administration of medication. This is a case report of direct needle and catheter placements into and through the filum terminale during a caudal approach to the epidural space. Design Single case report. Setting Beth Israel Deaconess Medical Center. Patient A 69-year-old woman who suffered from chronic low back and leg pain from lumbosacral radiculopathy, failed back surgery syndrome, and lumbar facet arthropathy. Interventions Caudal epidural steroid injection. Outcome Measures Patient safety. Results The needle and catheter placement were confirmed via intrathecal contrast spread to be in the filum terminale, which prompted abortion of the procedure. Conclusions Although caudal ESI is a relatively safe and routine intervention, care must be taken to ensure proper placement of needle, catheter, and injectate. While contrast is injected to ensure appropriate epidural spread, it serves also to reveal unexpected and unwanted spread. We present the first report of a needle being inserted directly into the filum terminale during a caudal ESI.

Acute Brachial Radiculitis (Parsonage-Turner Syndrome)

Parsonage-Turner syndrome (PTS), also known as neuralgic amyotrophy (NA), classically presents with extreme pain, followed by weakness, atrophy, and sensory abnormalities typically affecting the upper extremities. The etiology and pathophysiology of the disorder still remain unclear but may involve a combination of genetic predisposition, mechanical stressors, and immunological factors. Diagnosis is made clinically and often requires testing including electrodiagnostics in order to exclude other causes. Although prognosis has traditionally been thought of as positive, recent evidence has shown that recovery is usually slow and incomplete, occurring over a period of months to years. Many patients are left with residual pain and or deficits interfering with daily life as well as their ability to return to work. Treatment typically includes pain control as well as an outpatient therapy program. Some claim early corticosteroid therapy may be beneficial, but studies to prove its efficacy have been lacking.

Poster 375 Distention Capsulography for the Treatment of Adhesive Capsulitis

Results or Clinical Course: A Spearman’s correlation was run to determine the side-to-side relationship of EMG activity for each lower extremity muscle tested during the double leg squat in FAI and control groups. Bonferroni correction was used to determine the P value equal to .004. The two groups demonstrated different patterns of correlated side-to-side EMG activity in 4 muscles. Control group had statistically significantly correlation in tibialis anterior (r1⁄40.5597, P1⁄4.0001) and FAI group did not (r1⁄40.1749, P1⁄4.3224). Whereas FAI group had statistically significant side-to-side correlation with gluteus medius, soleus and medial/lateral gastrocs (r1⁄40.6608, P1⁄4.0000; r1⁄40.8151, P1⁄4.0000; r1⁄40.4129, P1⁄4.0123; r1⁄40.6330, P1⁄4.0000) and the control group did not. (r1⁄40.2811, P1⁄4.0968; r1⁄40.4129, P1⁄4.0123; r1⁄40.2952, P1⁄4.0804; r1⁄4-0.1498, P1⁄4.3832) Conclusion: Individuals with FAI appear to utilize different motor control strategies than healthy controls when asked to perform a double leg squat.

Poster 453 Paraparesis After Spinal Cord Stimulator Trial and Placement in 2 Patients: A Case Report

bladder, or sexual dysfunction. Diagnosis is made by MRI of the spine. Treatment options include open surgical ligation or resection of the malformation, endovascular occlusion, spinal radiation, or a combination of these techniques. Conclusions: We present a rare case of a patient with a thoracic spinal arteriovenous malformation. Clinicians should be aware of this entity and should consider further imaging of the spine in patients presenting with lower extremity weakness and a normal lumbar MRI.