Gregory R. Saboeiro

Ultrasound-Guided Intratendinous Injections With Platelet-Rich Plasma or Autologous Whole Blood for Treatment of Proximal Hamstring Tendinopathy A Double-Blind Randomized Controlled Trial

To compare the effects of ultrasound‐guided platelet‐rich plasma (PRP) and whole blood (WB) injections in patients with chronic hamstring tendinopathy.

Ultrasound-guided ganglion cyst aspiration.

Soft tissue ganglia can occur around multiple joints throughout the musculoskeletal system. These can present clinically as slowly enlarging masses, which may or may not be painful. Cross-sectional imaging can be helpful in both diagnosis and treatment of these lesions. The diagnostic ability of sonography and magnetic resonance imaging (MRI) to define the internal characteristics of periarticular lesions as cystic or solid is invaluable to diagnosis. They can also meticulously outline the regional anatomy, identifying regional neurovascular structures that could potentially pose a problem if surgical excision is considered. We describe a case of a soft-tissue ganglion of the foot, localized immediately deep to a first order branch of the dorsalis pedis artery, diagnosed with magnetic resonance imaging and treated with sonographic-guided aspiration.

Imaging-Guided Treatment of Scapulothoracic Bursitis

Scapulothoracic region pain can be a diagnostic dilemma, occasionally being confused with other causes of shoulder pain or even a thoracic or cervical radiculopathy. True scapulothoracic bursitis can be caused by abnormal biomechanics between the scapula and the rib cage as an isolated entity, due to a structural lesion such as a tumor, posttraumatic, idiopathic, or secondary to a postsurgical deformity of the chest wall [1, 2]. Treatment of scapulothoracic bursitis can include conservative and surgical options, such as arthroscopic release of fibrous adhesions or bursectomies, or image-guided steroid/anesthetic injections of the bursa [2, 3, 4]. We present a case of a patient with scapulothoracic bursitis related to prior chest wall trauma and subsequent thoracoplasty, diagnosed with real-time fluoroscopy and treated with ultrasound-guided injection.

Magnetic Resonance Angiography in the Management of Recurrent Hemarthrosis After Total Knee Arthroplasty

Spontaneous hemarthrosis is an infrequent but disabling complication after total knee arthroplasty. The purpose of this case series is to demonstrate the utility of magnetic resonance angiography (MRA) in the evaluation of hemarthrosis after total knee arthroplasty. Patients presenting with hemarthrosis unexplained by trauma, anticoagulation, or a bleeding diathesis were retrospectively identified. Eighteen patients were referred for MRA to evaluate recurrent hemarthrosis after failing conservative therapy (n = 16) or synovectomy (n = 2). Despite artifact caused by the metallic components, diagnostic evaluation of regional vessels was made. In 12 of 13 cases that underwent embolization or synovectomy, a hypertrophic feeding artery (or arteries) was visualized on MRA. One case of negative MRA did not have subsequent surgery, and we are unable to comment on the rate of false-positives because all patients in this case series had evidence of bleeding. By characterizing the vascular anatomy and identifying a dominant artery (or arteries) supplying the hypervascular synovium, MRA can serve as a guide for subsequent embolization or synovectomy, as indicated.

Sonographic Evaluation and Sonographic-Guided Therapeutic Options of Lateral Ankle Pain: Peroneal Tendon Pathology Associated with the Presence of an Os Peroneum

Clinical implications of acute injuries of the os peroneum have been described, with the recommendation in some cases being the excision of the bone fragments. We describe the spectrum of sonographic appearances associated with pain in the region of the os peroneum, document associated peroneal tendon pathology, and describe the use of sonography to direct and guide therapeutic and/or diagnostic injections. All sonographic examinations in our ultrasound database from Jan 1, 2001–Jan 30, 2007 with the words “os peroneum” were reviewed. Patients were cross-referenced in our radiology database to find relevant foot or ankle radiographs for correlation. There were 47 patients (18 men and 29 women, age range 16 to 83) referred for sonographic evaluation of lateral foot and/or ankle pain who had an os peroneum identified during the sonographic evaluation. Eighteen patients were referred specifically for targeted injection of the lateral ankle, including peroneal tendon sheath injections (N = 10), calcaneocuboid joint injections (N = 1), and injections around symptomatic os peroneum (N = 7). All 47 patients had tendinosis of the peroneus longus, in varying degrees of severity. Radiographs were available for correlation in 28 patients. The causes of lateral ankle pain with a co-existent os peroneum are multifactorial and may not directly relate to the presence of an os peroneum. Ultrasound can be of value in separating out the specific etiology for pain, as well as provide a method for problem solving by the performance of targeted diagnostic or therapeutic injections in the lateral ankle.

Sonography in the Treatment of Calcific Tendinitis of the Rotator Cuff

escribed as early as 1872, calcific tendinitis of the rotator cuff is a commonly diagnosed entity that may be responsible for considerable shoulder pain and limitation of motion in many patients. 1 By definition, this disease involves the deposition of calcium hydroxyapatite within the tendons of the rotator cuff. The entity is more common in women and is most often symptomatic in patients 40 to 60 years of age. The etiology of this condition is uncertain, with most theories suggesting that the calcium deposition occurs within an area of tendon degeneration or hypovascularity. Over the years, several therapies have been proposed as the optimal treatment for this condition. The ideal treatment technique for this or any other condition should meet several criteria. The procedure should be relatively comfortable for the patient, minimally invasive, and of as short a duration as possible. It should be cost-effective and safe, with a proven record of minimal complications. As the calcium deposition is the cause of the patient’s symptoms, a procedure that includes the effective removal of this calcification is ideal. Finally, a procedure that also addresses the patient’s pain during the ensuing weeks and months would be optimal. This article will discuss the vital importance of sonography in confirming the diagnosis of calcific tendinitis as well as in guiding the percutaneous lavage aspiration that should be the mainstay of therapy in this patient population.

Ultrasound-guided perineural injection for nerve blockade: Does a single-sided injection produce circumferential nerve coverage?

Our current clinical technique for sonographic‐guided perineural injection consists of two‐sided perineural needle placement to obtain circumferential distribution of the injectate. This study aimed to determine if a single‐side needle position will produce circumferential nerve coverage.

Ultrasound Diagnosis and Evaluation of Plantar Heel Pain

BACKGROUND One of the most common causes of heel pain is plantar fasciitis; however, there are other pathologic disorders that can mimic the symptoms and clinical presentation of this disorder. The purpose of this study was to retrospectively review the prevalence of various pathologic disorders on ultrasound in patients with proximal plantar heel pain. METHODS The medical records and diagnostic ultrasound reports of patients presenting with plantar heel pain between March 1, 2006, and March 31, 2007, were reviewed retrospectively, and the prevalence of various etiologies was collected. The inclusion criteria were based on their clinical presentation of plantar fasciitis or previous diagnosis of plantar fasciitis from an unknown source. Ultrasound evaluation was then performed to confirm the clinical diagnosis. RESULTS We examined 175 feet of 143 patients (62 males and 81 females; age range, 16-79 years). Plantar fibromas were present in 90 feet (51%). Plantar fasciitis was diagnosed in 128 feet (73%). Coexistent plantar fibroma and plantar fascial thickening was found in 63 feet (36%). Of the 47 feet that were negative for plantar fasciitis on ultrasound, 27 (57%) revealed the presence of plantar fibroma. CONCLUSIONS Diagnostic ultrasound can effectively and safely identify the prevalence of various etiologies of heel pain. The high prevalence of plantar fibromas and plantar fascial tears cannot be determined by clinical examination alone, and, therefore, ultrasound evaluation should be performed for confirmation of diagnosis.

Multiple hereditary exostoses.

This is a case of a 50-year-old male with worsening pain over the past 8 years in both the right upper extremity and right lower extremity. The patient, of note, did not have any neck pain. On clinical examination, there was mild right upper extremity weakness (4/5) and abnormal reflexes in the right upper extremity and right lower extremity. There was mild right lower extremity weakness. Given the neurologic symptoms, radiographs were obtained, including imaging of the axial skeleton.

Lumbar discal cyst: Diagnostic discography followed by therapeutic computed tomography-guided aspiration and injection.

Discal cysts are extradural masses that communicate with the intervertebral disk and are a rare cause of lower back pain and lumbar radiculopathy. This case report describes a lumbar discal cyst, the diagnosis of which was confirmed on conventional discography, and which was treated with computed tomography-guided aspiration and steroid injection. Several reports have described this procedure, but only one in the radiology literature, and thus the purpose of this report is to remind the radiology community of the existence of this entity and propose a minimally invasive means of treatment.