Jeffrey M. Payne

Sonographically guided carpal tunnel injections: the ulnar approach.

Objective. The purpose of this report is to describe a new sonographically guided technique for carpal tunnel injections using an ulnar approach. Methods. Previously published sonographically guided techniques for carpal tunnel injections were reviewed. Described approaches were noted to be technically challenging because of the need to perform long‐axis imaging of the carpal tunnel, short‐axis (out‐of‐plane) imaging of the needle, or both. Results. We developed and herein describe the ulnar approach for sonographically guided carpal tunnel injections. Advantages of this approach include transverse imaging of the carpal tunnel, long‐axis (in‐plane) imaging of the needle, and versatility in targeting structures within the carpal tunnel. Conclusions. Clinicians should consider the ulnar‐sided approach when performing sonographically guided carpal tunnel injections.

Digital ischemia after carpal tunnel injection: a case report.

A 51-year-old woman described paresthesias in her right thumb, index, and middle fingers consistent with carpal tunnel syndrome. Using a sterile technique, a 25-G, 1 1/4-in needle was introduced ulnar to the palmaris longus tendon, and a mixture of 1.5 mL of 40 mg/mL of triamcinolone acetonide and 1.5 mL of 1% lidocaine was injected. After the injection, the patients hand exhibited signs of ischemia including coolness and discoloration. Rewarming of the hand with paraffin was performed immediately, and normative color returned. At follow-up visits, the patient described burning in the hand, and blotchiness of the digits was noted. A magnetic resonance imaging angiogram of the right wrist showed a single deep palmar arch. Electromyography and nerve conduction study weeks after the injection showed bilateral median neuropathies, moderately severe on the right and mild on the left. She underwent an open carpal tunnel release 6 weeks postinjection. The patient did well and returned to her job without restrictions. The exact etiology of the hand ischemia is unclear but may be related to vasospasm as has been described in the spine-injection literature. Regardless of the etiology, this case shows an uncommon adverse event in a commonly performed procedure and raises questions for further review.

Ultrasound-Guided Hip Procedures.

This article describes the techniques for performing ultrasound-guided procedures in the hip region, including intra-articular hip injection, iliopsoas bursa injection, greater trochanter bursa injection, ischial bursa injection, and piriformis muscle injection. The common indications, pitfalls, accuracy, and efficacy of these procedures are also addressed.

Can a Brief Training Session Prepare Physician Sonographers of Differing Experience to Measure the Ischiofemoral Space? A Reliability Study

The primary aim of this study was to determine the inter‐ and intrarater reliability of ultrasound (US) measurements of the ischiofemoral space (IFS) following a brief training session. A secondary aim was to determine if reliability correlated with sonographer experience.

Poster 74 Factors that Predict Survival in Spinal Cord Injury: Analysis of Both Traumatic and Non-Traumatic Etiologies

Objective: To evaluate the feasibility of using a newly developed active-assistive gait device (AAGAD) for locomotion training in hemiplegic stroke patients. Design: Randomized, controlled study. Setting: Gait training with active-assistive system at therapeutic room. Participants: 20 subjects randomly assigned to the AAGAD (n1⁄410) or control (n1⁄410) group. Interventions: Both groups were treated with a standard rehabilitation program, and 20 min of gait training on treadmill for 5 days a week during 4 weeks with AAGAD and without AAGAD in control group Main Outcome Measures: The 10 m walking test, walking speed (m/s), step cycle (cycle/s), and step length (m) were measured as a gait parameter on a treadmill (Gait Trainer, Biodex, USA) before and after gait training. The angle of ankle dorsiflexion in swing phase was also measured (MotionTwin, Simi, Germany). Clinical parameters measured before and after gait training included Korean Modified Barthel Index (K-MBI), Manual Muscle Test (MMT), and Modified Ashworth Scale (MAS) of hemiplegic ankle. Results or Clinical Course: 1) The 10-m walking time was improved in both groups (P<.05), but step length and step cycle were not. Walking speed and angle of dorsiflexion were improved in AAGAD group (P<.05). K-MBI and MMTwere improved after gait training except ankle power (P<.05), but MAS was not in both groups. 2) The 10-m walking test, Walking speed, angle of dorsiflexion, and step length were greater in AAGAD group (P<.05). Conclusion: AAGAD increases speed and posture of gait in hemiplegic patients. It can be a useful device for gait training in hemiplegic patients.