Mark Hurdle

Accuracy of Ultrasound-Guided Versus Fluoroscopically Guided Contrast-Controlled Piriformis Injections A Cadaveric Study

Objective. The purpose of this study was to compare the accuracy of ultrasound‐guided piriformis injections with fluoroscopically guided contrast‐controlled piriformis injections in a cadaveric model. Methods. Twenty piriformis muscles in 10 unembalmed cadavers were injected with liquid latex using both fluoroscopically guided contrast‐controlled and US‐guided injection techniques. All injections were performed by the same experienced individual. Two different colors of liquid latex were used to differentiate injection placement for each procedure, and the injection order was randomized. The gluteal regions were subsequently dissected by an individual blinded to the injection technique. Colored latex seen within the piriformis muscle, sheath, or both was considered an accurate injection. Results. Nineteen of 20 ultrasound‐guided injections (95%) correctly placed the liquid latex within the piriformis muscle, whereas only 6 of the 20 fluoroscopically guided contrast‐controlled injections (30%) were accurate (P = .001). The liquid latex in 13 of the 14 missed fluoroscopically guided contrast‐controlled piriformis injections and the single missed ultrasound‐guided injection was found within the gluteus maximus muscle. In the single remaining missed fluoroscopically guided contrast‐controlled piriformis injection, the liquid latex was found within the sciatic nerve. Conclusions. In this cadaveric model, ultrasound‐guided piriformis injections were significantly more accurate than fluoroscopically guided contrast‐controlled injections. Despite the use of bony landmarks and contrast, most of the fluoroscopically attempted piriformis injections were placed superficially within the gluteus maximus. Clinicians performing piriformis injections should be aware of the potential pitfalls of fluoroscopically guided contrast‐controlled piriformis injections and consider using ultrasound guidance to ensure correct needle placement.

Utility of ultrasound-guided surface electrode placement in lateral femoral cutaneous nerve conduction studies

Introduction: Meralgia paresthetica is a common clinical complaint for which some patients ultimately undergo surgical treatment. The lateral femoral cutaneous nerve (LFCN) has been difficult to reliably test electrophysiologically, likely due to anatomic variability and lack of responses in asymptomatic obese subjects. Methods: We compared a novel ultrasound‐guided antidromic sensory nerve conduction study (NCS) with a technique described previously in a population of normal subjects, of whom 50% had body mass indices within the obese range (>27.5). Results: Responses were obtained in at least 92% of subjects using either technique, and 92% of normal subjects had <60% interside variability using the ultrasound‐guided technique. Conclusions: LFCN sensory nerve action potentials can be obtained in the vast majority of normal subjects, even in an obese population and can provide a useful sensory NCS for evaluation of mid‐lumbar radiculopathy, plexopathy, or meralgia paresthetica. Muscle Nerve, 2011

Ultrasound-guided thoracic facet injections: description of a technique.

The purpose of this study was to describe a technique using ultrasound guidance to perform thoracic facet joint injections.

Sonographically Guided Costotransverse Joint Injections A Computed Tomographically Controlled Cadaveric Feasibility Study

The primary purpose of this study was to describe and validate a novel sonographically guided costotransverse (CTRV) joint injection technique.

Biceps Tendon Sheath Injection: An Anatomical Conundrum

Objective Long head biceps tendon peritendinous or sheath injections are routinely administered at or immediately distally to the bicipital groove. The main indication for injection remains the clinical diagnosis or treatment of biceps tendinopathy, although true inflammation of the tendon within the bicipital groove is rare. Because the tendon sheath is merely an extension of the joint cavity, it is plausible to assume that an injection into the sheath would result in intraarticular spread. Surprisingly, such an anatomical tenet has a vague confirmation in the published clinical literature. This experiment was undertaken to investigate patterns of injectate spread when peri-tendon injection at the bicipital groove is performed. Design An experimental cadaveric study. Setting An institutional clinical anatomy laboratory. Methods Twelve ultrasound-guided methylene blue injections of the bicep tendon sheath were performed on cadaver specimens. Dissections and gross examination of staining of the internal joint surfaces were performed. Visual confirmation of the intra- and/or extra-articular spread of the injectate was performed. Results In 11 specimens, injected contrast was found spreading onto the entire internal joint surface, including glenoid cartilage. One extraarticular injection was attributable to a technical issue. Conclusions The experiment confirmed continuity of the joint capsule and the biceps tendon sheath. These results suggest a low diagnostic utility of peritendinous injections at the level of the bicep groove. Such injections would likely result in intraarticular deposit of the injectate. Nonetheless, this approach may be utilized as an alternative simplified access to the glenohumeral joint.

Descriptive Cadaveric Study Comparing the Accuracy of Ultrasound Versus Fluoroscopic Guidance for First Sacral Transforaminal Injections: A Comparison Study

Ultrasound is rarely used for guiding lumbosacral epidural steroid injections due to its technical limitations. For example, sonographic imaging lacks the ability to confirm epidural spread and identify vascular uptake. The perceived risk that these limitations pose to human subjects has precluded any large scale clinical trials to date.

Poster 304 The Associations Between Extension Muscle Strength and Pressure Pain Threshold in Fibromyalgia

tin regimen, with no adjustment or additions permitted. Main Outcome Measures: This post hoc analysis considered change from baseline to day 14 in Brief Pain Inventory (BPI) scores (0, no pain, to 10, most severe pain) for worst pain, least pain, and average pain. Results: Allodynia was present in 57 of 107 enrolled patients (53.3%), including 11 of 11 patients with PHN (100%), 27 of 49 patients with DN (55.1%), and 19 of 47 patients with LBP (40.4%). The baseline mean pain rating was 6.7 (PHN), 3.5 (DN), and 2.7 (LBP). Patients with allodynia had a greater change from baseline in BPI worst (2.0), average (1.5), and least (1.7) pain scores compared with those without allodynia pain (worst, 1.1; average, 0.9; least, 0.8). Patients with LBP and allodynia had a greater change from baseline in BPI worst (1.5), average (2.4), and least (2.0) pain scores compared with patients with LBP and without allodynia (worst pain, 0.6; average pain, 1.0; least pain, 0.8). Overall, 29% of patients reported 1 treatment-emergent adverse event (AE); the most frequent was dermatitis (PHN, 0%; DN, 2%; LBP, 4.3%). Patients with PHN had a total of 4 AEs in 4 diverse categories. Conclusions: Addition of topical lidocaine 5% patch to a gabapentin regimen reduced pain intensity in patients with PHN, DN, and LBP. Patients with allodynia obtained greater pain relief than those without allodynia.