Guided Corticosteroid Injection Research Articles

CT-guided steroid injections for the diagnosis and management of piriformis syndrome

Objectives: Piriformis syndrome (PS) is an extra-spinal tunnel neuropathy affecting the sciatic nerve. While typically diagnosed clinically, with confirmation through exclusion of other conditions, accurate diagnosis remains challenging. This study assesses the clinical outcomes of computed tomography (CT)-guided corticosteroid injection for suspected PS, considering its potential role as both a diagnostic and a therapeutic intervention. Materials and Methods: We conducted a retrospective review of 32 patients suspected to have PS, based on clinical presentation and examination findings, who underwent CT-guided steroid injections between July 2013 and February 2020. Effectiveness was evaluated qualitatively through clinic letters from patient reviews with a mean follow-up of 5 months (range 3–7) Results: Thirty-two patients received 44 injections. The cohort had an average age of 45 years, with many being physically active. Initial follow-up showed that 56% experienced pain relief, though 16% of these cases were short-lived. About 19% reported partial benefit, while 31% reported no improvement. Repeat injections were performed on nine patients, with some undergoing up to two repeat procedures. About 47% of patients were discharged following injections, repeats, or surgery, while 53% required further specialist input. Conclusion: CT-guided corticosteroid injections appear to be a valuable management tool for diagnosis and treatment of PS, particularly when conservative management fails. However, the long-term benefits are inconsistent, highlighting the need for a more standardized treatment pathway. Given the high degree of diagnostic uncertainty and lack of accurate diagnostic tools for PS, we propose the use of local anesthetic and steroid injections as a diagnostic approach, as well as a management option.

GIBPS technique-a novel sequential technique of performing shoulder corticosteroid injections.

The introduction of the xxxxxxxx (GIBPS) technique represents a patient-centric novel and innovative method of ultrasound guided corticosteroid injection targeting the Glenohumeral joint (GHJ) and the Subacromial-Subdeltoid (SASD) bursa in a sequential manner, in the same setting. By integrating the two different sites of injection into a single technique, the procedure has the potential of transforming musculoskeletal interventional radiology and maximising patient care in shoulder pathologies. This procedure aims to reduce patient discomfort, optimise procedural efficiency, and enhance treatment precision through ultrasound guidance and improve the overall patient experience.

A BIOINDUCTIVE PATCH FOR PARTIAL THICKNESS HIP ABDUCTOR TENDON TEARS: A PRELIMINARY REPORT

Partial thickness abductor tendon tears are a significant source of recalcitrant laterally based hip pain. For those that fail conservative treatment, the results of endoscopic repair are highly successful with minimal morbidity. The principal burden is the protracted rehabilitation that is necessary as part of the recovery process. There is a wide gap between failed conservative treatment and successful surgical repair. It is hypothesized that a non-repair surgical strategy, such as a bioinducitve patch, could significantly reduce the burden associated recovery from a formal repair. Thus, the purpose of this study is to report the preliminary results of this treatment strategy.Symptomatic partial thickness abductor tendon tears are treated conservatively, including activity modification, supervised physical therapy and ultrasound guided corticosteroid injections. Beginning in January 2022, patients undergoing hip arthroscopy for intraarticular pathology who also had persistently symptomatic partial thickness abductor tendon tears, were treated with adjunct placement of a bioinducitve (Regeneten) patch over the tendon lesion from the peritrochanteric space. The postop rehab protocol is dictated by the intraarticular procedure performed. All patients are prospectively assessed with a modified Harris Hip Score (mHHS) and iHOT and the tendon healing response examined by ultrasound.Early outcomes will be presented on nine consecutive cases.Conclusions - Will be summarized based on the preliminary outcomes to be reported.

ID: 219222 Peripheral Nerve Stimulation for Refractory Plantar Fibromatosis Pain: A Case Report and Literature Review

41-year-old man was referred by orthopedics to the outpatient pain clinic with history of chronic bilateral plantar heel pain and a diagnosis of plantar fibromatosis following diagnostic ultrasound evaluation. He had failed numerous non-operative treatments including shoe wear modification, orthoses, physical therapy, acupuncture, shock wave therapy, ultrasound guided corticosteroid injection, and percutaneous needle tenotomy. Upon initial consultation, the patient endorsed a 5-year history of bilateral medial plantar heel pain, provoked with weight bearing activities. He denied paresthesias and weakness. Given his refractory symptoms joint the decision was made to proceed with a diagnostic block of his more symptomatic side with goal to pursue bilateral percutaneous 60-day peripheral nerve stimulator placement if he experienced a favorable response. Diagnostic target was the left tibial nerve just proximal to the medial malleolus and prior to its division into plantar and calcaneal branches. Diagnostic injectate consisted of 2cc 1% lidocaine and 5mg of dexamethasone for a total volume of 2.5cc. Patient rated his pain 8/10 prior to injection and 0/10 following. He subsequently underwent placement of dual peripheral nerve stimulators targeting the bilateral tibial nerves with implantation 5cm proximal to the medial malleoli. At 60 day follow up, the device was explanted. The patient was no longer tender with palpation of either foot. He reported 50% reduction compared to pre-operative pain, significant improvement in his quality of life and physical functioning, and a reduction in oral analgesic regimen. The patient is currently awaiting permanent stimulator placement.

Ultrasonography (USG)-guided corticosteroid injection with needle release of the A1 pulley: serial case report

Background: Trigger finger is associated with limited flexion and extension of the finger due to inflammation in the flexor tendon pulley and leads to a loss of functional capacity in the hands. There is a need for safe, fast management and a low risk of recurrence in managing this disease. This study aims to evaluate the clinical effectiveness of the USG-guided corticosteroid injection with needle release of the A1 pulley in treating the trigger finger, particularly in pain degree, joint function, and adverse effects. The parameters were evaluated, including the NRS, Quinnell grading system, and inflammation or infection signs from the physical examination. Case Presentation: There were seven trigger fingers in five patients with various Quinnell grades ranging from 2 to 3. They received a single treatment of USG-guided corticosteroid injection with needle release of the A1 pulley. Follow-up was carried out immediately after the procedure (day 0), 1 day, and 30 days after. Improvement was seen in all fingers immediately and one day after the procedure. After 30 days, all patients no longer experienced pain, snapping, or locking sensations. No adverse events were observed during the follow-up period. Conclusion: USG-guided corticosteroid injection with needle release of the A1 pulley in treating trigger fingers is safe and has a good effect on reducing pain and improving joint finger function.

Comparison of functional outcome between corticosteroid injection alone vs combination with physiotherapy for frozen shoulder

Introduction: Most common cause for shoulder pain and disability is frozen shoulder affecting approximately 2-4% of the general population. With the increase in age there is increase in the incidence of frozen shoulder with peak incidence of fifth and sixth decade and slightly female predominance. The aim of this study is to investigate the additional effect of physiotherapy after corticosteroid injections in first 2 stages of frozen shoulder. Methods: This is randomised controlled trial. Painful frozen shoulder is the eligible criteria for this study. Patients were randomised into two group after obtaining patients consent. Ultrasound guided corticosteroid injection intra-articularly was given to both the groups. The physiotherapy group underwent physiotherapy whereas the other group did not. The shoulder pain and disability index were the primary outcome index. Range of motion and pain were the secondary outcome index. The patients were followed up after 6, 12, 26 weeks. Result: A number of 30 patients were considered in this study in order to compare the relationship between CSI with and without physiotherapy out of which 16 patients were in the non-PT and 14 were in PT group. At baseline range of movements such as external rotation, abduction, anterior flexion was equally restricted in both the groups with mean range of 5.8 degree, 52.4 degree and 83.6 degree respectively. At the end of 26 weeks shoulder range of movements measurements were available for 90% of patients. No complications or adverse events were reported in both groups. Conclusion: Physiotherapy along with corticosteroid injection improves ROM and functional movement restrictions in the early stage of frozen shoulder in the first 12 weeks when compared with corticosteroid alone.

EFFICACY OF ULTRASOUND GUIDED CORTICOSTEROID INJECTION IN CARPAL TUNNEL SYNDROME

BACKGROUND : Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The etiology can be hereditary, repetitive movements of the wrist in mechanical workers, injury to the wrist, pregnancy, obesity, metabolic disorders, auto immune conditions such as diabetes mellitus, rheumatoid arthritis and in elderly population. Females are affected more than males. A lot of treatment options are available for carpal tunnel syndrome. Corticosteroid injections are very effective in mild to moderate carpal tunnel syndrome on short and in some cases on long term basis.
 OBJECTIVES:To evaluate the efficacy and clinical outcomes of ultrasound guided corticosteroid injection for treatment of carpal tunnel syndrome.
 STUDY SETTING: Department of Orthopedic surgery Services Hospital Lahore .
 STUDY DESIGN: Cross sectional study.
 STUDY DURATION: From December 2018 to December 2019 
 METHODOLOGY: This prospective cross sectional study was carried out from Dec 2018 – Dec 2019 on OPD basis. A total number of 80 patients were included in the study. There were 40 males and 40 females in our study. Each patient was injected triamcinolone 40 mg with 2 % xylocaine. After the injection every patient was followed at 6 weeks, 3 months and at 6 months.
 At each follow up these patients were assessed by Phalen test, Tinel sign, Boston carpal tunnel syndrome severity score, functional assessment scale, electrophysiological studies and nerve conduction study.
 RESULTS : Our study included 80 patients with 40 males and 40 females. 40 female patients were housewives, 25 male patients were manual workers and remaining 15 patients were computer operator. 30 patients had mild symptoms of carpal tunnel syndrome, 35 had moderate while the remaining 15 patients had severe symptoms of carpal tunnel syndrome. All these patients were having symptoms for the last 6 – 12 weeks which did not improve with the conservative management. These patients were having symptoms of numbness and tingling at the initial presentation. Phalen test was positive in 95 % (76 patients) patients while Tinel test was positive in 80 % patients ( 64 patients ) at the initial presentation . 
 Boston’s severity symptom score was 35.34 +/- 3.59 and functional status scale was 25.43 + 5.82 (At the initial presentation) in all patients. Following corticosteroid injection at 06 weeks the symptoms severity score was 21+/-3.32 ( mean ) and at 03 months 18.80 + 3.41 ( mean ) in 72 patients while 8 patients did not respond to corticosteroid injection while the functional status scale 17.62 +- 5.01 and 13.45 +- 4.2 at 03 months .
 Electrophysiological study was also improved after 06 weeks and after 03 months
 CONCLUSION : Corticosteroid injections are very effective regarding the outcomes on short term basis . However , they are effective in small number of patients on long term basis

Efficacy of Fluoroscopically Guided Corticosteroid Injections for Foot and Ankle Pain

Category:Midfoot/Forefoot; Ankle; Ankle Arthritis; Hindfoot; Lesser ToesIntroduction/Purpose:Arthritis of the foot and ankle can severely hamper quality of life resulting in decreased mobility and functionality. Conservative treatment can involve corticosteroid injections into affected joint spaces. Fluoroscopic guided injections provide confirmation that the injection was successfully applied within the appropriate joint space. Due to this, they can be of diagnostic value and result in more accurate injection placement. Current literature focuses on ultrasound guided injections and does not fully address the efficacy of fluoroscopic injections. Objective: Assess and determine overall efficacy of fluoroscopically guided corticosteroid injections including the degree and period of relief provided.Methods:We retrospectively reviewed patient charts from 2016 through 2020 of patients that received fluoroscopically guided corticosteroid injections in foot or ankle joints. 224 injections were reviewed, gathering responses to percent relief, days of relief, pre-/post-injection VAS pain score and efficacy of repeat injections. Additionally, Kellgren-Lawrence arthritis scale vs pain relief were analyzed.Results:Analysis limited by incomplete patient response. 24/83 (28.9%) injections provided less than 2 weeks of relief while 59/83 (71.1%) injections averaged 109.49 +- 72.03 days of pain relief. Of 127 responses, post-injection relief at first follow up had an average VAS reduction of 2.87 +- 3.17 with 70.38 +- 30.8 % improvement. 40 subjects with repeat injections had 109.41 +- 64.96 days of relief per injection. No significant correlation was found between joint injected or degree of arthritis and percent improvement.Conclusion:Fluoroscopic guided injections are an effective conservative option providing prolonged but varying relief of 3-4 months irrespective of the specific joint or degree of arthritis. Repeat injections show similar efficacy. In contrast to ultrasound guided injections, fluoroscopy provides additional diagnostic and therapeutic value. This can be beneficial if the injections fail and the patient must progress to surgery. Future prospective studies could directly compare different injections modalities and further analyze efficacy for specific diagnoses.

Effectiveness of Ultrasound-Guided Versus Anatomic Landmark-Guided Corticosteroid Injection on Pain, Physical Function, and Safety in Patients With Subacromial Impingement Syndrome: A Systematic Review and Meta-analysis.

The aim of the study was to compare the efficacy and safety of ultrasound-guided versus anatomic landmark-guided corticosteroid injection for the treatment of subacromial impingement syndrome. PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, ClinicalTrials.gov , CBM, CNKI, and Wanfang databases were searched from inception to August 15, 2021, for randomized controlled trials comparing ultrasound-guided versus anatomic landmark-guided injections of corticosteroids for the treatment of subacromial impingement syndrome. Twelve randomized controlled trials with 891 patients were included in this study; 454 patients received ultrasound-guided injections and 437 received anatomic landmark-guided injections. Pooled results showed that ultrasound-guided injection was more beneficial for pain relief (10 trials; mean difference = -0.58; 95% confidence interval = -1.05 to -0.10; P = 0.017) and functional improvement (11 trials; standard mean difference = -0.84; 95% confidence interval = -1.41 to -0.27; P = 0.004). There was no significant difference in shoulder range of motion. In the subgroup analysis, there was a significant difference in pain relief and functional improvement at 6-8 wks and with methylprednisolone. Ultrasound-guided injection of corticosteroids is potentially superior to anatomic landmark-guided injection in improving the clinical symptoms of subacromial impingement syndrome; however, these findings should be interpreted with some caution as the quality of evidence was rated as moderate to very low.

Acute Calcific Tendinitis of the Forefoot in Young Women- A Presentation of Two Cases

Introduction: Calcific tendinitis is an uncommon presentation in the forefoot with relatively few cases reported in the medical literature. It is commonly overlooked and should form part of a differential diagnosis when assessing patients presenting with acute pain of the forefoot localised to a single joint or tendon. We present two cases of young women involved in amateur running and martial arts respectively who presented with acute pain of their forefoot. Case Description: These 2 cases describe a 44 year old amateur female runner and 23 year old female martial arts athlete who presented with acute onset of pain affecting the dorsal aspect of their great toe interphalangeal joint and base of 1st metatarsal respectively. Both patients had tender erythematous swellings at the site of pain and difficulty weightbearing. Plain radiography revealed areas of calcification at the respective sites which was confirmed with ultrasound. Both patients underwent US guided corticosteroid injections with significant symptom improvement within 48 hours of injections and rapid return to sport. Discussion: These two cases demonstrate an atypical presentation of acute calcific tendinitis affecting the forefoot and add two more cases to the reported literature. Combining the characteristic clinical presentation of acute pain affecting a tendon or joint with a tender erythematous swelling on examination with the typical radiographic features of calcification can promptly diagnose this often misdiagnosed condition and avoid unnecessary investigations. Conservative treatment and intralesional injection with corticosteroids can lead to rapid resolution and favourable patient outcomes.

Radial Tunnel Syndrome.

Radial tunnel syndrome is defined as a compressive neuropathy of the posterior interosseus nerve. It is differentiated from posterior interosseus nerve compression by symptom profile. The purpose of this article is to review past and current literature on the topic and determine if there are any emerging treatment options for this condition. Traditionally, conservative management of Radial Tunnel syndrome has been relatively unsuccessful. As a result, patients afflicted by this neuropathy require operative intervention. Effectiveness of surgical decompression is variable and can range from 67 to 92% but currently remains the standard treatment. However, there are some conservative treatment options that have been recently reported that show promising results. Such treatments include dry needling of the affected area and ultrasound guided corticosteroid injections to hydro dissect around the posterior interosseus nerve at sites of compression. Radial tunnel syndrome is an uncommon and unique peripheral neuropathy. It involves the posterior interosseus nerve however it can be differentiated from PIN syndrome based on the symptom profile. There are various compressive etiologies that can cause a patient to become symptomatic; therefore it is important to critically assess the patient and their symptoms and use appropriate imaging to determine the cause and appropriate treatment. Typically, conservative treatments are attempted first. Traditionally, conservative therapy is unsuccessful and operative decompression is necessary. However, current literature highlights various new nonsurgical options that suggest some promise and could be alternatives to surgical decompression.

Comparison between different methods of trigger finger treatment – USG assisted steroid injection, USG guided percutaneous pulley release and open surgery: A randomized controlled trial

Introduction: Trigger finger is frequently encountered in outpatient department, mostly idiopathic but seen especially in diabetic, hypothyroid or gout patients, the cause being, stenosing tenosynovitis at the A1 pulley, which is usually progressive. There are various treatment options available for this problem.Objective: The aim of this study was to compare the efficacy of USG guided corticosteroid injection, USG guided percutaneous pulley release and open surgery for the treatment of trigger finger in view of cure, relapse and complication rates.Methods: Sixty patients, >20 years of age with a trigger on any finger of the hand (Quinnell Type II - IV) were randomly categorized into one of the 3 treatment groups, each consisting of 20 patients, with one of the 3 treatment modalities allocated equally, from 60 sealed nontransparent envelopes, were studied and followed up for at least 6 months for cure, relapse and failure rates. Group A (N = 20) – Patients to be treated with conservative steroid injection under USG guidanceGroup B (N = 20) – Patients to be treated with percutaneous pulley release under USG guidance andGroup C (N = 20) – Patients to be treated with open surgery as minor OT procedure.Results: Cure rate for first (steroid inj.) group of patients was 60%, and in some patients second injection was repeated, which escalated the cure rate to 85%.For USG guided percutaneous release and open surgery groups, there was complete remission in all cases.Conclusions: The percutaneous release and open surgery methods were equally effective and proved superior to local steroid injections method in terms of trigger cure and relapse rates.

Non-remitting Gluteal Pain In An Adolescent Soccer Player

HPI: 14 y/o male soccer player presents to clinic with 12 months of right gluteal pain when active or sitting for a prolonged time. He described the pain as dull with normal activity and sharp with low levels of exertion particularly in hip flexion. His pain is maximal during soccer while kicking the ball with his opposite foot. In addition, he reports point tenderness over the proximal right hamstring and while sitting down on hard surfaces. He was evaluated roughly 1 year ago by an outside physician with a normal XR of the pelvis. Per patient and father reported an “injury to the Sits bone”. Patient was subsequently taken out of sports for 6 months and had a non-US guided corticosteroid injection into the posterior thigh 3 months prior to clinic visit. The injection provided short term relief, no additional treatment (PT) was prescribed. ROS: CONSTITUTIONAL: No fevers, chills, sweats, night pain or weight changes. CARDIOVASCULAR: No chest pains, palpitations, orthopnea and paroxysmal nocturnal dyspnea. RESPIRATORY: No dyspnea on exertion, no wheezing or cough. MUSCULOSKELETAL: per HPI NEUROLOGIC: No numbness, tingling or weakness. PHYSICAL EXAM: Gait: Able to bear weight with a normal gait MSK: No swelling, ecchymosis ROM: Full ROM intact both actively and passively. There was mild pain with active deep flexion during squat Straight leg raise: Significant for pain on proximal right hamstring Tenderness: Over ischial tuberosity and toward proximal hamstring Strength: 4/5 on hip extension remainder of strength testing unremarkable Log Roll: neg FABER/FADIR neg/neg Ober Test: neg Thomas Test: neg Sensation: intact to light touch DIFFERENTIAL DIAGNOSIS: Chronic hamstring strain Bone contusion Tumor Osteomyelitis INITIAL TESTING IN CLINIC: X-Ray Hip AP/lateral: Irregular lucency along inferolateral aspect of right ischium. Correlates to insertion of the hamstring. However, the appearance is not typical for an avulsion injury or tendon strain. Femoro-acetabular joints preserved. MRI: Ill-defined area within the ischium approximately 1.7 x 0.6 x 3.6 cm corresponding to the suspicious area seen on prior x-ray. Findings are likely due to a healing avulsion fracture of the right ischial tuberosity. FINAL WORKING DIAGNOSIS: Healing avulsion fracture over right ischial tuberosity, clinically improving with PT

Impact of fluoroscopic injection location on immediate and delayed pain relief in patients with greater trochanteric pain syndrome.

The purpose of this study was to assess whether fluoroscopically guided corticosteroid injections into the extrabursal tissues, trochanteric (subgluteus maximus) bursa, or subgluteus medius bursa provide better immediate and short-term pain relief. All fluoroscopically guided corticosteroid injections performed over a 67-month period for greater trochanteric pain syndrome were retrospectively reviewed. Procedural images were reviewed by two musculoskeletal radiologists to determine the dominant injection site based on final needle positioning and contrast spread pattern, with discrepancies resolved by consensus. Statistical analysis of the association between pain score reduction and dominant injection site was performed. One hundred forty injections in 121 patients met the inclusion criteria. The immediate and 1-week post-injection pain reduction was statistically significant for trochanteric bursa, subgluteus medius bursa, and non-bursal injections. However, there was no statistically significant difference in the degree of pain reduction between the groups. There was statistically significant increase in the 1-week post-injection mean pain score compared with immediate post-injection mean pain score in the subgluteus medius bursa and non-bursal injection groups (p < 0.01) but not in the trochanteric bursa group. Fluoroscopy is frequently chosen over blind injection or ultrasound guidance for trochanteric steroid injections in patients with a high body mass index. Our results indicate that fluoroscopically guided steroid injections into the trochanteric bursa and subgluteus medius bursa significantly reduced immediate and 1-week post-injection pain scores, as do non-bursal injections. Steroid injection into the subgluteus medius bursa and non-bursal sites may be less effective in maintaining pain reduction at 1-week post-injection.

Étude prospective randomisée comparant les injections des corticoïdes à l’aveugle versus guidées par échographie pour le traitement de la maladie de Quervain

BackgroundUltrasonography (US)-guided corticosteroid injection (CI) has been attempted to improve injection accuracy in de Quervain‘s disease (dQD), but its role in improving clinical outcomes and decreasing skin hypopigmentation or atrophy was not established well. HypothesisWe hypothesized that the US-guided CI is superior to blind CI in symptom improvement and development of skin hypopigmentation or atrophy. Patients and methodsForty-four patients (48 wrists) with dQD received ultrasonography-guided CI (24 wrists/22 patients, group A) or blind CI (24 wrists/22 patients, group B) between December 2016 and February 2018. The visual analogue scale for pain and the Patient-rated Wrist Evaluation (PRWE) were used. Skin hypopigmentation or atrophy was evaluated using the modified Vancouver scar scale (mVSS). ResultsAt 4 weeks post-injection, pain and PRWE scores improved for 22 wrists in group A and 21 wrists in group B. At 3 months post-injection, 10.0% (2/20) and 26.3% (5/19) of wrists in group A and B, respectively, had symptom recurrence after initial improvement. Improvement and aggravation rates were not significantly different between groups. The incidence of skin hypopigmentation or atrophy was 69.6% (16/23 wrists) and 70.0% (14/20 wrists) in group A, and 59.1% (13/22 wrists) and 78.9% (15/19 wrists) in group B at 4 weeks and 3 months post-injection, respectively. The mean mVSS scores at the injection site in groups A and B were 2.0 (0–4.0) and 1.8 (0–5.0) at 4 weeks post-injection and 2.4 (0–7.0) and 2.9 (0–6.0) at 3 months post-injection, respectively. The incidence and severity of skin hypopigmentation or atrophy were not significantly different between groups at both time points. DiscussionPain and clinical outcomes significantly improved after CI in dQD. Pain, clinical outcomes, and the incidence and severity of skin hypopigmentation or atrophy were not significantly different between ultrasonography-guided and blind CI. Level of EvidenceI, Therapeutic.

Ultrasound-guided Cubital Tunnel Injection: A Review and Exploration of Utility as a Diagnostic Aid in Mild or Nonclassic Cubital Tunnel Patients

Cubital tunnel syndrome (CuTS) is a common and potentially debilitating neuropathy that results from chronic forces on the ulnar nerve at the elbow. First-line treatment options such as physiotherapy and nighttime splinting are effective in many patients, with refractory patients often benefiting from in situ ulnar nerve decompression or ulnar nerve decompression and transposition. However, identification of the most ideal surgical candidates can often present a clinical challenge, particularly in patients with a nonclassic presentation, significant comorbidities, or a negative nerve conduction study. Current literature suggests that there may be both a therapeutic and diagnostic benefit of ultrasound (US)-guided corticosteroid injections into the cubital tunnel among this population, although existing study designs have differed in terms of injection technique and outcome measurements. A descriptive case series at our institution examined 63 patients (66 arms) with mild CuTS symptoms over the course of 6 years and suggested a potential diagnostic benefit of US-guided injections in this population. In this series, those patients who experienced transient relief after US-guided injection also exhibited good long-term outcomes from surgical decompression. Randomized, controlled studies that further investigate the therapeutic and diagnostic value of US-guided cubital tunnel injections for certain patients with mild or nonclassic presentations of CuTS are recommended.

Effect of fluoroscopically guided corticosteroid injection versus oral nonsteroidal anti-inflammatory drugs for treatment of coccydynia: A randomized, controlled, single-blind study

Background: Coccydynia is a major cause of coccyx pain that can result in chronic pain as well as reduced functional performance in patients. The aim of this study was to compare the efficacy of fluoroscopically guided corticosteroid injection with an oral nonsteroidal anti-inflammatory drug (NSAID) to relieve coccyx pain. Methods: In a clinical trial study, 28 patients with coccydynia who were randomly divided into two groups and matched based on sex, age, and body mass index. One group was treated with celecoxib 200 mg (every 12 hr) for 1 mo along with regular use of a tailbone pillow while sitting on hard surfaces. The second group received local periarticular injection of methylprednisolone acetate 40 mg along with lidocaine 1%, which was fluoroscopically guided. The patients were followed for 4 mo. Results: There was a significant difference in pain severity of the patients when compared with their condition at the beginning of the study in each group (P&lt;0.001). The final pain severity of NSAID group and steroid group was 37.9±14.2 mm and 38.7±16.1 mm, respectively, which was not significantly different. Also the trend of pain severity was similar between the two groups. Conclusions: Corticosteroid injection for coccydynia treatment at least has the same advantages of oral NSAID medication. Regarding its single-dose administration and reasonable price, it can be considered as an alternative modality in treatment of this disease if the target patient is selected correctly. Level of Evidence: Level I.

Prospective randomized comparison of ultrasonography-guided and blind corticosteroid injection for de Quervain's disease

Ultrasonography (US)-guided corticosteroid injection (CI) has been attempted to improve injection accuracy in de Quervain's disease (dQD), but its role in improving clinical outcomes and decreasing skin hypopigmentation or atrophy was not established well. We hypothesized that the US-guided CI is superior to blind CI in symptom improvement and development of skin hypopigmentation or atrophy. Forty-four patients (48 wrists) with dQD received ultrasonography-guided CI (24 wrists/22 patients, group A) or blind CI (24 wrists/22 patients, group B) between December 2016 and February 2018. The visual analogue scale for pain and the Patient-rated Wrist Evaluation (PRWE) were used for evaluation. Skin hypopigmentation or atrophy was evaluated using the modified Vancouver scar scale (mVSS) RESULTS: At 4weeks post-injection, pain and PRWE scores improved for 22wrists in group A and 21wrists in group B. At 3months post-injection, 10.0% (2/20) and 26.3% (5/19) of wrists in group A and B, respectively, had symptom recurrence after initial improvement. Improvement and aggravation rates were not significantly different between the groups. The incidence of skin hypopigmentation or atrophy was 69.6% (16/23 wrists) and 70.0% (14/20 wrists) in group A, and 59.1% (13/22 wrists) and 78.9% (15/19 wrists) in group B at 4weeks and 3months post-injection, respectively. The mean mVSS scores at the injection site in group A and B were 2.0 (0-4.0) and 1.8 (0-5.0) at 4weeks post-injection and 2.4 (0-7.0) and 2.9 (0-6.0) at 3 months post-injection, respectively. The incidence and severity of skin hypopigmentation or atrophy were not significantly different between the groups at both time points. Pain and clinical outcomes significantly improved after CI in dQD. Pain, clinical outcomes, and the incidence and severity of skin hypopigmentation or atrophy were not significantly different between ultrasonography-guided and blind CI. I, Therapeutic.

Peroneal Tendon Sheath Ultrasound Guided Corticosteroid Injection: Clinical Outcomes and Complications

Category:AnkleIntroduction/Purpose:Painful peroneal tendon pathologies fall into three primary categories: tendinopathy, tendon subluxation/dislocation, and tendon tears/ruptures. For symptomatic peroneal tendinopathy and tears, treatment traditionally begins with NSAIDs, rest/activity modification, physical therapy, and immobilization and with surgery typically reserved for cases of failed non-operative treatment. Ultrasound-guided peroneal tendon sheath (US PTS) corticosteroid injection is an additional nonoperative modality used by many orthopedists, however limited data has been published on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US PTS corticosteroid injection for chronic tendinopathy or tears. We hypothesized that following injection, patients would have improved pain without increased incidence of spontaneous tendon rupture.Methods:We identified a retrospective cohort of patients who had undergone US PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation. Underlying diagnosis was based on clinical exam, MRI results, and/or intraoperative findings, when available. Medical record data was supplemented by email or telephone follow-up. Collected information included patient age, sex, BMI, smoking status, worker’s compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any perceived adverse outcomes of injection.Results:We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons. 24/96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients experienced 0 -1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) >12 weeks of pain relief. Pre-injection duration of symptoms correlated positively with post- injection duration of pain relief (p=0.036). There was no significant difference between progression to surgery or duration of pain relief based on peroneal pathology, prior surgery, smoking status, worker’s compensation status, sex, or BMI. There were 2 reported complications (1.8%): one case of self-limited sural nerve irritation and one of peroneus longus tear progression.Conclusion:In this series of 109 US PTS corticosteroid injections, the complication rate was 1.8%. Pre-injection symptom duration correlated positively with post-injection pain relief duration. Our study demonstrates US PTS corticosteroid injection is safe in patients with pain originating from peroneal tendon tears or tendinopathy, including those who have undergone prior surgery, and should be considered in a comprehensive protocol of nonoperative management. Further research is needed to elucidate the effect of multiple injections and of injection timing, as well as whether these injections can decrease the rate of patients progressing to surgery.

Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Treatments for CTS alternate from conservative strategies to surgical decompression of median nerve. Few studies have applied platelet-rich plasma (PRP) for treating idiopathic CTS, with acceptable success rates. Further studies are needed to reach concrete conclusion. To study the effect of PRP injection in treatment of mild to moderate idiopathic CTS. This is a randomized controlled trial in a cohort of Egyptian patients suffered from mild to moderate CTS. They were randomly divided into two groups. Group 1: patients received ultrasound guided PRP injection and group 2 patients received ultrasound guided corticosteroid injection. The outcome measures were assessed via Visual Analog Scale, the Boston Carpal Tunnel Syndrome Questionnaire, electrophysiological findings in sensory and motor functions of median nerve and morphological changes of median nerve detected by ultrasound. This study included 150 patients suffered from mild to moderate idiopathic CTS 15 did not provide the written consent and 37 participants were excluded from the study based on the exclusion criteria leaving only 98 patients to participate in the study they were divided into two groups PRP Injection Group (PRP-inj-G) - this group included 49 patients (40 females and 9 males) steroid injection Group (St-inj-G) - included 49 patients (41 females and 8 males). At the beginning of study there was no significant difference between both groups in all parameters. (a) PRP injection had significantly improved the clinical manifestations, the electrodiagnostic examination (EDX) parameters of the median nerve (MN), and the median nerve cross sectional area (m-CSA) at 1month and 3months post-injection evaluation in comparison to baseline recordings; (b) local steroid injection had significantly improved the clinical manifestations, the EDX parameters of the MN, and the m-CSA at 1month and 3months post-injection evaluation in comparison to baseline recordings and (c) PRP injection was superior to the local steroid injection in the improvement of clinical manifestations as well as the MN motor conduction velocity along the wrist-elbow segment, the sensory latency (SL) and the MN sensory conduction, this superiority was observed in third month follow-up suggesting better outcomes in long-term follow-up. Platelet-rich plasma could be effective treatment of mild to moderate idiopathic CTS and superior to corticosteroid in improving pain, function, and distal sensory latency of median nerve. Clinical Trials.gov Identifier: NCT03863873Key Points:• PRP is effective treatment of mild to moderate CTS.• PRP is superior to corticosteroids in improving pain and function in CTS.