Needle-based Therapy Research Articles

Periarticular needle-based therapies can cause periprosthetic knee infections

Periarticular needle-based therapies such as dry needling, acupuncture, and genicular nerve radiofrequency ablation are becoming more popular for treatment of knee osteoarthritis. These therapies are also being used after total knee arthroplasty for persistent postoperative pain. Although limited published evidence exists for the risk of periprosthetic joint infection after these procedures, we describe one case of periprosthetic joint infection developing shortly after dry needling and another case developing shortly after genicular nerve blocks. We present details of these 2 cases along with a review of the literature regarding the use of periarticular needle-based therapies after total knee arthroplasty.

Apomorphine therapy in Parkinson's disease and future directions

Apomorphine infusion or injection is an important dopamine agonist non-oral therapy usually used in advanced Parkinson's disease (PD) with refractory motor fluctuations. The drug also has appreciable efficacy for nonmotor fluctuations and is the quickest to reverse predictable “off” periods. Current subcutaneous administration, however, is complicated by problems associated with needle-based therapies, such as skin nodule formation, skin irritation, and avoidance of this treatment option by needle-phobic subjects.In this review we focus on what the future might hold for apomorphine injection/infusion. We discuss interesting and novel delivery strategies of apomorphine or esters via oral, buccal, inhalation and a novel pump-patch route. We also discuss recent research that has highlighted some important properties of apomorphine in animal models, such as a potential anti-amyloid effect and its potential impact in the management of PD dementia or perhaps even Alzheimer's disease. A potential role for apomorphine infusion in cases with impulse control disorders and other nonmotor issues is also discussed.

Dark circles in the periorbital region: diagnosis and treatment options

Dark circles under the eyes are a common but challenging problem in aesthetic practice. The causes of dark circles are multifactorial and can be grouped into three categories. Aetiological factors described in the literature include a ‘shadow in the valley’, due to the obicularis retaining ligaments and tear trough ligaments, superficial venous congestion and skin discolouration. Several validated treatment modalities have been described, including cosmetic surgery, dermal fillers, energy-based devices, needle-based therapy, chemical peels and topical agents. A review of the available management options, their therapeutic targets and the author's evaluation of their efficacy and cost in practice is presented in this paper.

Target Tracking Errors for 5D and 6D Spatial Measurement Systems

In recent years, magnetic tracking systems, whose fundamental unit of measurement is a 5D transformation (three translational and two rotational degrees-of-freedom), have become much more popular. Two 5D sensors can be combined to obtain a 6D transformation similar to the ones provided by the point-based registration in optical tracking. However, estimates of the tool tip uncertainty, which we have called the target tracking error (TTE) since no registration is explicitly performed, are not available in the same manner as their optical counterpart. If the systematic bias error can be corrected and estimates of the 5D or 6D fiducial localizer error (FLE) are provided in the form of zero mean normally distributed random variables in [Formula: see text] and [Formula: see text], respectively, then the TTE can be modeled. In this paper, the required expressions that model the TTE as a function of the systematic bias, FLE and target location are derived and then validated using Monte Carlo simulations. We also show that the first order approximation is sufficient beyond the range of errors typically observed during an image-guided surgery (IGS) procedure. Applications of the models are described for a minimally invasive intracardiac surgical guidance system and needle-based therapy systems. Together with the target registration error (TRE) statistical models for point-based registration, the models presented in this article provide the basic framework for estimating the total system measurement uncertainty for an IGS system. Future work includes developing TRE models for commonly used registration methods that do not already have them.

Therapeutic needling in osteopathic practice: An evidence-informed perspective

The use of acupuncture and dry needling as an adjunct to manipulative medicine is increasingly popular among osteopaths. Needle-based therapies are not a traditional component of osteopathy, therefore osteopaths typically acquire clinical needling skills at postgraduate short courses and professional development seminars, usually within the context of one of the popular treatment models. This paper presents osteopaths who use needling with an overview of the current scientific literature pertaining to clinical considerations for therapeutic needling in the management of neuromusculoskeletal pain. While not intended to be prescriptive, emphasis is given to evidence that may aid osteopaths in formulating appropriate needling treatment strategies for their patients.

Minimization of needle deflection in robot‐assisted percutaneous therapy

Needle deflection and tissue deformation are two problems encountered during needle insertion into soft, non-homogeneous tissue. They affect the accuracy of needle placement, which in turn affects the effectiveness of needle-based therapies and biopsies. In this study, a needle is inserted using a robot with two degrees of freedom. The needle is modelled as a flexible beam with clamped support at one end, and its deflection is estimated using online force/moment measurements at the needle base. To compensate for the needle deflection, the needle is axially rotated through 180 degrees . The needle deflection estimation data is used to find the insertion depths at which needle rotations are to be performed. A bevelled-tip needle was inserted into animal tissue. The needle deflection at the target was reduced by about 90%. It was observed that minimization of needle deflection reduced tissue deformation. The proposed method reduced needle deflection more than when needle insertion was performed with constant rotation. Estimating needle tip position using online force/moment measurement improves the accuracy of robot-assisted percutaneous procedures when imaging feedback is not available.

Review of minimally invasive renal therapies: Needle-based and extracorporeal

Management of the small renal mass (≤3 cm) is a topic of significant debate among urologists worldwide. With the advent of needle-based therapies and, less frequently, reports of extracorporeal approaches, along with ongoing refinements in each technology, patients with such masses may have the option of being treated in a truly minimally invasive, or even noninvasive, manner. Herein we review the body of available clinical literature on these modalities with respect to patient selection, success and complication rates, follow-up information, energy delivery devices, and current probe configurations.

Atlas of Uncommon Pain Syndromes

S. D. Waldman Saunders, 2003. £75 This book aims to promote the more rapid diagnosis of less common pain conditions. Seventy-one of these are included in this book, and each is given a chapter of a few pages length. Within these chapters, a format of sections describing signs, symptoms, differential diagnosis, treatment and complications is followed. How this book differs from most is in its use of illustrations. These usually represent patients engaged in activities that bring on the pain. Orange stars are drawn exploding over the painful areas. These large, full-colour drawings might not be to everyone's taste, but must increase the chances of the condition being recalled at a later date. The book is a companion text to Atlas of Common Pain Syndromes by the same author. Presumably, this goes some way to explain which syndromes made it into this book. The content may also be a reflection of the referral patterns to a pain clinic in the USA. One might expect many of the syndromes included in the book to be diagnosed by another clinician, be it general practitioner or hospital specialist. Hence, most would then not be referred to a pain clinic. This particularly concerns the inclusion of many syndromes of limb tendonitis, bursitis, ligament strain, and nerve entrapment. Obviously, there is always the possibility of slipping through the diagnostic net, so perhaps this is an unfair criticism. The judgement as to which conditions are too common and which too uncommon to be included this book is arguable. Syndromes are logically ordered and divided topographically. Each syndrome's chapter is short enough to be read quickly. This is important when considering several diagnoses. This also encourages a casual pick up and browse approach when spare moments arise. The sections covering facial, neck, thoracic and abdominal pains should be particularly educational for many readers. The use of out of favour terminology such as ‘reflex sympathetic dystrophy’ will grate with some readers, although inevitably please others. The differential diagnosis and investigation included are suitably thorough. The treatments suggested contain few surprises. Needle-based therapies are mentioned, but the details are not dwelt on. This does not detract from a book that is more diagnosis aid than treatment aid. A ‘Clinical Pearls’ section imparting important practical information ends each chapter. This reflects the practical and focused style of the book as a whole. Ultimately, given the uncommon nature of the syndromes included, it cannot be expected that the book will prove its worth very often. It is probably a more worthwhile purchase for a department rather than an individual. Given its easy to browse style, perhaps a position akin to a coffee table would be more appropriate for it than a departmental library.