ABSTRACT
OBJECTIVE: This study evaluated the feasibility of ultrasound-guided lumbar nerve root block (LNRB) and S1 nerve root block by identifying spread patterns via fluoroscopy in cadavers.METHOD: A total of 48 ultrasound-guided injections were performed in 4 fresh cadavers from L1 to S1 roots. The target point of LNRB was the midpoint between the lower border of the transverse process and the facet joint at each level. The target point of S1 nerve root block was the S1 foramen, which can be visualized between the median sacral crest and the posterior superior iliac spine, below the L5-S1 facet joint. The injection was performed via an in-plane approach under real-time axial view ultrasound guidance. Fluoroscopic validation was performed after the injection of 2 cc of contrast agent.RESULTS: The needle placements were correct in all injections. Fluoroscopy confirmed an intra-foraminal contrast spreading pattern following 41 of the 48 injections (85.4%). The other 7 injections (14.6%) yielded typical neurograms, but also resulted in extra-foraminal patterns that occurred evenly in each nerve root, including S1.CONCLUSION: Ultrasound-guided injection may be an option for the delivery of injectate into the S1 nerve root, as well as lumbar nerve root area.
Subject(s)
Cadaver , Fluoroscopy , Injections, Spinal , Lumbosacral Region , Methods , Needles , Spinal Nerve Roots , Spine , Ultrasonography , Zygapophyseal JointABSTRACT
OBJECTIVE: To assess the accuracy and confidence of the glenohumeral joint injection using an anterior approach in cadavers. METHOD: Eight shoulders from six cadavers were placed supine with arm abduction and external rotation. A single physiatrist performed all the ultrasonography guided injection using an anterior approach. A twenty-one gauge needle was placed into shoulder and intraarticular position was verified by small injection of blue dye. And then the anatomic dissection was done. RESULTS: Seven out of eight (87.5%) were judged to be accurately placed by the anatomic section. In one case, the needle tip was placed in supraglenoid space. In one of the seven accurate cases, the needle traversed the long head tendon of biceps muscle. Confidence of the injections was 87.5%. CONCLUSION: Ultrasonography guided glenohumeral injection using an anterior approach was efficient and safe.
Subject(s)
Arm , Cadaver , Head , Injections, Intra-Articular , Muscles , Needles , Shoulder , Shoulder Joint , TendonsABSTRACT
OBJECTIVE: To evaluate the effect of tear after passive ROM exercise during distension arthrography in patients with frozen shoulder. METHOD: Fifteen patients (male: 7, female: 8, mean 57.5 years old) who had complained of shoulder pain with decreased ROM at least 3 months prior were enrolled. Distension arthrogrphy of 35 ml of fluid which contained 10 ml of 1% lidocaine, 1 ml of depomedrol (40 mg), 19 ml of normal saline, and 5 ml of radiocontrast material was injected by a single physician. Then if there was no capsular tear, passive ROM exercise was performed for two minutes. RESULTS: In seven of the thirteen patients, the occurrence of capsular tear was observed after only distension arthrography. In five of the six patients without capsular rupture, the occurrence of capsular tear was observed by passive ROM exercise after distension arthrography. Two patients were interrupted because of severe pain. Clinical outcomes of occurrence of capsular tear by conventional distension arthrography and by passive ROM exercise after distension arthrography were similar. CONCLUSION: Passive ROM exercise after distension arthrography could serve as an effective method of capsular tear in patients with frozen shoulder.
Subject(s)
Humans , Arthrography , Bursitis , Injections, Intra-Articular , Lidocaine , Rupture , Shoulder PainABSTRACT
OBJECTIVE: Neuromuscular imbalance of vastus medialis obliquus and vastus lateralis muscles is one of the major causes of patellofemoral pain syndrome. This study was designed to evaluate the effect of the angular velocity on the electromyographic activities of vastus medialis obliquus and vastus lateralis during isokinetic cycling. METHOD: Fifteen healthy women (23.6+/-2.7 years) without any knee problem performed two sets of isokinetic bicycling using Motomed (RECK, Germany) at three different revolutions per minutes (30 RPM, 45 RPM, 60 RPM). Integrated electromyographic (iEMG) activities of vastus medialis obliquus and vastus lateralis were measured during cycling. RESULTS: iEMG activities of vastus medialis obliquus increased as angular velocity increased (p<0.05). The vastus medialis obliquus : vastus lateralis iEMG ratio at 60 RPM was significantly greater than the ratio at 30 RPM (p<0.05). CONCLUSION: Preferential vastus medialis obliquus activation was achieved by isokinetic cycling at high angular velocity. This suggests the meaningful therapeutic protocol for the patients with patellofemoral pain syndrome in altering neuromuscular imbalance between vastus medialis obliquus and vastus lateralis.