Tuberculous Sacroiliitis

Tuberculosis can affect the sacroiliac joint. The involvement has been reported in up to 10 percent of patients with osteoarticular tuberculosis. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. Lack of awareness of this presently uncommon form of infection often leads to diagnostic delay and increased morbidity. Early diagnosis and proper treatment with anti-tuberculous medication could obtain a satisfactory functional outcome. We report a case of tuberculous sacroiliitis in a 21 year-old male patient including his clinical presentation, radiographic features and outcome of medical treatment.

Confirming of Needle Position and Spreading of Solution according to Injection Volume in Caudal Epidural Injection

OBJECTIVE: To know the accuracy of caudal epidural steroid injection procedure without fluoroscopy guidance, and determine ascending level of injected solution according to injection volume. METHOD: The subjects were 35 patients with low back pain. Needle insertion was performed without fluoroscopy, then we confirm the position of needle with fluoroscopy. The level of injected solution was measured with fluoroscopy and x-ray after injecting every 5 ml of solution, which is mixture of triamcinolone, 2% lidocaine, contrast medium, and normal saline. The effect of treatment was measured by Visual Analogue Scale (VAS). RESULTS: Successful needle placement occurred in 27 cases without fluoroscopy. After injecting 20 ml of solution, the ascending level of solution were S1 in 8 cases, L5 in 12 cases, L4 in 8 cases, L3 in 1 case, L2 in 4 cases, L1 in 2 cases. In the comparison of the VAS before and after treatment, it was 6.3+/-1.2 and 2.9+/-1.3 respectively, which demonstrated statistically significant decrease (p+/-0.05). CONCLUSION: Caudal epidural injection could be performed more accurately under the fluoroscopic guidance. After injecting 20 ml of solution, the ascending level of the solution were restricted at lower lumbosacral area in most of cases.

Ultrasonographic Findings of Chronic Lateral Epicondylitis with Partial Tear before and after Prolotherapy

OBJECTIVE: To compare the ultrasonographic findings of chronic lateral epicondylitis of elbow with partial tear of common extensor tendon before and after prolotherapy. METHOD: The subjects were 12 cases of chronic lateral epicondylitis with partial tear of common extensor tendon, which were confirmed by ultrasonography. We examined the common extensor tendon with ultrasonography at initial visit. After injecting 15% dextrose solution monthly for five times, follow up ultrasonography was performed one month after last injection. RESULTS: Before prolotherapy, every case had anechoic focus without normal fibrillar pattern, which represented partial tear of tendon. Seven cases showed focal or diffuse hypoechoic foci with loss of normal fibrillar pattern of tendon, which represented tendinosis. After prolotherapy, initial anechoic foci were changed to smaller size with diffuse fibrillar pattern inside in 6 cases, to the same the sized hypoechoic foci with diffuse fibrillar pattern inside in 2 cases. And a few fibrillar pattern were seen within the initial anechoic focus in 1 case and most of anechoic foci were filled with fibrillar pattern except small anechoic foci in 3 cases. CONCLUSION: Prolotherapy can help the recovery process of chronic lateral epicondylitis. And ultrasonography can be a useful method to evaluate the therapentic effect of lateral epicondylitis.

The Effect of Prolotherapy on Lateral Epicondylitis of Elbow

OBJECTIVE: To determine the effect of prolotherapy on lateral epicondylitis, and the difference of treatment effect according to the findings of ultrasonography. METHOD: The subjects were 84 patients who were diagnosed as lateral epicondylitis. The pain score was evaluated by using VAS (Visual Analogue Scale) before treatment and 1 month and 6 months after the 3rd injection. Ultrasonography was done to 49 patients who were suspicious of tendinous tear. RESULTS: In the comparison of the VAS before treatment and after the 3rd injection, it was 6.79+/-0.88, 2.95+/-1.90, respectively, which demonstrated statistical significant decrease (p<0.01). We found more significant reduction of VAS in the subjects without tendinous tear (7.08+/-0.91 to 2.16+/-1.57) than those with partial tendinous tear (6.90+/-0.93 to 3.67+/-1.76) (p<0.01). Among 71 patients whose symptom was improved after the treatment, 57 patients (80.2%) demonstrated sustained improvement at 9 months and 14 patients (19.7%) relapsed at 9 months. CONCLUSION: Prolotherapy is an effective treatment method in the lateral epicondylitis of elbow. Ultrasonography could be a useful diagnostic method which could predict the effect of prolotherapy.

The Effect of Prolotherapy for the Chronic Pain of Musculoskeletal System

OBJECTIVE: The goal of this study was to determine the efficacy of prolotherapy in relieving the pain of patients with tendon or ligament laxity. METHOD: The subjects were 67 patients (40 male, 27 female) who were suffering from chronic musculoskeletal pain, excluding those with metabolic diseases that could influence the nature of the pain. The effect of the treatment was evaluated by checking the VAS score after a monthly injection of 15% dextrose solution injected around the patient's ligaments and teno-osseous junction that were suspicious of laxity. This same procedure was followed after a second injection. To make an accurate evaluation before and after the treatment, the use of NSAID, physical therapy or exercise therapy was prohibited. RESULTS: The mean pain duration of the subjects was 5.48+/-7.04 years, and the mean age of the subjects was 49.58+/-16.52 years. The result from VAS showed a statistically remarkable reduction after the injection (p0.05). CONCLUSION: This research demonstrated that prolotherapy is an effective method in treating patients with chronic musculoskeletal pain caused by tendon or ligament relaxation.