Anatomical basis in the treatment of sinus tarsi syndrome by local steroid injection / 解剖学报

Objective To provide anatomical basis for the treatment of sinus tarsi syndrome by developing the anatomical structure of sinus tarsi. Methods Thirty formalin fixed lower limb specimens were dissected. The anatomic structures of the sinus tarsi, neurovascular tissue, ligament and adipose tissue were observed and measured. Morphologies of the sinus tarsi and canal of tarsus in intact dry calcaneus and talus of 136 Chinese adult specimens were investigated and measured. Results The artery of the sinus tarsi and its periphery issued from the dorsalis pedis artery, anterior medial malleolar artery, perforating peroneal artery and lateral tarsal artery. The laterosuperior point of cuboidal articular surface of calcaneus was the obvious osseous marks of the lateral surface of sinus tarsi. The length canal of tarsus, sinus tarsi and the calcaneal sulcus were (14. 85 ±2. 08) ( 8. 33-22. 00) mm, (26.38±3.05) ( 16. 54-35. 79) mm and (41. 25 ± 3. 52) (31. 06-53. 92) mm respectively. There was a angle between two axes of calcaneus and tarsal canal, which was (49. 37± 4.76) (39. 18~56.37)°. Conclusion During the treatment of sinus tarsi syndrome by the local steroid injection, the laterosuperior point of cuboidal articular surface of calcaneus should be palpated firstly, which is the point of inserting the needle. Then, the injection needle is towards posteromedial at 49°, and advance 2.5 mm to touch the sinus tarsi.

Effectiveness of Initial Extracorporeal Shock Wave Therapy on the Newly Diagnosed Lateral or Medial Epicondylitis

OBJECTIVE: To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared to local steroid injection. METHOD: An analysis was conducted of twenty-two patients who were newly confirmed as lateral or medial epicondylitis through medical history and physical examination. The ESWT group (n=12) was treated once a week for 3 weeks using low energy (0.06-0.12 mJ/mm2, 2,000 shocks), while the local steroid injection group (n=10) was treated once with triamcinolone 10 mg mixed with 1% lidocaine solution. Nirschl score and 100 point score were assessed before and after the treatments of 1st, 2nd, 4th and 8th week. And Roles and Maudsley score was assessed one and eight weeks after the treatments. RESULTS: Both groups showed significant improvement in Nirschl score and 100 point score during the entire period. The local steroid injection group improved more in Nirschl score at the first week and in 100 point score at the first 2 weeks, compared to those of the ESWT group. But the proportion of excellent and good grades of Roles and Maudsley score in the ESWT group increased more than that of local steroid injection group by the final 8th week. CONCLUSION: The ESWT group improved as much as the local steroid injection group as treatment for medial and lateral epicondylitis. Therefore, ESWT can be a useful treatment option in patients for whom local steroid injection is difficult.

The Effect of Conservative Treatment for the Calcific Tendinitis on Gluteus Medius Tendon / 대한스포츠의학회지

Calcific tendinitis on gluteus medius tendon of the amateur athletes were reviewed, and a study on the therapeutic effect of conservative treatment methods. From January 2003 to December 2010, among the patients who had been treated with calcific tendinitis on gluteus medius tendon, there were nine patients available to monitor more than a year as outpatients. ten cases were observed from them and were retrospectively analyzed and magnetic resonance examinations were performed in every case. All of the ten cases were initially treated with non-steroid anti-inflammatory oral doses. If a non-steroid anti-inflammatory treatment could not relieve pain or caused an aggravation of a condition, a local steroid injection was enforced. There were responses to non-steroid antiinflammatory oral doses of therapeutic methods in four cases and the time required for the symptoms to be improved was approximately 3 weeks (range: 1-3 weeks). In the remainder of six cases, conditions got worsened or did not improve even after 3 weeks. In these cases, the condition was altered for better in 3 days (range: 1-3 days) by using local steroid injections. There was no recurrence in all cases. The amateur athlete with a severe pain around his or her hip joint should be questioned with calcific tendinitis on gluteus medius tendon and differential diagnosis of hip around diseases. After calcific tendinitis was diagnosed, initial treatment was considered conserevative treatment. Although it is invasive, the initial treatment with a local steroid injection is considered to be helpful in treating amateur athletes with calcific tendinitis.

Comparison between the Effect of Local Steroid Injection and Prolotherapy on Iliac Crest Pain Syndrome

OBJECTIVE: To evaluate the therapeutic effect of local steroid injection and prolotherapy on the iliac crest pain syndrome (ICPS) in patients with nonspecific low back pain. METHOD: 44 patients with ICPS were chosen randomly. The treatment groups were divided into two. The first group received a mixture of triamcinolone and lidocaine. The second received with a mixture of dextrose and lidocaine. The patients in each group were injected once a week over 4 weeks. The effectiveness of treatment was evaluated by a visual analogue scale (VAS), a pressure threshold and patient's life activities with modified Oswestry questionnaire before injection, 30 minutes, 1 week, 4 weeks and 3 months later after injection respectively. RESULTS: VAS, pressure threshold and patient's life activities of two groups were all improved at 30 minutes, 1 week, 1 month and 3 months after injection compared with those of pre-injection, and there was no significant difference between groups. CONCLUSION: The low back pain on ICPS can be significantly improved by local steroid injection and prolotherapy equally. Therefore, patients with risk of steroid injection could be treated by prolotherapy.

Clinical Experience of Local Steroid Injections through the Flexor Carpi Radialis for Treating Carpal Tunnel Syndrome / 대한마취과학회지

BACKGROUND: Local steroid injections for the treatment of carpal tunnel syndrome have become common, but median nerve injuries after the injections have rarely been reported. In our study, we checked the occurrence of a severe pain during local steroid injections through the flexor carpi radialis, and we evaluated the efficacy of injections for several short-term period. METHODS: A total of 24 patients with 32 affected hands were studied. The patients who presented with known medical causes or thenar muscle atrophy or a previous trauma history at the affected wrist were excluded from the study. The diagnosis was made both clinically and electrophysiologically, and then the injections were performed through the flexor carpi radialis with the hand in the supine position. Triamcinolone Acetonide (TA) 40 mg was injected first, and TA 20 mg was reinjected when the recovery rate on a 100 mm visual analog scale (VAS) score was below 50% 1 week after the injection. The patients were reevaluated with the VAS score before and 1, 3 and 6 months after the injections. RESULTS: In our study, no patients reported severe pain indicating there was median nerve injury during the injections. The mean VAS scores were 64.9, 9.5, 31.1 and 47.3 before and 1, 3 and 6 months after the injections respectively. As a result, the injections were deemed for the short-term period (P < 0.05). CONCLUSIONS: In our study, we concluded that local steroid injection through the flexor carpi radialis for treating carpal tunnel syndrome is a safe and effective method.

Spontaneous Achilles Tendon Rupture After Repeated Local Steroid Injention: A Case Report / 대한족부족관절학회지

It is known that steroids increase the risk for tendon ruptures. Despite this local steroids are still used in the treatment of achilles tendinitis. 46-year-old women had occurred achilles tendon rupture after repeated local steroid injection. Intraoperatively, necrotic change were seen at both side of ruptured end. Like this, tendon rupture after repeated steroid injection often result in a large defect, which needed surgical repair. After debridement of ruptured end, tenorrhaphy with single Krackow method and plantaris tendon augmentation was done. The patient showed favorable result with return to range in a degree of activity levels.