Ultrasound-guided shoulder injections in the treatment of subacromial bursitis.

OBJECTIVE: To investigate the treatment effectiveness between ultrasound-guided and blind injection techniques in the treatment of subacromial bursitis. DESIGN: A total of 40 patients with sonographic confirmation of subacromial bursitis were recruited into this study. These patients were divided into blind and ultrasound-guided injection groups. The shoulder abduction range of motion was compared before injections and 1 wk after the completion of injections in both groups. RESULTS: The shoulder abduction range of motion before injection in the blind injection group was 71.03 +/- 12.38 degrees and improved to 100 +/- 18.18 degrees 1 wk after the injection treatments. However, the improvement did not reveal significant statistical differences (P > 0.05). The shoulder abduction range of motion before injection in the ultrasound-guided injection group was 69.05 +/- 14.72 degrees and improved to 139.29 +/- 20.14 degrees 1 wk after the injection treatments (P < 0.05). CONCLUSIONS: Ultrasound may be used as an adjuvant tool in guiding the needle accurately into the inflamed subacromial bursa. The ultrasound-guided injection technique can result in significant improvement in shoulder abduction range of motion as compared with the blind injection technique in treating patients with subacromial bursitis.

Ultrasound guidance in caudal epidural needle placement.

BACKGROUND: This study was conducted to investigate the feasibility of using ultrasound as an image tool to locate the sacral hiatus accurately for caudal epidural injections. METHODS: Between August 2002 and July 2003, 70 patients (39 male and 31 female patients) with low back pain and sciatica were studied. Soft tissue ultrasonography was performed to locate the sacral hiatus. A 21-gauge caudal epidural needle was inserted and guided by ultrasound to the sacral hiatus and into the caudal epidural space. Proper needle placement was confirmed by fluoroscopy. RESULTS: In all the recruited patients, the sacral hiatus was located accurately by ultrasound, and the caudal epidural needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy in caudal epidural needle placement into the caudal epidural space under ultrasound guidance as confirmed by contrast dye fluoroscopy. CONCLUSIONS: Ultrasound is radiation free, is easy to use, and can provide real-time images in guiding the caudal epidural needle into the caudal epidural space. Ultrasound may therefore be used as an adjuvant tool in caudal needle placement.

Biomechanics of the heel pad for type 2 diabetic patients.

OBJECTIVES: To quantify the dynamic behavior of the heel pad in type 2 diabetic patients and age-matched healthy individuals using mathematical modeling. BACKGROUND: No single parameter can fully describe the heel-pad biomechanical properties during the loading-unloading process. DESIGN: A descriptive study using pseudoelastic modeling was conducted to simulate the heel-pad stress-strain relationship in the loaded and unloaded states. Transmission electron microscope was used to examine six heel specimens taken from amputated legs in diabetic and non-diabetic patients. METHODS: Energy dissipation ratio, loading curvature, and unloading curvature were calculated from the stress-strain curve-fits. Differences in ultrastructure between the heel pad of healthy subjects and those with diabetes were described. RESULTS: The diabetic patients had a significantly higher mean energy dissipation ratio (mean 36.1% (SD, 8.7%) vs mean 27.9% (SD, 6.1%); P<0.001) and mean unloaded curvatures (mean 11.8 (SD, 5.1) vs mean 8.46 (SD, 2.6); P<0.001) than those of the control group. The collagen fibrils in diabetic heel samples were ruptured with unclear striation and uneven distribution. CONCLUSIONS: The curvature parameters may explain the poor rebound phenomenon resulting in the high impact energy in diabetic heel pads. Breakdown in collagen fibrils may be responsible for this observation. RELEVANCE: These findings can be integrated into the fabrication of orthotics that dissipate excessive heel impact energy and protect against injury.