Ultrasound-guided needle release of A1 pulley combined with corticosteroid injection is more effective than ultrasound-guided needle release alone in the treatment of trigger finger.

BACKGROUND: The purpose of the present study was to evaluate the clinical effectiveness of ultrasonography-guided needle release of A1 pulley combined with corticosteroid injection by comparing it with ultrasound-guided needle release of the A1 pulley alone. METHODS: A total of 49 patients (55 fingers, thumb) with trigger fingers were included in this retrospective study. Twenty-seven fingers were treated with ultrasound-guided needle release of the A1 pulley alone (monotherapy group), and 28 fingers were treated with needle release of the A1 pulley combined with corticosteroid injection (combination group). Visual analog scale (VAS), Froimson scale, postoperative recurrence rate, and thickness of A1 pulley at baseline, Week-2, Week-12, and Month-6 were recorded. RESULTS: Higher clinical cure rates were observed in the combination group at Week-2 after treatment among patients with the Froimson scale Grade III and IV (p < 0.05). Among Froimson scale Grade IV patients, the combination group had a significantly thinner thickness of A1 pulley and better articular pain relief at Week-2 (all p < 0.05). No significant differences were found in the clinical cure rate, the thickness of the A1 pulley, articular pain relief, and recurrence rate between the two groups at Week-12 and Month-6 (all p > 0.05). CONCLUSIONS: Ultrasonography-guided needle release of A1 pulley plus corticosteroid injection was superior to ultrasonography-guided A1 pulley needle release alone during early-stage treatment of severe patients with trigger fingers. Moreover, ultrasonography-guided A1 pulley needle release combined with corticosteroid injection narrows the thickness of the A1 pulley. It is necessary to carry out preoperative evaluation and individualized treatment for patients of various severities.

Comparison of the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger.

OBJECTIVE: To compare the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger. METHODS: A total of 60 patients with trigger finger were enrolled in this retrospective study. Among them, 30 patients were treated with ultrasound-guided needle release of the A1 pulley with corticosteroid injection (group A) and 30 patients were treated with single ultrasound-guided corticosteroids injection (group B). The following parameters were evaluated including clinical parameters (pain degree, function of joint, finger tendon function, postoperative satisfaction), and ultrasound parameter (thickness of A1 pulley). RESULTS: The postoperative visual analogue scale (VAS) and Quinnell scores in two groups were significantly lower than that before operation (p < 0.05). The postoperative Quinnell score of group A was significantly lower than that in group B (p < 0.05). The TAM results showed that the postoperative overall excellent and good rate of group A was significantly higher than that in group B (p < 0.05). The postoperative survey showed that more than 80% patients reported satisfaction in the two groups. The ultrasound imaging results showed that the postoperative thickness of A1 pulley in two groups were thinner than that before operation (p < 0.05). There were no adverse effects and complications in the two groups. CONCLUSIONS: Both approaches had treatment benefit in trigger finger. Ultrasound-guided needle release of the A1 pulley with corticosteroid injection had better treatment benefits than single ultrasound-guided corticosteroids injection in improving finger tendon function and joint function.

Feasibility and Reliability of an Ultrasound Examination to Diagnose Piriformis Syndrome.

OBJECTIVE: We explored the diagnostic performance of ultrasound examinations in the diagnosis of piriformis syndrome (PS). METHODS: In our single-center retrospective study, 52 patients with a diagnosis of PS and 50 healthy volunteers were enrolled to undergo ultrasound examination of the piriformis and sciatic nerve. The thicknesses of the piriformis and the diameter of the sciatic nerve were measured to compare the differences between the patients with PS and healthy volunteers. The diagnostic performance of ultrasound examinations was assessed by constructing a receiver operating characteristic curve and calculating the area under the curve. RESULTS: In patients with PS, the piriformis and sciatic nerve were enlarged on the abnormal side compared with the asymptomatic side, accompanied by a decreased echo intensity and an unclear perineurium. In addition, the piriformis thickness and sciatic nerve diameter of those with PS were significantly greater than were those of the healthy volunteers. The diagnostic performance of ultrasonography was significant. The area under the receiver operating characteristic curve for piriformis thickness and sciatic nerve diameter to discriminate between the abnormal and asymptomatic sides was 0.778 and 0.871, respectively. CONCLUSION: Ultrasound examinations can assist in the clinical diagnosis of PS and have the potential to be an alternative method for the diagnosis of PS for most musculoskeletal clinicians.

Ultrasound-guided needle release of the transverse carpal ligament with and without corticosteroid injection for the treatment of carpal tunnel syndrome.

BACKGROUND: To compare the clinical effectiveness of ultrasound-guided needle release of the transverse carpal ligament (TCL) with and without corticosteroid injection in carpal tunnel syndrome (CTS). METHODS: From June 2016 to June 2017, 49 CTS patients (50 wrists) were included in this study. Twenty-five wrists were treated with ultrasound-guided needle release of the TCL plus corticosteroid injection (group A), and 25 wrists were treated with single ultrasound-guided needle release of the TCL (group B). The following parameters were assessed and compared including postprocedure results according to relief of symptoms, ultrasound parameters (cross-sectional area of the median nerve at the levels of pisiform, flattening ratio of median nerve at the levels of the hamate bone, and the thicknesses of TCL on the cross-section at the level of the hamate bone), and electrophysiological parameters (distal motor latency and sensory conduction velocity). RESULTS: Group A had higher overall excellent and good rate 3 months after the procedure than group B (84 vs 52%, P < 0.05). There were significant differences regarding the above ultrasonic and electrophysiological parameters between the baseline and postprocedure values in both groups (all P < 0.05). There were significant differences regarding the postprocedure values of above ultrasonic and electrophysiological parameters between the two groups (all P < 0.05). No complications such as infection or tendon rupture were noted. No procedures were converted to the open release. CONCLUSIONS: Both techniques are effective in treating CTS. Ultrasound-guided needle release of the TCL with corticosteroid injection had better treatment benefits than single ultrasound-guided needle release of the TCL in treating CTS.

[The methodology and influential factors of real-time elastography in liver examination].

OBJECTIVE: To investigate the methodology and influential factors of real-time elastography (RTE) in liver examination. METHODS: Forty normal volunteers received the examination of liver with RTE. All strain images were analyzed by the Strain Histogram Measurement and the liver fibrosis index (LFI) values were recorded. Two-tailed t-test was used to evaluate the significance of the potential influence factors of RTE, including inter-lobar variations, respiratory phase, different sections and gender. A paired two-tailed t-test and Bland-Altman test were used in the analysis of the inter- and intra-observer consistency. RESULTS: There were significant differences between the LFI values in the left lobe and those in the right lobe (2.52 +/- 0.47 vs. 1.58 +/- 0.41), also between right intercostal and right sub-costal approach (1.58 +/- 0.41 vs. 1. 59 +/- 0.45). There were no significant differences either between the LFI values of end-expiration and those of end-inspiration (2.61 +/- 0.54 vs. 1.58 +/- 0.41) or between male and female (1.57 +/- 0.37 vs. 1.60 +/- 0.46). RTE showed goodness of fit between the inter- and intra-observer consistency. CONCLUSION: Liver stiffness measurement performed by RTE at end-inspiration in the right lobe with inter-costal approach may reveal liver elasticity more accurately.

[Ultrasound tissue characterization of hepatic fat in rats using radiofrequency signal analysis].

OBJECTIVE: To investigate the significance of multi-parameter quantitative evaluation of hepatic fat using ultrasound radiofrequency signal analysis. METHODS: Thirty two SD rats were divided into two groups, with 24 having fatty livers and 8 serving as normal controls. Radiofrequency signals were sampled with a 13-MHz ultrasound probe and digitized at 40 MHz in 16-bit resolution. Four statistical parameters of the radiofrequency envelope [Mean, Mean/SD ratio (MSR), skewness (SK), and kurtosis (KU)] within the ROI were calculated offline, and their ability to diagnose fatty liver was analyzed. RESULTS: The rats with fatty livers had greater Mean and MSR but lower skewness and kurtosis than the controls. The areas under the ROC curve of Mean, MSR, skewness and kurtosis for diagnosing fatty livers were 0.85, 0.96, 0.98, and 0.98 respectively. The sensitivity and specificity of Mean, MSR, skewness and kurtosis for diagnosing fatty livers were 70.8%/88.9%, 87.5%/100%, 95.8%/100% and 95.8%/100% respectively, whereas conventional ultrasound achieved only 68.2% in sensitivity and 66.7% in specificity. CONCLUSION: Compared with conventional ultrasound, radiofrequency signal analysis is more accurate in diagnosing fatty livers.

Extrahepatic portal vein aneurysm after orthotopic liver transplantation: a case with 9-year ultrasound observations.

We report a case of extrahepatic portal vein aneurysm (PVA) in the late postoperative period after orthotopic liver transplantation (OLT). A 46-year-old man underwent OLT in 2001 for treatment of hepatitis B virus-induced cirrhosis and received ultrasound follow-up for 9 years. The long-term ultrasound observations showed that the diameter of the main portal vein had progressively increased from 12 mm in 2001 to 34 mm in 2007, and then remained at 34 mm from 2007 to 2010. The patient did not show any symptoms or complications that required surgical treatment during the clinical follow-up. Our case suggests that PVA after OLT can remain without a sign of deterioration for a long time, and careful observation by ultrasound may be one of the options in the clinical management.