OBJECTIVE: Injection of the tibiotalar (TT) joint is commonly performed in clinical practice under ultrasound (US) guidance using an anteromedial approach. However, in some patients, this approach may be technically challenging due to post-traumatic and/or degenerative bony changes. Therefore, the aim of this cadaveric investigation was to demonstrate the feasibility of the ultrasound-guided (USG) injection of the ankle joint via the anterolateral sulcus (ALS) by confirming the dye placement/distribution inside the articular space. Likewise, the safety of the procedure has also been evaluated by measuring the distance between the needle and the intermediate dorsal cutaneous nerve of the foot. DESIGN: A descriptive laboratory study with eight embalmed cadaveric ankles using the Fix for Life (F4L) method was performed at the setting of an academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced into the TT joint through the ALS under US guidance, i.e., in-plane anterior-to-posterior approach. With the objective to confirm its correct placement, the needle was kept in situ and-to demonstrate the location of the dye inside the articular space-all eight ankles were injected with 3 mL of green color dye. Thereafter, a layer-by-layer anatomical dissection was performed on all four cadavers. RESULTS: The position of the needle's tip within the ALS was confirmed in all specimens. Accurate placement of the dye inside the articular space of the ankle was confirmed in seven of the eight cadaveric ankles, with 87.5% of accuracy. Herewith, unintentional spilling of the dye within the superficial soft tissues was reported in two of the eight ankles (25.0%). The mean distance between the needle and the intermediate dorsal cutaneous nerve of the foot, measured in all eight procedures, was 3 cm. CONCLUSION: USG injection of the ALS using the in-plane, anterior-to-posterior approach can accurately place the injectate inside the articular space. CLINICAL RELEVANCE: This cadaveric investigation described the accuracy and potential pitfalls of USG injection of the ankle via the anterolateral approach which represents an alternative technique in patients with reduced accessibility of the anteromedial recess due to degenerative and/or post-traumatic bony changes.
- MeSH
- hlezenní kloub * diagnostické zobrazování MeSH
- injekce intraartikulární metody MeSH
- intervenční ultrasonografie metody MeSH
- lidé MeSH
- mrtvola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Background: Cartilage intermediate layer protein 2 (CILP2) is a monomeric glycoprotein that is mostly expressed in the intermediate zone of articular cartilage and can be detected in the extracellular matrix (ECM). The level of CILP2 in serum and its quantity on the articular cartilage surface and throughout the articular cartilage indicates the potential utility of CILP2 for investigation as a biomarker for determining cartilage deterioration in joint disorders. The CILP2 measurement of changes in cartilage biomarkers may be an effective and sensitive tool for detecting the early development of knee osteoarthritis (KOA) in people at risk for KOA. Changes in CILP2 levels may be beneficial for the early diagnosis of KOA, as CILP2 appears to be linked to cartilage thickness reduction in people who are more likely to develop KOA. Platelet rich plasma (PRP) effectiveness of transforming growth factor, platelet-derived growth factor, and the vascular endothelial growth factor is thought to be related to their release. Because of their capacity to increase matrix formation,growth factors have been widely researched for OA and cartilage regeneration. Hyaluronic acid (HA) is a glycosaminoglycan polymer composed of N-acetyl glucosamine and D-glucuronic acid disaccharide molecules. Early embryonic development, inflammatory, wound repair, cell differentiation, and viscoelasticity are all affected by HA, and other biological processes The study was aimed to evaluate effecte of CILP2 levels after intraarticular injecting pure platelet-rich plasma and hyaluronic acid into patients with early knee osteoarthritis.Materials and Methods: BT LAB kits were used to assess the serum CILP2 level. The experimental investigation included 18 control groups, 10 HA injections, and 21 pure PRP injections. age ranged from 35 to 75. The study was exluded all individuals with advanced osteoarthritis in the knee, COVID-19, diabetes, and autoimmune diseases. the time frame running from November 2021 until June 2022. Other variables in our research were age, gender, family history, use of antihypertensive medications or medications for other disorders, and body mass index (BMI). Results: The findings of this study demonstrate elevated CILP2 levels in patients with early KOA before treatments injection compared with the healthy control. After treatments injection, the level of CILP2 was decreased compared with before injection.
- Klíčová slova
- CILP2,
- MeSH
- artróza kolenních kloubů * farmakoterapie patologie diagnóza MeSH
- časná diagnóza MeSH
- extracelulární matrix - proteiny analýza MeSH
- injekce intraartikulární metody MeSH
- kloubní chrupavka patologie MeSH
- kyselina hyaluronová aplikace a dávkování terapeutické užití MeSH
- lidé MeSH
- osteoartróza patologie MeSH
- plazma bohatá na destičky MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- klinické zkoušky MeSH
BACKGROUND: Ultrasound (US) guided intra-articular elbow injections are commonly performed in clinical practice. OBJECTIVE: To describe a proximal to distal approach for US-guided intra-articular elbow injection. DESIGN: Cadaveric study. SETTINGS: Academic institution. METHODS: Both elbows of a single cadaver were injected with green-colored water-diluted latex dye using the US-guided proximal to distal approach. In the left elbow, the needle was kept in situ; in the right elbow, the needle was removed. Subsequently, a layer-by-layer anatomical dissection was performed in both elbows. MAIN OUTCOME MEASURES: Presence and distribution of the latex dye and location of the needle tip within the elbow joint capsule. RESULTS: Anatomical dissection of both elbows confirmed the correct intra-articular position of the needle tip in the left elbow as well as correct placement of the latex dye bilaterally. During layer-by-layer dissection of the left elbow, the position of the radial nerve was observed anterior to the needle. CONCLUSIONS: This cadaveric observation demonstrated that the US-guided proximal to distal approach is a convenient technique to access the elbow joint. Compared to the previously described techniques, the in-plane, proximal to distal approach may provide excellent needle visibility during the entire procedure, precisely targeting the articular space. The preliminary data need to be validated in additional clinical studies.
- MeSH
- injekce intraartikulární metody MeSH
- intervenční ultrasonografie metody MeSH
- latex MeSH
- lidé MeSH
- loket MeSH
- loketní kloub * diagnostické zobrazování MeSH
- mrtvola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- artróza kolenních kloubů * terapie MeSH
- injekce intraartikulární metody MeSH
- klinické zkoušky kontrolované jako téma MeSH
- kyselina hyaluronová * aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- osteoartróza terapie MeSH
- viskosuplementace metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
Častou příčinou bolestí zad může být dysfunkce sakroiliakálního (SI) skloubení. Projevují se pseudoradikulární bolestí a jsou spojeny s pozitivními manévry na sakropelvická ligamenta a s provokačními testy, jako je např. Patrickův test. V terapii této bolesti používáme obstřiky SI skloubení navigované pomocí mobilního CT přístroje O-arm, kdy aplikujeme směs depotního steroidu, lokálního anestetika a rtg kontrastní látky. V našem souboru je 31 pacientů (5 mužů, 26 žen, průměrný věk 52 roků), u 58% pacientů se snížila úroveň bolesti o polovinu podle NRS (numeric rating scale) po dobu delší než 3 týdny, u 28% pacientů nastala úleva od bolestí pouze o čtvrtinu až polovinu a u 14% pacientů nebyl dosažen analgetický efekt. Tento obstřik nám slouží též jako diagnostická metoda, jestli je indikované pacientům nabídnout definitivní řešení – operační dézu SI skloubení.
Sacroiliac joint dysfunction can often be the cause of chronic low back pain. The main symptom is pseudoradicular leg pain as well as positive maneuvers of the sacropelvic ligaments and the Patrick' test. We used a mixture of depot steroid, local anesthetic and contrast medium for navigated sacroiliac joint injections using O-arm, portable CT scanner. There are 31 patients in our study group, 5 male and 26 female, average age 52 years. In 58% of cases we achieved pain relief of more than one-half on the Numeric Rating Scale for 3 weeks or more, in 28% of cases we achieved pain relief of one quarter to one half and in 14% patients showed no pain relief. We utilize these injections as a diagnostic tool for selecting patients suitable for sacroiliac arthrodesis.
- MeSH
- chronická nemoc MeSH
- diagnostické zobrazování metody MeSH
- injekce intraartikulární metody přístrojové vybavení MeSH
- lidé MeSH
- lumbalgie * diagnostické zobrazování terapie MeSH
- počítačová rentgenová tomografie MeSH
- sakroiliakální kloub diagnostické zobrazování účinky léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- klinická studie MeSH
- Klíčová slova
- MD-Lumbar - FRM léčba,
- MeSH
- anestetika lokální terapeutické užití MeSH
- glukokortikoidy terapeutické užití MeSH
- injekce intraartikulární metody MeSH
- kolagen terapeutické užití MeSH
- lidé MeSH
- muskuloskeletální bolest * diagnóza farmakoterapie MeSH
- neuronavigace metody přístrojové vybavení MeSH
- ultrasonografie metody přístrojové vybavení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- rozhovory MeSH
OBJECTIVE: To evaluate the efficacy and safety of an intraarticular injection of Cingal (Anika Therapeutics, Inc., Bedford, MA) compared with Monovisc (Anika Therapeutics, Inc., Bedford, MA) or saline for the treatment of knee osteoarthritis. DESIGN: This multicenter, double-blind, saline-controlled clinical trial randomized subjects with knee osteoarthritis (Kellgren-Lawrence grades I-III) to a single injection of Cingal (4 mL, 88 mg hyaluronic acid [HA] plus 18 mg triamcinolone hexacetonide [TH]), Monovisc (4 mL, 88 mg HA), or saline (4 mL, 0.9%). The primary efficacy outcome was change in WOMAC (Western Ontario and McMaster Universities Arthritis Index) Pain Score through 12 weeks with Cingal versus saline. Secondary outcomes included Patient and Evaluator Global Assessments, OMERACT-OARSI Responder index, and WOMAC Total, Stiffness, and Physical Function scores through 26 weeks. RESULTS: A total of 368 patients were treated (Cingal, n = 149; Monovisc, n = 150; saline, n = 69). Cingal improvement from baseline was significantly greater than saline through 12 weeks ( P = 0.0099) and 26 weeks ( P = 0.0072). WOMAC Pain was reduced by 70% at 12 weeks and by 72% at 26 weeks with Cingal. Significant improvements were found in most secondary endpoints for pain and function at most time points through 26 weeks. At 1 and 3 weeks, Cingal was significantly better than Monovisc for most endpoints; Cingal and Monovisc were similar from 6 weeks through 26 weeks. A low incidence of related adverse events was reported. CONCLUSIONS: Cingal provides immediate and long-term relief of osteoarthritis-related pain, stiffness, and function, significant through 26 weeks compared to saline. Cingal had similar immediate advantages compared with HA alone, while showing benefit comparable to HA at 6 weeks and beyond.
- MeSH
- antiflogistika terapeutické užití MeSH
- artróza kolenních kloubů farmakoterapie MeSH
- dvojitá slepá metoda MeSH
- injekce intraartikulární metody MeSH
- kolenní kloub účinky léků patologie MeSH
- kombinovaná terapie metody MeSH
- kyselina hyaluronová aplikace a dávkování terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- triamcinolonacetonid aplikace a dávkování analogy a deriváty terapeutické užití MeSH
- viskoelastické doplňky kloubní tekutiny terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
Diagnostika onemocnění čelistního kloubu se v zobrazovacích metodách opírá o rentgenový snímek a pak především o magnetickou rezonanci, která má ale řadu nevýhod: vysoká nákladnost, množství kontraindikací (gravidita, přítomnost feromagnetického materiálu v těle, přítomnost kardiostimulátoru nebo kochleárního implantátu) i fakt, že vyšetření může být pro mnoho pacientů nepříjemné (pro hluk a omezený prostor vyvolávající klaustrofobii). Autoři prezentují alternativní zobrazovací metodu magnetické rezonance - ultrasonografické vyšetření a jeho využití v terapii poruch čelistního kloubu.
Diagnostics of temporomandibular disorders is based on x-ray and especially magnetic resonance imaging (MRI). MRI has a number of inconviences: high cost and contraindications (gravidity, presence of ferromagnetic material in the body, presence of cardiostimulator or cochlear implant). MRI examination may be discomfortable for patients due to noise and limited space causing claustrophobia. Authors present paging method alternative to MRI – ultrasound examination and its use in therapy of temporomandibular joint disorders.
