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Petrera MR, Aparisi Gómez MP, Guglielmi R, Guglielmi G, Bazzocchi A. Interventional Radiology for Rheumatic Diseases. Radiol Clin North Am 2024; 62:913-927. [PMID: 39059981 DOI: 10.1016/j.rcl.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Imaging plays a key role in the management of rheumatological pathologies, also as guidance for diagnostic and therapeutic interventional procedures, as it can provide better accuracy and safety compared to palpation-guided interventions. Inflammatory and degenerative conditions nonresponsive to systemic treatment may benefit from intra-articular and periarticular administration of drugs, with therapeutic and symptomatic actions or providing a bridge for surgery. Desired effects include reduction of inflammation and pain and improvement of physical function of patients. Training and knowledge of indications, appropriate procedures, contraindications, and side effects are necessary to obtain maximum accuracy and safety in performing interventional procedures.
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Affiliation(s)
- Miriana Rosaria Petrera
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Anatomy and Medical Imaging, Waipapa Taumata Rau | University of Auckland, Building 501-002, 85 Park Road, Grafton, New Zealand; Department of Radiology, IMSKE, Calle Suiza, 11, València 46024, Spain
| | - Riccardo Guglielmi
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy; Radiology Unit, "Dimiccoli" Hospital, Barletta, Italy; Department of Radiology, Hospital IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
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Vitt M, Macaraeg S, Stapleton Z, Mata A, Ross BS. Ultrasound verification of palpation-based dry needling techniques of rotator cuff muscles: a prospective feasibility trial. J Man Manip Ther 2024; 32:166-172. [PMID: 37574811 PMCID: PMC10956912 DOI: 10.1080/10669817.2023.2244735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVES The primary purpose of this study is to investigate the feasibility of using ultrasound to verify the placement of narrow-gauge dry needles within the supraspinatus and infraspinatus muscles utilizing palpation-based dry needle techniques. METHODS This is a prospective observational study with 10 participants recruited. Each participant had a dry needle placed within the infraspinatus and supraspinatus muscles by a trained physical therapist utilizing palpation-based methods. Following needle placement, ultrasound examination was then performed to determine the feasibility of needle tip visualization within the targeted tissues. RESULTS The needle tip was successfully visualized on ultrasound in 19/20 cases. The needle tip accurately resided in the targeted muscle tissue in each of the 19 cases it was successfully visualized. CONCLUSIONS Narrow-gauge dry needles used in physical therapy practice can be consistently visualized in the supraspinatus and infraspinatus muscles using ultrasound imaging. Also, the palpation method utilized is an accurate means of guiding dry needles into the targeted rotator cuff muscles. These are significant findings because most physical therapy clinics do not have the benefit of real-time imaging guidance and must rely solely on palpation-based needling methods.
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Affiliation(s)
- Michael Vitt
- Department of Therapy Services, University of Chicago Medicine, Chicago, IL, USA
| | - Sarah Macaraeg
- Department of Therapy Services, University of Chicago Medicine, Chicago, IL, USA
| | - Zachary Stapleton
- Department of Therapy Services, University of Chicago Medicine, Chicago, IL, USA
| | - Angeli Mata
- Department of Therapy Services, University of Chicago Medicine, Chicago, IL, USA
| | - Brendon S. Ross
- Department of Orthopedic Surgery & Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL, USA
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ElMeligie MM, Allam NM, Yehia RM, Ashour AA. Systematic review and meta-analysis on the effectiveness of ultrasound-guided versus landmark corticosteroid injection in the treatment of shoulder pain: an update. J Ultrasound 2023; 26:593-604. [PMID: 35524038 PMCID: PMC10468470 DOI: 10.1007/s40477-022-00684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Corticosteroid (CS) can be injected in a blind fashion (landmark-guided) or with ultrasound (US) guidance, and this may contribute to varying clinical results. We conducted this systematic review and meta-analysis to assess the effectiveness of US-guided versus landmark CS injections in the treatment of adult patients with shoulder pain. METHODS We searched MEDLINE (via PubMed), Scopus, Web of Science, EBSCO, and Cochrane Library for randomized controlled trials (RCTs) comparing US-guided versus landmark CS injection regarding visual analogue scale (VAS), functional scores, disability scores, abduction degree, and side effects. The data were pooled as mean difference (MD), standardized mean difference (SMD), or risk ratios (RRs), with 95% confidence intervals (CIs), using R software (meta package 4.9-0) for windows. Subgroup analysis and leave-one-out analysis were conducted. RESULTS Eighteen RCTs, with a total of 1010 patients, were included in this meta-analysis. The pooled estimate favored the US-guided over landmark CS injection in terms of the mean change of VAS between 6 weeks and baseline (SMD = - 0.48, 95% CI [- 0.79, - 0.17]), the shoulder functional scores (SMD = 0.35, 95% CI [0.05, 0.65]) and shoulder abduction degree (MD = 8.78, 95% CI [3.11, 14.46]). Whilst no significant difference was found between the compared group regarding the overall shoulder disability scores (SMD = - 0.51, 95% CI (- 1.25, 0.22]) and side effects (RR = 0.45, 95% CI [0.15, 1.34]). None of the eligible study analyzed the cost-effectiveness of the US-guided method compared with the landmark method for CS injection. CONCLUSION Our analysis showed that US-guided CS injection was effective in the treatment of various shoulder diseases. Further research on the cost-effectiveness of US-guided CS methods is needed.
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Affiliation(s)
- Mohamed Magdy ElMeligie
- Present Address: Department of Basic Sciences, Faculty of Physical Therapy, Ahram Canadian University, 4th Industrial Zone, Banks Complex، 6th of October City, Giza, Egypt
| | - Nashwa M. Allam
- Department of Physical Therapy for Orthopedics & Sport Injuries, October 6 University, Central Axis, 6th of October City, Giza, Egypt
| | - Radwa M. Yehia
- Department of Physical Therapy for Women’s Health, Faculty of Physical Therapy, October 6 University, Giza, Egypt
| | - Ahmed A. Ashour
- Department of Biomechanics, Faculty of Physical Therapy, October 6 University, Central Axis, 6th of October City, Giza, Egypt
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Elsawy NA, Ibrahiem AH, Younis GA, Meheissen MA, Abdel-Fattah YH. Clinical examination, ultrasound assessment and aspiration of knee effusion in primary knee osteoarthritis patients. J Orthop Surg Res 2023; 18:422. [PMID: 37301888 DOI: 10.1186/s13018-023-03891-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND To assess the diagnostic performance of clinical examination and ultrasound (US) assessment of knee effusion in primary knee osteoarthritis (KOA) patients. Furthermore, the success rate for effusion aspiration and the factors related to it were investigated. METHODS This cross-sectional study included patients diagnosed with primary KOA-induced knee effusion clinically or sonographically. The affected knee of each patient was subjected to clinical examination and US assessment using the ZAGAZIG effusion and synovitis ultrasonographic score. Patients with confirmed effusion and consented to aspiration were prepared for direct US-guided aspiration under complete aseptic techniques. RESULTS One hundred and nine knees were examined. During visual inspection, swelling was detected in 80.7% of knees and effusion was confirmed by US in 67.8% of knees. Visual inspection was the most sensitive at 90.54% while bulge sign was the most specific at 65.71%. Only 48 patients (61 knees) consented to aspiration procedure; 47.5% had grade III effusion, and 45.9% had grade III synovitis. Successful aspiration was achieved in 77% of knees. Two needle types were used; a 22 gauge / 3.5-inch spinal needle in 44 knees and an 18 gauge/ 1.5-inch needle in 17 knees, with a success rate of 90.9% and 41.2%, respectively. Aspirated amount of synovial fluid correlated positively with effusion grade (rs=0.455, p < 0.001) and negatively with synovitis grade on US (rs = - 0.329, p = 0.01). CONCLUSIONS The superiority of the US over clinical examination in detecting knee effusion suggests that US should be used routinely to confirm the presence of effusion. Long needles (spinal needle) may have a higher success rate of aspiration than shorter needles.
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Affiliation(s)
- Noha Abdelhalim Elsawy
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Aya Hanafy Ibrahiem
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Gihan Abdellatif Younis
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Marwa Ahmed Meheissen
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yousra Hisham Abdel-Fattah
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Dejaco C, Machado PM, Carubbi F, Bosch P, Terslev L, Tamborrini G, Sconfienza LM, Scirè CA, Ruetten S, van Rompay J, Proft F, Pitzalis C, Obradov M, Moe RH, Mascarenhas VV, Malattia C, Klauser AS, Kent A, Jans L, Hartung W, Hammer HB, Duftner C, Balint PV, Alunno A, Baraliakos X. EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2022; 81:760-767. [PMID: 34893469 DOI: 10.1136/annrheumdis-2021-221261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). METHODS European Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS A total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periarticular musculoskeletal structures, nerves and the spine. While US is the favoured imaging technique for peripheral joints and nerves, the choice of the imaging method for the spine and sacroiliac joints has to be individualised according to the target, procedure, expertise, availability and radiation exposure. All imaging guided interventions should be performed by a trained specialist using appropriate operational procedures, settings and assistance by technical personnel. CONCLUSION These are the first EULAR PtC to provide guidance on the role of imaging to guide interventional procedures in patients with RMDs.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria
- Department of Rheumatology (ASAA-SABES), Brunico Hospital, Brunico, Italy
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Philipp Bosch
- Department of Rheumatology, Medical University of Graz, Graz, Austria
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Universita degli Studi di Milano, Milano, Italy
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Epidemiology Research Unit, Italian Society of Rheumatology, Milano, Italy
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology, St. Anna Hospital, Herne, Germany
| | - Jef van Rompay
- Patient Research Partners, Patient Research, Antwerpen, Belgium
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Marina Obradov
- Radiology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Rikke Helene Moe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Vasco V Mascarenhas
- UIME (Unidade de Imagem Musculo-esquelética), Hospital da Luz Imaging Center, Lisbon, Portugal
- Rheumatic Diseases Lab, CEDOC, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genova, Italy
| | - Andrea Sabine Klauser
- Radiology II, Medical University Innsbruck Department of Radiology, Innsbruck, Austria
| | - Alison Kent
- Salisbury Hospital NHS Foundation Trust, Salisbury, UK
| | - Lennart Jans
- Radiology, Ghent University Hospital Radiology Department, Gent, Belgium
| | - Wolfgang Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach, Germany
| | - Hilde Berner Hammer
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
| | - Xenofon Baraliakos
- Rheumatology, Ruhr-University Bochum, Rheumazentrum Ruhrgebiet Herne, Herne, Germany
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Smolen JS. Greetings from the editor. Ann Rheum Dis 2022. [PMID: 35577363 DOI: 10.1136/annrheumdis-2022-222621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Josef S Smolen
- Rheumatology, Medical University of Vienna, Vienna, Austria
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Carubbi F, Bosch P, Machado PM, Scirè CA, Alunno A, Proft F, Baraliakos X, Dejaco C. Current Practice of Imaging-Guided Interventional Procedures in Rheumatic and Musculoskeletal Diseases: Results of a Multinational Multidisciplinary Survey. Front Med (Lausanne) 2021; 8:779975. [PMID: 34881271 PMCID: PMC8645558 DOI: 10.3389/fmed.2021.779975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/31/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives: To investigate opinion and routine practice of specialists from different disciplines on imaging techniques for interventional procedures related to rheumatic and musculoskeletal diseases (RMDs). Methods: An English-language questionnaire was developed by an international working group and distributed to health care providers of various disciplines involved in the care of people with RMDs via an online survey tool (SoSci Survey®) from December 2019 to May 2020. Results: A total of 1,105 respondents from 56 countries completed the survey, over 60% of participants were rheumatologists. The majority of respondents (88%) performed interventional procedures in RMDs patients and 90% of them used imaging guidance. Ultrasonography was the most frequently used technique, particularly among rheumatologists. X-ray and computed tomography were mainly used by radiologists. A discrepancy emerged between the importance assigned to certain items such as the availability of a second operator and their actual implementation in clinical practice. Local barriers, lack of resources and facilities were mentioned as the most relevant obstacles in this regard. Lack of training on imaging and/or imaging guided procedures did not emerge as a barrier to perform such interventions; in fact, 19% of respondents performing the procedures indicated not to have received adequate training in this field. Conclusions: This is the first multinational multidisciplinary survey exploring in detail the opinions and practice on imaging guidance for interventional procedures in RMDs. A harmonization of protocols based on international guidelines, along with adequate training programmes and interventions on barriers at national/local levels are the main unmet needs requiring attention.
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Affiliation(s)
- Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Philipp Bosch
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Pedro M. Machado
- Department of Neuromuscular Diseases, Centre for Rheumatology University College London, London, United Kingdom
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Christian Dejaco
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Bruneck, Italy
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