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Hung CY, Wang B, Chang HC, Wu WT, Liu PT, Chang KV, Su DCJ, Mezian K, Ricci V, Özçakar L. Pictorial Essay on Ultrasound and Magnetic Resonance Imaging of Paraspinal Muscles for Myofascial Pain Syndrome. Life (Basel) 2024; 14:499. [PMID: 38672769 PMCID: PMC11051048 DOI: 10.3390/life14040499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.
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Affiliation(s)
- Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan;
| | - Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, Taipei 24213, Taiwan;
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
| | | | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, 12800 Prague, Czech Republic;
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Department of Biomedical and Neuromotor Science, Istituto di Ricovero e Cura a Carattere Scientifico Rizzoli Orthopedic Institute, 40136 Bologna, Italy;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
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Su DCJ, Hung CY, Lam KHS. Ultrasound Evaluation and Guided Injection of the Subscapularis and Serratus Anterior Muscles Between the Scapula and the Thoracic Cage: A Technical Note. J Ultrasound Med 2024. [PMID: 38581172 DOI: 10.1002/jum.16459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/22/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
Most subscapularis and serratus anterior muscles lie between the scapula and the thoracic cage. Evaluation of this area in patients with scapulothoracic dyskinesis, snapping scapular syndrome, or interscapular pain can provide valuable information to clinicians. However, ultrasound scanning of pathologies in this area is hindered by anatomical limitations. In this study, we described a simple patient setup position and scanning method for ultrasound evaluation and guided intervention of the subscapularis and serratus anterior muscles between the scapula and thoracic cage.
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Affiliation(s)
- Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan
| | - Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - King Hei Stanley Lam
- The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, Hong Kong
- Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Wu WT, Onishi K, Mezian K, Naňka O, Wang B, Su DCJ, Ricci V, Chang KV, Özçakar L. Ultrasound imaging of the posterior lateral corner of the knee: a pictorial review of anatomy and pathologies. Insights Imaging 2024; 15:39. [PMID: 38334861 PMCID: PMC10857999 DOI: 10.1186/s13244-024-01606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
Assessment of the posterior lateral knee pain poses diagnostic challenges, requiring accurate evaluation of various structures in light of the medical history and physical examination. Despite substantial progress in the ultrasonographic diagnosis of musculoskeletal disorders, the current protocol (EURO-MUSCULUS/USPRM. Basic scanning protocols for knee) fails to conduct a comprehensive investigation into the intricate, tendons, and ligaments of the posterior lateral knee. This pictorial review aims to bridge this gap by offering a systematic approach to utilize ultrasound examination of the less-discussed structures in this specific region. Providing cadaveric and magnetic resonance images, this essay demonstrates the efficacy of ultrasound in diagnosing posterior lateral knee pain. Notably, pathologies such as ligamentous sprains and tears are clearly discernible. Moreover, the integration of ultrasound guidance plays a vital role in reducing the risk of inadvertent neurovascular injury during injection, such as the common peroneal nerve and lateral genicular artery. This comprehensive approach will enhance clinicians' understanding and equip them with effective management strategies for posterior lateral knee pain.Critical relevance statement In this visual exposition, we delve into the intricacies of the posterior lateral corner of the knee. Offering a methodical approach to employ ultrasound for visualization of the less-explored structures within this region, the authors aim to enhance the diagnosis in posterior lateral knee pain.Key points1. Ultrasound excels at revealing intricate structures in the posterior lateral knee.2. Due to proximity of vital structures, extreme caution is crucial during injections.3. Employing dynamic scan and understanding ligaments enables a comprehensive exploration of pathologies.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Nei-Jiang Rd., Wan-Hwa District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Nei-Jiang Rd., Wan-Hwa District, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Su DCJ, Chang KV, Lam SKH. Shear Wave Elastography to Guide Perineural Hydrodissection: Two Case Reports. Diagnostics (Basel) 2020; 10:diagnostics10060348. [PMID: 32481511 PMCID: PMC7344597 DOI: 10.3390/diagnostics10060348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
Radial nerve palsy is not uncommon after humeral shaft fractures. Ultrasound-guided hydrodissection is an emerging treatment for nerve entrapment. Two cases of radial nerve injury after humeral shaft fractures with plate fixation are presented. Shear wave elastography was used to identify hardened scars surrounding the nerve, causing entrapment. These areas were marked on the skin as targets for ultrasound-guided hydrodissection. Each patient experienced full recovery of their radial nerve function. Shear wave elastography may be used to precisely identify sites of neural entrapment by scar tissue and accurately guide perineural hydrodissection, particularly in complex postoperative cases.
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Affiliation(s)
- Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan 710, Taiwan;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 108, Taiwan;
| | - Stanley K. H. Lam
- Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin 999077, Hong Kong
- Correspondence:
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Chang KV, Kara M, Su DCJ, Gürçay E, Kaymak B, Wu WT, Özçakar L. Sonoanatomy of the spine: a comprehensive scanning protocol from cervical to sacral region. Med Ultrason 2019; 21:474-482. [PMID: 31765457 DOI: 10.11152/mu-2034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Ultrasound has been increasingly used in the musculoskeletal system, including the spine. In this protocol, the probe positionings, anatomical relationships, and ultrasound images of commonly scanned spinal structures are described. With an international consensus of several expert physiatrists i.e. USPRM; Ultrasound Study Group of ISPRM (International Society of Physical and Rehabilitation Medicine), this guide can provide a standardized approach for physicians who are interested in ultrasound diagnosis and guided pain interventions of the spine.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Taipei, Taiwan.
| | - Eda Gürçay
- Gaziler Training and Research Hospital, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.
| | - Bayram Kaymak
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
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Su DCJ, Chang KV. Mid-foot cellulitis? Ultrasound imaging of stress fracture at the third metatarsal bone. Kaohsiung J Med Sci 2016; 32:162-3. [DOI: 10.1016/j.kjms.2015.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 11/30/2022] Open
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