A novel approach to refractory coccydynia: ultrasound- fluoroscopy-guided cryoablation of sacrococcygeal nerve.

Coccydynia, also termed chronic pain in the tailbone, is a complex condition with limited treatment options for refractory cases. This case series introduces a novel approach for treating refractory coccydynia using cryoablation of the sacrococcygeal nerves under combined ultrasound and fluoroscopy guidance. Two female patients, suffering from chronic pain for over six months and unresponsive to conservative interventions, underwent cryoablation.

Boosting Confidence: Enhancing Spinal Cord Stimulator Needle and Lead Placement Through Simulation Training.

Background This pilot study aims to examine the effectiveness of a spinal cord stimulator (SCS) simulator training system in improving the confidence of pain fellows in SCS placement. Methodology Five Ukrainian physicians (neurologists, neurosurgeons, and an anesthesiologist) completed a 10-item survey regarding their confidence in various aspects of SCS placement and their opinions on how effective SCS models were for educational purposes. After placing SCS leads using the SCS simulator, the physicians took the same survey again.

Ultrasound Measurement of Femoral Articular Cartilage Thickness Before and After Marathon Running.

Objective: The purpose of this study was to use ultrasonography to measure femoral articular cartilage thickness changes during marathon running, which could support MRI studies showing that deformation of knee cartilage during long-distance running is no greater than that for other weight-bearing activities.

Materials And Methods: Participants included 38 marathon runners with no knee pain or history of knee injury, aged 18-39. Ultrasound images of the femoral articular cartilage were taken two hours before and immediately after the race.

Comprehensive Evaluation of Primary Care Sports Medicine Fellowship Websites.

Objective: To evaluate the comprehensiveness of primary care sports medicine fellowship websites and identify potential areas of improvement.

Design: Cross-sectional analysis of fellowship program websites using quantitative and descriptive statistics.

Setting: Internet.

Pain Medicine Fellowship Program Websites in the United States of America - A Nonparametric Statistic Analysis of 14 Different Criteria.

Objective: To evaluate the content of Pain Medicine Fellowship Program websites in the United States of America.

Methods: We obtained a list of accredited 104 Pain Medicine Fellowship Program websites from the Accreditation Council for Graduate Medical Education and the Electronic Residency Application Service. Individual Pain Medicine Fellowship Program websites were then evaluated on 14 different criteria.

Revisiting the Genicular Nerve Block: An Up-to-Date Guide Utilizing Ultrasound Guidance and Peripheral Nerve Stimulation - Anatomy Description and Technique Standardization.

Background: Over the last decade, several authors have reported that percutaneous peripheral nerve stimulation (PNS) can be used to assist in verifying the position of the procedure needle tip in relation to nerve structures, and that the combined technique using both ultrasound (US) guidance and PNS may serve as a reliable method for confirmation of the correct position of the procedure needle tip. It has also been reported that, when combined with US guidance, PNS may increase the success rate of pain management interventions.

Objectives: The aim of this technical report was to standardize an effective and easy to learn illustrated step-by-step technical approach to nerve identification during US-guided genicular nerve blocks, using percutaneous PNS as a verification instrument for procedure needle tip location.

Does Thoracic Manipulation Cause Extravasation at Joint Following Facet Injections?

Facet injections and other pain management interventions are commonly performed in combination with conservative therapy to address spinal pain. Joint mobilizations are a highly utilized intervention for manual practitioners to treat patients with spinal pain. Clinical reasoning and decision making models have not been well described in the literature assessing if and when joint mobilizations are appropriate interventions immediately or shortly following facet injection procedures.

Ultrasound-Guided Intercostal Peripheral Nerve Stimulator Implantation: Technique Report and Feasibility Study in a Cadaver.

Objective: This study aimed to describe and validate a novel ultrasound-guided intercostal peripheral nerve stimulator implantation technique.

Methods: The fifth to tenth ribs on both sides of an unembalmed cadaveric specimen were localized using a 15-6-MHz linear array transducer, counting distally from T-1 bilaterally. A single interventionist then implanted 12 peripheral nerve stimulators on the fifth through tenth ribs, six MicroLeads on the left side and six StimRouters on the right side, using an in-plane lateral to medial approach to the inferior border of the corresponding rib.

Ultrasound-guided Percutaneous Peripheral Nerve Stimulation for the Treatment of Complex Regional Pain Syndrome Type 1 Following a Crush Injury to the Fifth Digit: A Rare Case Report.

This case report presents an application of percutaneous peripheral nerve stimulation to the left ulnar nerve to treat a patient with complex regional pain syndrome type 1 following a crush injury to the left fifth digit. Conventional treatment had failed to ameliorate the patient's condition. After a successful seven-day trial with an ulnar peripheral nerve catheter, which followed an unsuccessful capsulectomy of the metacarpophalangeal and proximal interphalangeal joints of the left fifth digit with tenolysis of the flexor tendons, the patient underwent an uneventful implantation of a percutaneous peripheral nerve stimulator parallel with the trajectory of the left ulnar nerve just distal to the ulnar tunnel.

Descriptive Cadaveric Study Comparing the Accuracy of Ultrasound Versus Fluoroscopic Guidance for First Sacral Transforaminal Injections: A Comparison Study.

Background: Ultrasound is rarely used for guiding lumbosacral epidural steroid injections due to its technical limitations. For example, sonographic imaging lacks the ability to confirm epidural spread and identify vascular uptake. The perceived risk that these limitations pose to human subjects has precluded any large scale clinical trials to date.

Ultrasound-Guided Spinal Procedures for Pain: A Review.

As the population ages, more patients are developing degenerative changes of the spine and associated pain. Although interventional procedures for axial and radicular spine pain have been available for decades, common imaging modalities have relied on ionizing radiation for guidance. Over the past decade, ultrasound has become increasingly popular to image both peripheral musculoskeletal and axial structures.

Ultrasound-guided intra-articular knee injection in an obese patient.

A 35-yr-old woman was referred to our outpatient clinic for a right intra-articular knee aspiration and injection. She had a medical history notable for lymphedema and morbid obesity (Fig. 1).

Accuracy of sonographically guided intra-articular injections in the native adult hip.

Objective: The purpose of this study was to determine the accuracy of sonographically guided intra-articular injections performed in the native adult hip using contrast-enhanced fluoroscopy as a reference standard.

Methods: Twenty-eight consecutive patients (ages 32-91 years; mean, 68 years) referred to the pain clinic for intra-articular hip injections were recruited to participate. In each case, a 2- to 6-MHz curvilinear array transducer was used to place the needle into the hip joint at the femoral head-neck junction using an oblique sagittal approach.

Ultrasound-guided intra-articular injection of the trapeziometacarpal joint: description of technique.

Objective: To describe a new technique to perform an ultrasound-guided intra-articular injection of the trapeziometacarpal (TMC) joint.

Design: Ultrasound-guided injection of the TMC joint was completed on fresh frozen cadaver hand specimens using diatriazoate meglumine contrast. A fluoroscopic posteroanterior image of the TMC joint was then obtained to verify intra-articular placement of the contrast.

Ultrasound-guided piriformis injection: technique description and verification.

Piriformis injections are commonly used in the evaluation and treatment of patients presenting with buttock pain syndromes. Because of its small size, deep location, and relation to adjacent neurovascular structures, the piriformis is traditionally injected by using electromyographic, fluoroscopic, computed tomographic, or magnetic resonance imaging guidance. This report describes and verifies a technique for performing ultrasound-guided piriformis injections.

Office-based ultrasound-guided intra-articular hip injection: technique for physiatric practice.

Intra-articular hip injections are commonly used in the evaluation and treatment of hip disorders. Although these injections are typically performed with fluoroscopic guidance, ultrasound provides a viable alternative for ensuring accurate intra-articular needle placement. This report describes the technique for performing ultrasound-guided intra-articular hip injections in the context of an office-based physiatric practice.

Intrinsic spinal cord catheter placement: implications of new intractable pain in a patient with a spinal cord injury.

We present a case of new intractable flank pain after intrathecal infusion system placement in a 45-yr-old man with a history of a T12 spinal cord injury with dysesthetic leg pain. Pain after intrathecal infusion system placement was evaluated by magnetic resonance imaging and the catheter was found to be intraparenchymal. The patient was treated by cessation of infusion and surgical removal of the system.