Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle?

Objective: This meta-analysis aimed to compare the efficacy and safety of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) local corticosteroid injection for carpal tunnel syndrome (CTS). Methods: Database including Pubmed, Embase, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs). The outcomes mainly included Boston Carpal Tunnel Questionnaire (BCTQ): Symptom Severity Scale (BCTQs), Functional Status Scale (BCTQf); and electrophysiological indexes: distal motor latency (DML), sensory distal latency (SDL), compound muscle action potential (CAMP), sensory nerve action potential amplitude (SNAP), and sensory nerve conduction velocity (SNCV). Adverse events were also recorded. Results: Overall, nine RCTs were finally screened out with 469 patients (596 injected hands). Pooled analysis showed that US-guided injection was more effective in BCTQs (SMD, −0.69; 95% CI, −1.08 to −0.31; P = 0.0005), BCTQf (SMD, −0.23; 95% CI, −0.39 to −0.07; P = 0.005), CAMP (MD, 0.64; 95% CI, 0.35−0.94; P < 0.0001) improvement, and a lower rate of adverse events (RR, 0.34; 95% CI, 0.22−0.52; P < 0.00001). Subgroup analysis revealed that the US-guided injection had significantly better CMAP than the LM-guided for the in-plane approach (MD, 0.69; 95% CI, 0.36−1.01; P < 0.0001) but not for the out-plane approach (MD, 0.39; 95% CI, −0.39 to 1.17; P = 0.33). Conclusions: US-guided injection was superior to LM-guided injection in symptom severity, functional status, electrodiagnostic, and adverse events improvement for CTS. To some extent, the in-plane approach yields better results compared with the out-plane process under US guidance.

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The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome

Rheumatology International ◽

10.1007/s00296-010-1772-z ◽

2011 ◽

Vol 32 (5) ◽

pp. 1285-1290 ◽

Cited By ~ 4

Author(s):

Orhan Deniz ◽

Recep Aygül ◽

Dilcan Kotan ◽

Gökhan Özdemir ◽

Faruk Ömer Odabaş ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Conduction Velocity ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Sympathetic Skin Response ◽

Skin Response ◽

Tunnel Syndrome ◽

F Wave ◽

Local Corticosteroid Injection

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Obturator Nerve Transfer to the Branch of the Tibial Nerve Innervating the Gastrocnemius Muscle for the Treatment of Sacral Plexus Nerve Injury

Neurosurgery ◽

10.1227/neu.0000000000001166 ◽

2015 ◽

Vol 78 (4) ◽

pp. 546-551 ◽

Cited By ~ 4

Author(s):

Gang Yin ◽

Huihao Chen ◽

Chunlin Hou ◽

Jianru Xiao ◽

Haodong Lin

Keyword(s):

Nerve Injury ◽

Gastrocnemius Muscle ◽

Tibial Nerve ◽

Nerve Transfer ◽

Obturator Nerve ◽

Surgical Reconstruction ◽

Sacral Plexus ◽

Medial Head ◽

Anterior Branch ◽

The Mean

Abstract BACKGROUND: Lower-limb function is severely impaired after sacral plexus nerve injury. Nerve transfer is a useful reconstructive technique for proximal nerve injuries. OBJECTIVE: To investigate the clinical effectiveness and safety of transferring the ipsilateral obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle to recover knee and ankle flexion. METHODS: From 2007 to 2011, 5 patients with sacral plexus nerve injury underwent ipsilateral obturator nerve transfer as part of a strategy for surgical reconstruction of their plexuses. The mean patient age was 31.4 years (range, 19-45 years), and the mean interval from injury to surgery was 5.8 months (range, 3-8 months). The anterior branch of the obturator nerve was coapted to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle by autogenous nerve grafting. RESULTS: Patient follow-up ranged from 24 to 38 months. There were no complications related to the surgery. Three patients recovered to Medical Research Council grade 3 or better in the medial head of the gastrocnemius muscle. Thigh adduction function was not affected in any patient. CONCLUSION: Knee and ankle flexion can be achieved by transferring the anterior branch of the obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle, which is useful for balance. This procedure can be used as a new method for treating sacral plexus nerve injury.

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Local skin depigmentation due to local corticosteroid injection

BMJ ◽

10.1136/bmj.288.6435.2000-a ◽

1984 ◽

Vol 288 (6435) ◽

pp. 2000-2000

Author(s):

A J Richards

Keyword(s):

Corticosteroid Injection ◽

Local Skin ◽

Local Corticosteroid Injection

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Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area

10.21203/rs.3.rs-23312/v3 ◽

2020 ◽

Author(s):

Heinz Lohrer

Keyword(s):

Achilles Tendon ◽

Repeated Measures ◽

Treatment Strategies ◽

Systematic Effect ◽

Partial Tear ◽

Partial Tears ◽

Significant Difference ◽

Respective Treatment ◽

Retrocalcaneal Bursa

Abstract Background: Achilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways and different treatment strategies are applied. The outcome is rarely investigated. Methods: This study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics.Results: The VISA-A-G outcome scores improved significantly from preoperative to six months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18-73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10-73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups. A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836).Conclusions: In Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups. Trial registration: DRKS, DRKS00014266. Registered 06 April 2018. 'Retrospectively registered', https://www.drks.de/drks_web/navigate.do?navigationId=results .

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