Adverse effects associated to the application of ultrasound-guided percutaneous needle electrolysis

Abstract Background Percutaneous needle electrolysis is a technique of invasive physical therapy which is increasingly used by physical therapists in their clinical practice. However, to date, no studies have analyzed the presence of adverse effects.The aim of the present study was to evaluate the incidence of adverse effects and the associated impact of the application of ultrasound-guided percutaneous needle electrolysis in disorders of the neuro-musculoskeletal system. Material and Method A prospective case series study was performed over a period of six months at the Sannus Clinic center (Madrid). A sample of patients was identified and recruited, and follow-up was performed up to six months after discharge. Initial information was collected regarding demographic data (age and sex) and clinical data (affected structure, area, type of pain and process associated to the pathology). During each of the sessions performed, percutaneous needle electrolysis was applied in an isolated manner and data were gathered on the treatment received, as well as the presence of any adverse effects. An adverse effect was considered as being any incident related with the application of percutaneous needle electrolysis which caused any damage, as perceived by both the patient and the physical therapist who applied the treatment. The type of adverse effect was recorded (pain, bleeding, hematoma, post-intervention vegetative reactions [sweating, pallor, abdominal discomfort], syncope, skin lesions, damage to organs, nerve lesions, pneumothorax, metal allergy), the moment these appeared (during application, after application, days after the application), its severity (transitory (<48h), reversible (resolved at discharge), irreversible), its impact (did not require any specific intervention, required an additional specific physical therapy intervention, required intervention from medical staff (without hospitalization), and cause (insufficient skill with the technique, malpractice, inappropriate protocol). The adverse effects were classified as mild or severe depending on whether or not an intervention was required. Results 214 patients (60.7% men; 39.3% women) received a total of 772 sessions, the mean number (and standard deviation) of sessions was 3.6 (1.1). The totality of patients treated with ultrasound-guided percutaneous electrolysis received more than one session, according to the methodology described by Valera & Minaya. The main reasons for consultation were tendinous pathologies (70.5%), muscle pathologies (11.7%), ligaments (6.5%), joint capsule-synovia (5.6%), nerve entrapments (4.2%) and others (1.4%). Degenerative processes were more common than acute inflammatory processes. The greatest incidence was in the lower limbs. Degenerative processes were significantly more frequent than tendinous problems. During the 772 sessions of ultrasound-guided percutaneous needle electrolysis, the most common adverse effects were pain during the intervention (96.1%) and in the days following treatment (71.1%), as well as mild vasovagal responses post-intervention (80.1%). One syncope was recorded (0.13%). All the effects were transitory and without impact. No hematomas were detected in the days after a mild bleeding, when this occurred (9.3%). Interventions were performed on the thorax in 1.5% of the procedures, close to organs (0.5%) or close to peripheral nerves (4.2%) without any adverse effect. In the 6-week follow-up after discharge no adverse effects were detected. Conclusions Percutaneous needle electrolysis is a safe technique. The adverse effects provoked by the application of percutaneous needle electrolysis are mild, transitory, without impact on the person's health and following a homogenous pattern. The pain and the mild vasovagal response associated with the intervention are frequent and inherent to the stimulus generated by the needling and the electric current employed.

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Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

The Journal of Knee Surgery ◽

10.1055/s-0040-1713898 ◽

2020 ◽

Author(s):

Jae Ik Lee ◽

Mohd Shahrul Azuan Jaffar ◽

Han Gyeol Choi ◽

Tae Woo Kim ◽

Yong Seuk Lee

Keyword(s):

Medial Patellofemoral Ligament ◽

Trochlear Dysplasia ◽

Case Series ◽

Patellofemoral Instability ◽

International Knee Documentation Committee ◽

Predisposing Factors ◽

Mpfl Reconstruction ◽

Patellar Tilt ◽

Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

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The case for skin camouflage in the management of upper limb scarring – A case series

Hand Therapy ◽

10.1177/17589983211007875 ◽

2021 ◽

pp. 175899832110078

Author(s):

Laura Adamson ◽

Anna Selby

Keyword(s):

Upper Limb ◽

Case Series ◽

Primary Objective ◽

Self Confidence ◽

Published Evidence ◽

Case Series Study ◽

Visual Impact ◽

Series Study ◽

Increasing Function

Introduction For some people the appearance of their hands is as important as function. Upper limb scarring can cause some patients distress. Skin camouflage is an intervention that can be used to reduce the visual impact of a scar but there is limited published evidence for its use for hand scarring. Methods This is a case series study with a primary objective to determine whether skin camouflage reduces distress in patients with an upper limb scar and to evaluate this new service. Patients experiencing distress from an upper limb scar were recruited from a hand therapy outpatient clinic. The intervention delivered was a one hour skin camouflage session. Photographs of the upper limb pre and post skin camouflage intervention were taken. The patient-rated Michigan Hand Questionnaire (MHQ) and Derriford Appearance Scale (DAS24) were completed before treatment, at 1 week and 1 month after treatment. Results Six participants reporting distress from an upper limb scar received skin camouflage intervention. Only three out of six participants completed all follow-up. All three showed improvement in at least two domains of the MHQ (function and aesthetics) at one month post treatment. Increased confidence during functional and work-based activities was also reported on the DAS24. Participants reported increased engagement in daily activities as a result of being able to camouflage their scars. Conclusions This small case series shows that skin camouflage intervention may be beneficial for some patients who are experiencing distress related to an upper limb scar by increasing function and self-confidence.

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The Association Between the Rotator Cuff Status and the Severity and Recovery of Weakness in the Shoulder Abductor Strength in a Case of Proximal Type Cervical Spondylotic Amyotrophy

Global Spine Journal ◽

10.1177/2192568220980441 ◽

2020 ◽

pp. 219256822098044

Author(s):

Sho Ishiwata ◽

Yoichi Iizuka ◽

Hitoshi Shitara ◽

Tokue Mieda ◽

Eiji Takasawa ◽

...

Keyword(s):

Rotator Cuff ◽

Biceps Brachii ◽

Case Series ◽

Manual Muscle Test ◽

Cuff Tear ◽

Cervical Spondylotic Amyotrophy ◽

Case Series Study ◽

Shoulder Abductor ◽

Series Study

Study Design: Case series study. Objective: We aimed to clarify the prevalence of rotator cuff tear (RCT), and the association between RCT and the severity and prognosis in patients with proximal type cervical spondylotic amyotrophy (CSA). Methods: We retrospectively analyzed 35 proximal type CSA patients who were treated conservatively. The following data was collected: age, rotator cuff status on MRI, manual muscle test (MMT) score of shoulder abductor and biceps brachii muscles both at the first visit and final follow-up. We investigated the prevalence of RCT and the association between the rotator cuff status, and the severity and recovery of upper extremity weakness in patients with proximal type CSA. Results: Of the 35 patients, 21 had an RCT on MRI, indicating that the prevalence of RCT in patients with proximal type CSA was 60%. An age-adjusted analysis showed that the presence of RCT was significantly associated with the MMT score of the shoulder abductor muscles both at the first visit and at the final follow-up. The presence of RCT was significantly associated with the recovery of the shoulder abductor muscles. The size of the RCT was negatively correlated with the MMT score of the shoulder abductor muscles at the final follow-up. The size of the RCT was independently correlated with the change of the MMT score of the shoulder abductor muscles. Conclusion: RCT was detected in >50% in patients with proximal type CSA, and the presence and severity of RCT can be used as prognostic factors for proximal type CSA patients who are treated conservatively.

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Long-term Outcomes of Microfracture for Treatment of Osteochondral Lesions of the Talus

Foot & Ankle International ◽

10.1177/1071100721995427 ◽

2021 ◽

pp. 107110072199542

Author(s):

Daniel Corr ◽

Jared Raikin ◽

Joseph O’Neil ◽

Steven Raikin

Keyword(s):

Survival Rate ◽

Case Series ◽

Return To Sport ◽

Osteochondral Lesions ◽

Long Term Outcomes ◽

Level Of Evidence ◽

Additional Surgery ◽

Case Series Study

Background: Microfracture is the most common reparative surgery for osteochondral lesions of the talus (OLTs). While shown to be effective in short- to midterm outcomes, the fibrocartilage that microfracture produces is both biomechanically and biologically inferior to that of native hyaline cartilage and is susceptible to possible deterioration over time following repair. With orthobiologics being proposed to augment repair, there exists a clear gap in the study of long-term clinical outcomes of microfracture to determine if this added expense is necessary. Methods: A retrospective review of patients undergoing microfracture of an OLT with a single fellowship-trained orthopedic surgeon from 2007 to 2009 was performed. Patients meeting the inclusion criteria were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the outcome of the procedure and their likelihood to recommend the procedure to a friend with the same problem using 5-point Likert scales. Patient demographics were reviewed and included for statistical analysis. Results: Of 45 respondents, 3 patients required additional surgery on their ankle for the osteochondral defect, yielding a 10-year survival rate of 93.3%. Of surviving cases, 90.4% (38/42) reported being “extremely satisfied” or “satisfied” with the outcome of the procedure. The VAS score at follow-up averaged 14 out of 100 (range, 0-75), while the FAAM-ADL and FAAM-Sports scores averaged 90.29 out of 100 and 82 out of 100, respectively. Thirty-six patients (85.7%) stated that their ankle did not prevent them from participating in the sports of their choice. Conclusion: The current study represents a minimum 10-year follow-up of patients undergoing isolated arthroscopic microfracture for talar osteochondral defects, with a 93.3% survival rate and 85.7% return to sport. While biological adjuvants may play a role in improving the long-term outcomes of microfracture procedures, larger and longer-term follow-up studies are required for procedures using orthobiologics before their cost can be justified for routine use. Level of Evidence: Level IV, retrospective cohort case series study.

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Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00210 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0021

Author(s):

Mauricio Drummond ◽

Caroline Ayinon ◽

Albert Lin ◽

Robin Dunn

Keyword(s):

Physical Therapy ◽

Rotator Cuff ◽

Conservative Treatment ◽

Conservative Management ◽

Surgical Intervention ◽

Corticosteroid Injection ◽

Calcific Tendinitis ◽

Ultrasound Guided ◽

Calcium Deposits

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods: A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant. Results: 239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention. Conclusions: Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

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Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients

Journal of Neurology ◽

10.1007/s00415-021-10664-w ◽

2021 ◽

Author(s):

Ilkka Rauma ◽

Tiina Mustonen ◽

Juha Matti Seppä ◽

Maritta Ukkonen ◽

Marianne Männikkö ◽

...

Keyword(s):

Multiple Sclerosis ◽

Adverse Events ◽

Case Series ◽

Retrospective Case ◽

Serious Adverse Events ◽

Highly Active ◽

Disease Modifying Therapy ◽

Case Series Study ◽

Multiple Sclerosis Patients

Abstract Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1–3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.

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The effect of functional limitations and fatigue on the quality of life in people with multiple sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000500006 ◽

2009 ◽

Vol 67 (3b) ◽

pp. 812-817 ◽

Cited By ~ 22

Author(s):

Leandro Alberto Calazans Nogueira ◽

Felipe Resende Nóbrega ◽

Kátia Nogueira Lopes ◽

Luiz Claudio Santos Thuler ◽

Regina Maria Papais Alvarenga

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Functional Limitations ◽

Case Series ◽

Lower Limbs ◽

Case Series Study ◽

Modified Ashworth Scale ◽

Mild Disability ◽

Fatigue Severity

The purpose of this study was to determine the effect of functional limitations and fatigue on the quality of life (QoL) in people with multiple sclerosis (MS). A descriptive case series study at Lagoa Hospital - Rio de Janeiro, Brazil was carried. The main outcome measurements were demographic variables, QoL (SF-36 v.1), disability (EDSS), motor function of the upper limb (Box & Blocks test), Tone (Modified Ashworth Scale), gait (Hauser ambulatory index) and fatigue (Fatigue Severity Scale). Sixty one patients fulfilled the study criteria. The mean age of patients was 39 years and 74% of patients were female. The most of cases presented mild disability (EDSS<3.5). A decrease was found in all domains of QoL. It was found association between physical functioning and the variables of EDSS, fatigue, lower limb tone and gait. Gait, disability, hypertonia of the lower limbs and fatigue negatively affected QoL in people with MS.

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Urinary and sexual functions after surgical treatment of penile fracture concomitant with complete urethral disruption

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.1.15 ◽

2014 ◽

Vol 86 (1) ◽

pp. 15 ◽

Cited By ~ 5

Author(s):

Ali Abdel Raheem ◽

Hassan El-Tatawy ◽

Ahmed Eissa ◽

Abdel Hamid Elbahnasy ◽

Mohamed Elbendary

Keyword(s):

Case Series ◽

Surgical Reconstruction ◽

Urethral Injury ◽

Penile Curvature ◽

Retrospective Case ◽

Penile Fracture ◽

Case Series Study ◽

Long Term Follow Up

Objectives: Penile fracture with concomitant complete urethral disruption is an uncommon urologic disorder. Data about the treatment and outcome measurements of this condition are scarce in the literature. The aim of the present study is to evaluate the long term urinary and sexual functions of patients with penile fracture associated with complete urethral injury after immediate surgical reconstruction. Patients and methods: Twelve patients met our inclusion criteria and were included in this retrospective case series study; however, one was lost during follow-up. Patient's medical records were reviewed and all patients were interviewed for clinical evaluation. Urinary function was assessed by history, uroflometry and retrograde urethrography, while, sexual function was assessed by questionnaire (Sexual Health Inventory for Men) and penile Doppler for patients with erectile dysfunction. Results: Patients’ mean age was 32.3 ± 7.5 years (range 21-43) and the mean follow-up period was 72.6 ± 45.4 months (range 14-187). Vigorous sexual intercourse was the main cause in 91% of our patients. No serious long term complications was found. Only 1 patient (9%) suffered from anterior urethral stricture, 1 patient (9%) complained of weak erection, 3 patients (27%) had a palpable fibrosis and 2 patients (18%) reported a slight penile curvature during erection. Ninety one percent of all our patients maintained their normal urinary and sexual functions. Conclusion: On the long term follow-up, most of the patients maintained their normal erectile and voiding functions with no harmful long-term complications. We advocate immediate surgical intervention and reconstruction of both corpora cavernous and urethra as a first line treatment for those patients.

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Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber

Ophthalmology and Eye Diseases ◽

10.4137/oed.s12672 ◽

2013 ◽

Vol 5 ◽

pp. OED.S12672

Author(s):

Kagmeni Giles ◽

Moukouri Ernest ◽

Domngang Christelle ◽

Nguefack-Tsague Georges ◽

Cheuteu Raoul ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Teaching Hospital ◽

Case Series ◽

University Teaching ◽

Case Series Study ◽

The Mean ◽

The University

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.

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