A pilot study of ultrasound-guided acupotomy for the treatment of frozen shoulder

Background:Frozen shoulder is prevalent among diabetic patients, and usually has aggressive course, with more tendency to be bilateral and resistant to treatment. Suprascapular nerve block (SSNB) is used with increasing frequency by anesthetists and rheumatologists in the management of frozen shoulder. We previously introduced a protocol of nine injections for SSNB with better short term outcome than single SSNB injection (1). Long term outcome of SSNB in management of frozen shoulder is still not detected.Objectives:To evaluate the long term effect of multiple (nine) ultrasound guided supra-scapular nerve block in treatment of diabetic frozen shoulder.Methods:A retrospective cohort study followed up 40 diabetic patients who received a course of ultrasound guided multiple supra-scapular nerve block (9 injections) on 2014. In this study we retrospectively assessed the patients from previously recorded data at a mean duration of 6 years after completing the 9 injection course SSNB clinically by measuring the shoulder active range of motion (using a goniometer in three planes: abduction, internal, and external rotation). Visual analogue scale and Functional assessment by shoulder pain and disability index (SPADI).Results:Thirty four patients (85% of original cohort) completed the long term follow up.The patients were 19 (55.9%) females, 60.6 y mean age, and the mean of disease duration was 85.6 months. The majority of patients (33 patients 97.05%) continues improvement and gained within normal complete range of motions in all directions and excellent grades of shoulder function (Table 1).Table 1.Clinical ParametersAt base lineAt 4 monthsLast follow up at (72months±4)**P valueSPADI pain score (100)(68.8 ± 0.5)a(10.3 ± 7.4)b(0.9±1.9)c0.00*SPADI disability score (100)(69.2 ± 7.7)a(6.25 ± 2.25)b(0.4±0.8)c0.00*SPADI total (100)(69.1 ± 8.5)a(8.15 ± 5.4)b(1.1±0.9)c0.00*Patient global assessment (100)(90.2 ± 8.2)a(8.2 ± 4.2)b(0.4±2.1)c0.00*Night pain (100)(55.4±10.2)a(10.3 ± 4.9)b(2.3±1.1)c0.00*Abduction (180°)(77.5 ± 4.7)a(170.3 ± 10.3)b(174.2±6.2)b0.00*External rotation (100 °)(46 ± 12.6)a(80.1 ± 10.2)b(86.4±10.3)b0.00*Internal rotation (70 °)(34.5 ± 2.4)a(55.4 ± 10.1)b(60.2±9.5)b0.00** P <0.05 there was a statistical significant difference•A,b,c--- the alphabet of different symbols ---means a significant statistical difference between groupsSPADI: shoulder pain and disability indexConclusion:The multiple injection courses for supra-scapular nerve block has an excellent long term efficacy as treatment of diabetic frozen shoulder. This method should be the treatment of choice in patients of diabetic frozen shoulder who do not respond to physiotherapy.References:[1]Mortada, M. A., Ezzeldin, N., Abbas, S. F., Ammar, H. A. & Salama, N. A. Multiple versus single ultrasound guided suprascapular nerve block in treatment of frozen shoulder in diabetic patients. J. Back Musculoskelet. Rehabil. 30, 537–542 (2017).Disclosure of Interests:None declared

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Mo1450 Is Ascites a Contra-Indication to Endoscopic Ultrasound-Guided Biliary Drainage in Case of Unsuccessful ERCP?: Results of a Pilot Study

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.03.1614 ◽

2015 ◽

Vol 81 (5) ◽

pp. AB424

Author(s):

Olivia B. Luna ◽

Ines Oria ◽

Fabien Fumex ◽

Julien Marsot ◽

Christine Lefort ◽

...

Keyword(s):

Pilot Study ◽

Endoscopic Ultrasound ◽

Biliary Drainage ◽

Ultrasound Guided

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Increased Needle Visibility in Ultrasound-Guided Percutaneous Liver Biopsy by an Echogenic Sheath: A Proof of Concept Study in a Human Cadaver

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02783-8 ◽

2021 ◽

Author(s):

Jana S. Hopstaken ◽

Leon de Jong ◽

Jurgen J. Fütterer

Keyword(s):

Pilot Study ◽

Liver Biopsy ◽

Human Cadaver ◽

Percutaneous Liver Biopsy ◽

Ultrasound Guided ◽

Biopsy Needle ◽

Phantom Model ◽

Likert Score ◽

Contrast Analysis ◽

Needle Visibility

Abstract Purpose For the safety and success of an ultrasound-guided percutaneous liver biopsy, needle visibility and needle tip identification are critical. The aim of this pilot study was to evaluate the influence of an innovative echogenic sheath placed over a standard biopsy needle on needle visibility in ultrasound imaging. Materials and methods Ultrasound videos of three sheaths with different coating characteristics (echogenicity) and one conventional liver biopsy needle were recorded at two angles (30° and 60°) and two depths (5 and 10 cm) in a human cadaver. The videos were blinded for needle type and presented to five independent radiologists who used Likert-scale scoring to rank each video for six characteristics on needle visibility. In addition, a phantom model was used to acquire standardized images for quantitative evaluation of the ultrasound visibility. Comparative statistical analysis consisted of a one-way ANOVA. Results The three prototype sheaths were ranked higher than the control needle at 60° with 5 cm depth, with an equal performance for the other conditions. The radiologists expressed more confidence in taking a biopsy with the echogenic sheaths than with the control needle, with 1 Likert score difference at 30°. Contrast analysis in the phantom model showed a statistically significant effect of a sheath (p = 0.004) on echogenic intensity. Conclusion This pilot study suggests that the use of an echogenic sheath may increase needle visibility, particularly for trajectories requiring steeper insertion angles. To investigate the superiority of the echogenic sheath over conventional needles, a clinical study is necessary.

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