Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study

Background:Tenosynovitis can occur in patients with Juvenile Idiopathic Arthritis (JIA) and may be clinically difficult to distinguish from joint synovitis. The role of musculoskeletal ultrasound (msk-US) is still discussed in the management of JIA but recent studies supported the utility of msk-US especially in detection of tenosynovitis. There is no consensus treatment for tenosynovitis in children with JIA and almost all studies focused on tendon sheath injection with glucocorticoids.Objectives:The aims of the study were: i) to define the prevalence of tenosynovitis of the ankle in JIA patients and ankle swelling; ii) to describe the clinical characteristics of patient with tenosynovitis and to analyze different response to treatment.Methods:We conducted an observational cross-sectional study of a group of patients with JIA followed at the Rheumatology Service of the Maternal and Child Institute “Burlo Garofolo” of Trieste. We enrolled all the patients who reported a swelling of the ankle at least once during the follow-up period and, among these patients, we included only those who underwent msk-US. Based on both clinical and sonographic examination, we identified patients with tenosynovitis and we described their demographical and clinical characteristics as well as the therapeutic approach undertaken in this group of patients.Results:On December 31st 2019, 56 swollen ankles of 48 patients were assessed with msk-US: 22 ankles showed sonographic signs of synovitis (39%), 16 ankles of both synovitis and tenosynovitis (28%), 14 ankles of tenosynovitis only (25%). Overall, tenosynovitis was detected on twenty-seven (56%) out of 48 children with at least a swollen ankle. The majority of patient were females (70%) and the most affected tendon was the tibialis posterior (66%). Twenty-five patients with tenosynovitis (92%) achieved clinical and radiological remission: seven out of 26 patients (26%) treated with methotrexate achieved clinical and radiological remission without the addition of other therapies; fifteen out of seventeen patients (88%) treated with a biological drug responded to the therapy, of which eleven (73%) were in combination therapy with methotrexate.Conclusion:We observed that more than 50% of the patients with a swelling of the ankle presented a tenosynovitis and among these patients about 50% did not show sonographic sign of synovitis. Msk-US was decisive in order to identify tenosynovitis and to characterize ankle swelling in JIA patients. Among patients with tenosynovitis biological therapy alone or in association with immunomodulating therapy showed effectiveness in inducing disease remission.References:[1]Peters SE, Laxer RM et al. Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study. Pediatr Rheumatol Online J. 2017 Apr 11;15(1):22.[2]Lanni S, Bovis F et al. Delineating the Application of Ultrasound in Detecting Synovial Abnormalities of the Subtalar Joint in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1346-53.[3]Cimaz R, Giani T et al. What is the real role of ultrasound in the management of juvenile idiopathic arthritis? Ann Rheum Dis. 2020 Apr;79(4):437-439. doi: 10.1136/annrheumdis-2019-216358[4]Lanni S, Marafon DP et al. Comparison between clinical and ultrasound assessment of the ankle region in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2020 Apr 27.[5]Laurell L, Court-Payen M et al. Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study. Pediatr Rheumatol Online J. 2011 Jan 29;9(1):4.Disclosure of Interests:None declared

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Ultrasonography and colour Doppler in juvenile idiopathic arthritis: Diagnosis and follow-up of ultrasound-guided steroid injection in the wrist

Pediatric Rheumatology ◽

10.1186/1546-0096-9-s1-p41 ◽

2011 ◽

Vol 9 (S1) ◽

Author(s):

Louise Laurell ◽

Michel Court-Payen ◽

Susan Nielsen ◽

Marek Zak ◽

Anders Fasth

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Steroid Injection ◽

Colour Doppler ◽

Ultrasound Guided

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A Case Report of Spontaneous Thrombosis of an Iatrogenic Breast Pseudoaneurysm

Archives of Breast Cancer ◽

10.32768/abc.202073132-135 ◽

2020 ◽

pp. 132-135

Author(s):

Masoumeh Gity ◽

Batoul Seifi Nadergoli ◽

Behnaz Moradi ◽

Mohammadreza Chavoshi

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Breast Biopsy ◽

Color Doppler ◽

Ultrasound Guided ◽

Core Needle ◽

Traumatic Injuries ◽

Uncommon Disease ◽

Contrast Ultrasound

Background: Pseudoaneurysm of the breast is a very uncommon disease mostly occurring following traumatic injuries including biopsy. Increasing the use of core needle biopsy in breast pathologies could lead to more cases of the iatrogenic pseudoaneurysm. Case presentation: Here we described a breast pseudoaneurysm case that occurred after core needle biopsy. The diagnosis was made by color doppler ultrasonography and MRI with contrast. Ultrasound-guided compression was used to treat the lesion. The lesion was followed up with ultrasonography and finally it was resolved.Conclusion: Although hematoma is a more common complication of breast biopsy, other complications including pseudoaneurysm should be kept in mind. Ultrasound is a useful technique for both the diagnosis and non-surgical treatment of the disease. Ultrasound-guided compression and follow up exams could be helpful to prevent invasive procedures.

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Power Color Doppler and Spectral Doppler Ultrasonography to Evaluate Response to Intra-articular Steroid Injection in Knee Joints in Juvenile Idiopathic Arthritis

The Indian Journal of Pediatrics ◽

10.1007/s12098-017-2418-x ◽

2017 ◽

Vol 84 (11) ◽

pp. 826-832 ◽

Cited By ~ 2

Author(s):

Tapas Baikar ◽

Amieleena Chhabra ◽

Tribhuvan Pal Yadav ◽

Namrita Sachdev ◽

Vivek Dewan

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Doppler Ultrasonography ◽

Steroid Injection ◽

Color Doppler ◽

Knee Joints ◽

Spectral Doppler

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Presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain’s syndrome

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415611414 ◽

2015 ◽

Vol 41 (2) ◽

pp. 212-219 ◽

Cited By ~ 10

Author(s):

E. De Keating-Hart ◽

S. Touchais ◽

Y. Kerjean ◽

L. Ardouin ◽

B. Le Goff

Keyword(s):

Conservative Treatment ◽

Analogue Scale ◽

Clinical Characteristics ◽

Ultrasound Examination ◽

Steroid Injection ◽

Phone Call ◽

Clinical Tests ◽

Ultrasound Guided ◽

Level Of Evidence

The purpose of this study was to find clinical or ultrasound characteristics that might predict the failure of conservative treatment in de Quervain’s syndrome. A total of 42 ultrasound-guided injections have been performed in 41 patients after clinical and ultrasound examination. Patients were immobilized for 3 weeks with a spica splint cast, and clinically evaluated at 3 and 6 weeks and by phone call at the end of the study. Ultrasound showed a septum between the tendons of the first comportment in 34% of the wrists. At last follow-up (mean 15.6 months after the injection) ten patients (24%) had undergone surgery. When comparing ultrasound and clinical characteristics of the operated and non-operated wrists, we found that patients with a high baseline visual analogue scale, with all positive clinical tests and with a persistent intracompartmental septum, had a significantly higher risk of failure following conservative treatment. Level of evidence: III.

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Endovenous laser ablation and sclerotherapy for incompetent vein of Giacomini

Phlebology The Journal of Venous Disease ◽

10.1177/0268355513496552 ◽

2013 ◽

Vol 29 (8) ◽

pp. 511-516 ◽

Cited By ~ 2

Author(s):

Ismail Guzelmansur ◽

Levent Oguzkurt ◽

Nihal Koca ◽

Cagatay Andic ◽

Murat Gedikoglu ◽

...

Keyword(s):

Laser Ablation ◽

Doppler Ultrasonography ◽

Color Doppler ◽

Color Doppler Ultrasonography ◽

Clinical Severity ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation ◽

Vein Insufficiency

Purpose To retrospectively evaluate the feasibility and effectiveness of endovenous laser ablation or ultrasound-guided foam sclerotherapy for Giacomini vein insufficiency. This is the largest cohort of patients treated for Giacomini vein insufficiency with endovenous laser ablation or ultrasound-guided foam sclerotherapy. Material and methods Over a three-year period, 23 females and nine males (age range, 19–67 years) treated for Giacomini vein insufficiency with or without saphenous vein insufficiency were retrospectively reviewed. Diagnosis of venous insufficiency was made by color Doppler ultrasonography. Symptomatic insufficiency of the Giacomini vein or the saphenous veins was treated with endovenous laser ablation. Ultrasound-guided foam sclerotherapy was used for tortuous incompetent Giacomini veins. The venous disease was categorized according to the clinical, etiological, anatomical, and pathological classification, and clinical severity was graded with the venous clinical severity score. Follow-up included clinical examination and color Doppler ultrasonography. Results Thirty-nine limbs in 32 patients were treated (25 endovenous laser ablation and seven ultrasound-guided foam sclerotherapy). All procedures were technically successful. One patient in the ultrasound-guided foam sclerotherapy group had a recurrence with successful repeated treatment. Recurrence was not seen in the endovenous laser ablation group. No complications were observed. All patients had resolution and improvement in 100% of their symptoms at 12 months of follow-up. Conclusion Giacomini vein insufficiency is mostly seen with insufficiency of the great saphenous vein and can be effectively treated with endovenous laser ablation or ultrasound-guided foam sclerotherapy.

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Proximal Approach of Ultrasound-guided Suprascapular Nerve Block: Comparison with Subacromial Steroid Injection

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.4.210 ◽

2019 ◽

Vol 22 (4) ◽

pp. 210-215 ◽

Cited By ~ 1

Author(s):

Kyu Hwan Bae ◽

Han Hoon Kim ◽

Tae Kang Lim

Keyword(s):

Los Angeles ◽

Nerve Block ◽

Steroid Injection ◽

External Rotation ◽

Suprascapular Nerve ◽

Consecutive Series ◽

Ultrasound Guided ◽

Suprascapular Nerve Block ◽

Significant Difference

Background: This study was undertaken to evaluate early clinical outcomes of ultrasound-guided suprascapular nerve block (SSNB) using a proximal approach, as compared with subacromial steroid injection (SA).Methods: This retrospective study included a consecutive series of 40 patients of SSNB and 20 patients receiving SA, from August 2017 to August 2018. The visual analogue scale (VAS), American Shoulder Elbow Surgeon’s score (ASES), University of California, Los Angeles score (UCLA), the 36 health survey questionnaire mental component summary (SF36-MCS), physical component summary (PCS), and range of motion (forward elevation, external rotation, and internal rotation) were assessed for clinical evaluations.Results: Compared with the baseline, VAS, and ranges of motion in the SSNB group significantly improved at the 4-week follow-up (VAS scores improved from 6.7 ± 1.6 to 4.3 ± 2.4, p<0.001; all ranges of motion p<0.05), while other variables showed no statistically significant differences. All clinical variables were significantly improved in the SA group (p<0.05). However, all clinical scores at the 4-week follow-up showed no significant difference between groups.Conclusions: Ultrasound-guided SSNB using proximal approach provides significant pain relief at 4-weeks after treatment, with statistically significant difference when compared with SA, suggesting that SSNB using proximal approach is a potentially useful option in managing shoulder pain. However, in the current study, it was less effective in improving shoulder function and health-related quality of life, compared with SA.

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Effects of steroid injection during rehabilitation after arthroscopic rotator cuff repair

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00332 ◽

2021 ◽

Vol 24 (3) ◽

pp. 166-171

Author(s):

Joong-Won Ha ◽

Hyunkyo Kim ◽

Seong Hun Kim

Keyword(s):

Rotator Cuff ◽

Functional Outcome ◽

Rotator Cuff Repair ◽

Steroid Injection ◽

Constant Score ◽

Arthroscopic Rotator Cuff Repair ◽

Ultrasound Guided ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Many patients fail to reap the benefits of rehabilitation after arthroscopic rotator cuff repair (ARCR) due to severe stiffness and pain. Thus, this study aims to compare the clinical outcomes of steroid injections during the rehabilitation period after ARCR.Methods: Among patients who underwent ARCR, 117 patients who met the inclusion and exclusion criteria were enrolled. Pain and range of motion (ROM) recovery at the 3-, 6-, and 24-month follow-up visits and functional outcome at the 24-month follow-up were compared between 45 patients who received ultrasound-guided subacromial steroid injection at postoperative week 4 or 6 and 72 patients who did not. Functional outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) score and Constant score. Healing of the repaired tendon and retear were observed at the 6-month follow-up via magnetic resonance imaging (MRI) or computed tomography (CT) arthrography.Results: At the 3-month follow-up, the steroid injection group showed lower visual analog scale scores than the control group (p<0.05) and showed faster recovery of forward flexion and internal rotation (p<0.05). From the 6-month follow-up, the two groups did not show differences in pain and ROM, and the ASES score and Constant score also did not significantly differ at the 24-month follow-up. The two groups did not differ in retear rate as determined by MRI or CT arthrography at the 6-month follow-up. Conclusions: This study demonstrated that ultrasound-guided subacromial steroid injection at 4 or 6 weeks after ARCR leads to quick pain reduction and ROM recovery until 3 months after surgery. Therefore, subacromial steroid injection is speculated to be an effective and relatively safe method to assist rehabilitation.

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