scholarly journals Sonoanatomy and Injection Technique of the Iliolumbar Ligament

2011 ◽  
Vol 5;14 (5;9) ◽  
pp. 469-474
Author(s):  
Dominic Harmon
Keyword(s):  
Back Pain ◽  
Case Report ◽  
Local Anesthetic ◽  
Pelvic Ring ◽  
Subjective Assessment ◽  
Injection Technique ◽  
Ultrasound Guided ◽  
Range Of Movement ◽  
Provocation Tests ◽  
Iliolumbar Ligament

Background: The iliolumbar ligament plays an important biomechanic role in anchoring the spine to the pelvic ring and stabilizing the sacroiliac joint. Iliolumbar syndrome is a back pain condition caused by pathology of the iliolumbar ligament. History and physical examination are important in the assessment of back pain, but they lack sufficient specificity. Injection of small volumes of local anesthetic into the structure considered to be the source of the pain (i.e. the iliolumbar ligament) increases the specificity of the diagnostic workup. Objective: To describe an ultrasound - guided technique for injecting the iliolumbar ligament. Study design: Case report based on knowledge of topographic anatomy and sonoanatomy. Setting: Outpatient clinic. Methods: A patient with a clinical picture suggestive of iliolumbar syndrome was selected. An ultrasound-guided injection of the iliolumbar ligament with local anesthetic was performed. We recorded the patient’s subjective assessment of pain and the change in range of movement and pain scores during provocative tests. Results: Following the injection, the patient’s pain score decreased, provocation tests became negative, and the range of movement increased. Limitations: Case report. Target specificity and dispersion of local anesthetic spread not confirmed with an independent technique (i.e. magnetic resonance imaging). Conclusions: Ultrasound guidance allows the selective deposition of small volumes of local anesthetic into structures believed to cause soft tissue back pain and thus to confirm or exclude the working diagnosis. Further studies are needed to confirm our conclusions and to prove the clinical feasibility of this technique. Key words: Technique, visualization, real-time, ultrasound, iliolumbar ligament,iliolumbar syndrome, diagnostic injection, low back pain, groin pain.

Poster 361 Ultrasound-Guided Injection Technique in a Patient with Xiphoidalgia: A Case Report

PM&R ◽  
2015 ◽  
Vol 7 ◽  
pp. S209-S209
Author(s):  
Enrique Galang ◽  
Michael P. Schaefer
Keyword(s):  
Case Report ◽  
Injection Technique ◽  
Ultrasound Guided

scholarly journals Ultrasound-guided facet block to low back pain: a case report

2014 ◽  
Vol 64 (4) ◽  
pp. 278-280 ◽  
Author(s):  
Ana Ellen Q. Santiago ◽  
Plinio C. Leal ◽  
Elmiro Helio M. Bezerra ◽  
Ana Laura A. Giraldes ◽  
Leonardo C. Ferraro ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Low Back ◽  
Ultrasound Guided

Single- versus double-injection costoclavicular block: a randomized comparison

2020 ◽  
Vol 45 (3) ◽  
pp. 209-213 ◽  
Author(s):  
Sebastián Layera ◽  
Julián Aliste ◽  
Daniela Bravo ◽  
Diego Fernández ◽  
Armando García ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Local Anesthetic ◽  
Single Injection ◽  
Onset Time ◽  
Injection Technique ◽  
Ultrasound Guided ◽  
Double Injection ◽  
Performance Time ◽  
Injection Group ◽  
Upper Limb Surgery

BackgroundThe costoclavicular approach targets the brachial plexus in the proximal infraclavicular fossa, where the lateral, medial, and posterior cords are tightly bundled together. This randomized trial compared single- and double-injection ultrasound-guided costoclavicular blocks. We selected onset time as the primary outcome and hypothesized that, compared with its single-injection counterpart, the double-injection technique would result in a swifter onset.MethodsNinety patients undergoing upper limb surgery (at or below the elbow joint) were randomly allocated to receive a single- (n=45) or double-injection (n=45) ultrasound-guided costoclavicular block. The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25%with epinephrine 5 µg/mL and 2 mg of preservative-free dexamethasone) was identical in all subjects. In the single-injection group, the entire volume of local anesthetic was injected between the three cords of the brachial plexus. In the double-injection group, the first half of the volume was administered in this location; the second half was deposited between the medial cord and the subclavian artery. After the performance of the block, a blinded observer recorded the onset time (defined as the time required to achieve a minimal sensorimotor composite score of 14 out of 16 points), success rate (surgical anesthesia) and block-related pain scores. Performance time and the number of needle passes were also recorded during the performance of the block. The total anesthesia-related time was defined as the sum of the performance and onset times.ResultsCompared with its single-injection counterpart, the double-injection technique displayed shorter onset time (16.6 (6.4) vs 23.4 (6.9) min; p<0.001; 95% CI for difference 3.9 to 9.7) and total anesthesia-related time (22.5 (6.7) vs 28.9 (7.6) min; p<0.001). No intergroup differences were found in terms of success and technical execution (ie, performance time/procedural pain). The double-injection group required more needle passes than the single-injection group (2 (1–4) vs 1 (1–3); p<0.001).ConclusionCompared with its single-injection counterpart, double-injection costoclavicular block results in shorter onset and total anesthesia-related times. Further investigation is required to determine if a triple-injection technique (with targeted local anesthetic injection around each cord of the brachial plexus) could further decrease the onset time.Trial registration numberNCT03595514.

scholarly journals The Best-Laid Plans of “Back Mice” and Men: A Case Report and Literature Review of Episacroiliac Lipoma

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. 181-188 ◽  
Author(s):  
Mark C. Bicket
Keyword(s):  
Clinical Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Literature Review ◽  
Physical Examination ◽  
Local Anesthetic ◽  
Case Reports ◽  
Fatty Tissue ◽  
Low Back

Background: Back mice, or episacroiliac lipoma, represent a potentially treatable cause of low back pain that may be under-recognized in clinical practice. Despite being well characterized based on clinical history and physical examination findings, implementation of appropriate treatment may be delayed or missed based on a lack of familiarity with the diagnosis. Objectives: In this case report and literature review, we describe a 47-year-old woman with history of persistent low back pain who presented with a pain exacerbation consistent with a back mouse. The history, epidemiology, clinical characteristics, differential diagnosis, potential mechanisms for pain, and treatment options for back mice were then reviewed. Study Design: Case report and literature review. Setting: Academic university-based pain management center. Results: Studies included one randomized clinical trial, 4 cross-sectional studies, 8 case reports or series, and 16 other publications prior to 1967. Limitations: A single case report. Conclusions: Firm, rubbery, mobile nodules that are located in characteristic regions of the sacroiliac, posterior superior iliac, and the lumbar paraspinal regions may represent fatty tissue that has herniated through fascial layers. When painful, these back mice may be confused with other causes of low back pain. In particular, the presence of point tenderness may mimic myofascial pain, and reports of radicular pain may imitate herniated nucleus pulposus. However, back mice may be distinguished from other entities based on findings from the history and physical examination such as absence of neurological deficit. Treatment consisting of injection of local anesthetic into the nodule with or without corticosteroid followed by repeated, direct needling has been reported to relieve pain in many case reports. The one clinical trial comparing injection of local anesthetic to normal saline, which did not include repeated needling, found only mild and transient benefit in the treatment group. Key words: Low back pain, back mice, back mouse, episacroiliac lipoma, lumbar subcutaneous nodules, multifidus triangle syndrome, subcutaneous fatty nodes, case report, review

Sign in / Sign up

Export Citation Format

Share Document