Intra-osseous migration in calcific rotator cuff tendinopathy- A novel depiction of temporal evolution on multi-modality imaging

We present a case of calcific tendinopathy of the rotator cuff with intraosseous migration of the calcification, treated with ultrasound-guided bursal steroid injection and followed up with multiple imaging modalities for a year following the initial presentation. The radiographs, ultrasound, CT, nuclear scintigraphy, and MRI images demonstrate the temporal evolution of the intraosseous migrated calcium and show how this pathology, in its acute phase, can mimic other pathologies like osteoid osteoma. The follow-up imaging also illustrated how the migrated intraosseous focus of calcification took a much longer time to heal compared to its intratendinous counterpart, possibly leading to the protracted course of recovery. This report also highlights a previously undescribed pattern of healing of the intraosseous migrated calcium on multiple imaging modalities.

A COMPARISON OF SUPRASCAPULAR NERVE BLOCK VS INTRAARTICULAR STEROID INJECTION IN IMPROVEMENT OF HEMIPLEGIC SHOULDER PAIN

Objectives: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular Nerve block and Intra-articular steroid injection in patients with hemiplegic shoulder pain. Study Design: Randomized Controlled Trial Place and Duration of Study: Pain Clinic, Armed Forces Institute of Rehabilitation Medicine Rawalpindi from 25th October 2017 to 24th April 2018 Patients & Methods: 60 patients with CVA and shoulder pain on hemiplegic side for at least 2 weeks were included in study after non-probability consecutive sampling after meeting inclusion criteria. Subjects were randomized by lottery into two groups; Group A receiving Suprascapular Nerve block with 5ml of 1% Lignocaine with Group B receiving Intra-articular 40mg Triamcinolone Acetonide plus 1 ml of 1% Lignocaine injections. Mean change in pain scores on VAS was calculated between score at baseline and at 4 weeks post-intervention Results: The mean age of patients in group A was 59.17 ± 9.81 years and in group B was 39.96 ± 11.11 years. Out of 60 patients, 34 (56.67%) were males and 26 (43.33%) were females with male to female ratio of 1.3:1. Mean duration of stroke was 7.50 ± 2.66 months. Mean pain change on VAS in Group A (Suprascapular Nerve block) was 3.83 ± 1.12 cm while in Group B (Intra-articular steroid injection) it was 2.17 ± 0.99 cm (p-value = 0.0001). Conclusion: This study concluded that Suprascapular Nerve block offered better improvement in hemiplegic shoulder pain on Visual Analogue Scale at 4 weeks as compared to intraarticular steroid injection.

Clinics in Surgery 1Remedy Publications LLC., | http://clinicsinsurgery.com/ 2021 | Volume 6 | Article 3380 The Effect of Spinal Steroid Injections on COVID-19 Infection and Its Severity

Aim: This paper is to determine the incidence of COVID-19 infection and severe symptoms following spinal steroid injections for pain control. Methodology: This a retrospective observational study based in the department of neurosurgery, Salford Royal Foundation Trust. Study period is from March 23rd, 2020 till December 31st, 2020. 222 patients had these injections during the time period. Data was collected by telephonic interview and online questionnaire. Data was analyzed to find out how many of the people who received steroid injection got COVID infection and how many had severe infection. It was then compared with local infection rates. Results: Out of 222 patients found, 130 patients opted to take part in the survey. Six patients among them had tested positive after the injection and two more patients had symptoms of COVID who have been considered to be positive. Overall, 6.15% of patients who received steroid injections had positive COVID-19 results. 3.85% patients had the infection within 3 months of injection. One patient (0.77%) needed hospital admission due to COVID. The incidence of COVID during this time period in Salford was 6.17% and rate of hospital admission due to COVID was 0.77%. Conclusion: The rate of COVID-19 infection after steroid injection are lower than the local incidence of COVID in Salford during that time period and equivalent to the rate of hospital admission due to COVID. This suggests that a steroid injection in the spine for pain management does not increase the incidence of COVID or cause severe infections.