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Pain Physician 2022 01;25(1):E15-E26

Department of Pain, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.

Background: Lumbar facet joint syndrome (LFJS) has been suggested to be a main source of low back pain. Methylene blue (MB), an inhibitor of nitric oxide synthesis with potential analgesic and anti-inflammatory properties, has been widely applied for a variety of pain-related diseases. However, no studies have been conducted on the treatment of LFJS patients using MB. Read More

Hand (N Y) 2022 Jan 7:15589447211068184. Epub 2022 Jan 7.

Cleveland Clinic Foundation, OH, USA.

The saline load test is routinely used to recognize other joints' traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. This was a cadaveric study of 16 hands (79 MCPJs). Read More

Acta Pharmacol Sin 2022 Feb 8;43(2):417-428. Epub 2021 Apr 8.

State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.

Oxidative stress-related cartilage degeneration, synovitis, and joint pain play vital roles in the progress of osteoarthritis (OA). Anti-oxidative stress agents not only prevent structural damage progression but also relieve OA-related pain. In this study, we investigated the therapeutic effect of methylene blue (MB), a classical and important anti-oxidant with strong neural affinity. Read More

Equine Vet J 2021 Nov 21;53(6):1159-1168. Epub 2020 Dec 21.

Faculty of Veterinary Science, Leahurst Equine Hospital, University of Liverpool, Neston, UK.

Background: Accuracy of intrasynovial injections can be challenging to assess in a clinical setting in horses. Contrast-enhanced ultrasonography (CEUS) using injectate agitated with air has been used to determine the success rates of synovial injections in human rheumatology.

Objectives: To assess the diagnostic sensitivity and specificity of CEUS and to describe its clinical use. Read More

J Shoulder Elbow Surg 2020 Sep 20;29(9):1869-1875. Epub 2020 May 20.

Department of Orthopaedic Surgery, Beaumont Farmington Hills, Farmington Hills, MI, USA.

Background: Traumatic elbow arthrotomies are common injuries evaluated for by orthopedic services; however, failed identification of a traumatic arthrotomy leads to a high risk of developing septic arthritis. Currently these injuries are evaluated by either a saline load test or a computed tomography (CT) scan, yet there is little published evidence regarding detection of traumatic elbow arthrotomies.

Hypothesis: In our study, we hypothesized better sensitivity and specificity of detecting a traumatic elbow arthrotomy with a CT scan over a saline load test. Read More

Injury 2020 Apr 19;51(4):1114-1117. Epub 2020 Feb 19.

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, United States.

Background: Limited studies have been conducted to determine the minimum amount and sensitivity of the saline load test of the ankle. Prior studies, only performed in arthroscopic models, have suggested a wide range of volumes necessary to confirm arthrotomy. The purpose of this study was to investigate the amount of fluid required and the sensitivity of the saline load test to identify an intra-articular arthrotomy of the ankle. Read More

Arthritis Res Ther 2019 11 13;21(1):238. Epub 2019 Nov 13.

Department of Bioengineering, Northeastern University, 805 Columbus Avenue, Boston, MA, 02120, USA.

Background: Most in vitro studies of potential osteoarthritis (OA) therapies have used cartilage monocultures, even though synovium is a key player in mediating joint inflammation and, thereby, cartilage degeneration. In the case of interleukin-1 (IL-1) inhibition using its receptor antagonist (IL-1Ra), like chondrocytes, synoviocytes also express IL-1 receptors that influence intra-articular IL-1 signaling and IL-1Ra efficacy. The short residence time of IL-1Ra after intra-articular injection requires the application of frequent dosing, which is clinically impractical and comes with increased risk of infection; these limitations motivate the development of effective drug delivery strategies that can maintain sustained intra-articular IL-1Ra concentrations with only a single injection. Read More

Vet Radiol Ultrasound 2020 Jan 1;61(1):67-76. Epub 2019 Oct 1.

Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK.

Desmopathy of the collateral ligaments of the distal interphalangeal joint is a common cause of equine foot lameness and carries a poor prognosis with conservative management. Intralesional injections may improve healing, although accuracy of radiographically guided injections is significantly less than when guided by MRI, which requires special needles. Longitudinal ultrasound-guided injection of the distal collateral ligament has not been evaluated objectively. Read More

Pain Med 2020 06;21(6):1240-1247

Department of Anesthesiology, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059 Toulouse, France.

Objectives: The primary aim of our study was to evaluate and compare the accuracy of ultrasound (US)-guided distal suprascapular nerve (dSSN) and proximal SSN (pSSN) blocks. Secondary aims were to compare the phrenic nerve involvement between groups and to describe the anatomical features of the sensory branches of the dSSN.

Methods: pSSN and dSSN blocks were performed in 14 cadavers (28 shoulders). Read More

J Shoulder Elbow Surg 2019 Jul 4;28(7):1291-1297. Epub 2019 Mar 4.

Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.

Background: A bone landmark-based approach (LBA) to the distal suprascapular nerve (dSSN) block is an attractive "low-tech" method available to physicians with no advanced training in regional anesthesia or ultrasound guidance. The primary aim of this study was to validate the feasibility of an LBA to blockade of the dSSN by orthopedic surgeons using anatomic analysis. The secondary aim was to describe the anatomic features of the sensory branches of the dSSN. Read More

PM R 2019 06 15;11(6):631-639. Epub 2019 Mar 15.

Department of Structural Biology and Anatomy, Department of Physical Medicine and Rehabilitation, 1300 Morris Park Avenue, Bronx, NY 10461.

Background: Neck pain is one of the most common causes of chronic pain and the fourth leading cause of disability worldwide; it is estimated that between 36% and 67% of this pain is due to facet arthropathy. For patients who have pain refractory to conservative treatments literature supports management with diagnostic cervical medial branch blocks (MBBs) to identify the associated facet innervation as the source of pain followed by therapeutic radiofrequency ablation (RFA) of the identified nerves. Cervical RFA has good published outcomes; however, the procedure is dependent upon the specificity of the diagnostic block to achieve maximal success. Read More

Front Vet Sci 2017 20;4:152. Epub 2017 Sep 20.

Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, Unites States.

Osteoarthritis (OA) is a ubiquitous disease affecting many horses. The disease causes chronic pain and decreased performance for patients and great cost to owners for diagnosis and treatment. The most common treatments include systemic non-steroidal anti-inflammatory drugs and intra-articular injection of corticosteroids. Read More

Reg Anesth Pain Med 2017 Nov/Dec;42(6):725-730

From the *Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark; †Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria; and ‡Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Copenhagen; and §Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.

Background And Objectives: The popliteal nerve plexus contributes to afferent knee-pain conduction. It is mainly formed by genicular branches from the posterior obturator and the tibial nerves, innervating the intra-articular and posterior knee region. A subinguinal obturator nerve block alleviates pain after total knee arthroplasty. Read More

Anesth Analg 2017 03;124(3):966-971

From the *Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada; and †Department of Anatomy, University of Toronto, Toronto, Ontario, Canada.

Background: Trochanteric bursa (TB) injection with local anesthetic and corticosteroid is a treatment for patients suffering from greater trochanteric pain syndrome. Both landmark (LM)-guided and ultrasound (US)-guided methods have been used, but their accuracies have not been determined. This study examined the accuracy of these injections with cadaveric dissection. Read More

Acta Orthop Traumatol Turc 2016 Dec 12;50(6):597-600. Epub 2016 Dec 12.

University of Maryland Medical Center, Baltimore, MD, United States. Electronic address:

Introduction: The aim of this systematic review was to assess the efficacy of Saline load tests (SLTs) to evaluate extension of periarticular wounds into capsule in emergent settings.

Methods: We systematically reviewed the literature to evaluate the accuracy of the SLT in diagnosing penetrating joint injuries in the elbow, wrist, shoulder, knee, or ankle.

Results: The SLT values to determine knee arthrotomies vary from 73. Read More

Vet Comp Orthop Traumatol 2016 Sep 29;29(5):386-93. Epub 2016 Jul 29.

John David Stack, MVB, MSc, MRCVS, University College Dublin Veterinary Hospital, Belfield, Dublin 4, Ireland, Phone: +353 8604 33 088, E-mail:

Objectives: To compare the accuracy and distribution of injectate for cranial (CR) and caudomedial (CM) ultrasound-guided injections of equine sacroiliac joints.

Methods: Both sacroiliac joints from 10 lumbosacropelvic specimens were injected using cranial parasagittal (CR; curved 18 gauge, 25 cm spinal needles) and caudomedial (CM; straight 18 gauge, 15 cm spinal needles) ultrasound-guided approaches. Injectate consisted of 4 ml iodinated contrast and 2 ml methylene blue. Read More

PM R 2016 11 4;8(11):1072-1082. Epub 2016 Apr 4.

Department of Family Medicine and Community Health, University of Wisconsin, School of Medicine and Public Health, Madison, WI(††).

Background: Dextrose injection is reported to improve knee osteoarthritis (KOA)-related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed.

Objective: To assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful KOA. Read More

Eur J Pharm Biopharm 2016 Apr 11;101:126-36. Epub 2016 Feb 11.

Pharmbiotec GmbH, Saarland University, Campus C 2.2, 66123 Saarbrücken, Germany; Department of Biopharmaceutics and Pharmaceutical Technology, Saarland University, Campus A 4.1, 66123 Saarbrücken, Germany; Helmholtz Centre for Infection Research and Helmholtz Institute for Pharmaceutical Research Saarland, Campus E 8.1, 66123 Saarbrücken, Germany.

The treatment of joint related diseases often involves direct intra-articular injections. For rational development of novel delivery systems with extended residence time in the joint, detailed understanding of transport and retention phenomena within the joint is mandatory. This work presents a systematic study on the in vitro permeation, penetration and accumulation of model polymers with differing charges and molecular weights in bovine joint tissue. Read More

J Biomed Res 2015 Sep 28;29(5):405-13. Epub 2015 Jun 28.

Department of Pharmaceutics, Indian Institute of Technology.

The present study was undertaken to investigate the effect of diacerein on the histopathology of articular cartilage and subchondral bone of the femorotibial joint in rats. Osteoarthritis was induced in rats after single intra-articular injection of sodium iodoacetate. Rats were sacrificed 1, 2, 4, and 8 weeks post intra-articular injection to evaluate the progression of histopathogenesis of osteoarthritis. Read More

Arthrosc Tech 2015 Apr 6;4(2):e143-8. Epub 2015 Apr 6.

Department of Orthopaedics, Faculty of Medicine, Thammasat University, Rangsit, Thailand.

Popliteal cysts are characterized by enlargement of the gastrocnemius-semimembranosus bursa. The pathogenesis includes a valvular opening between the knee joint and the bursa, and associated intra-articular pathology may give rise to knee effusion. The mainstay of treatment is conservative. Read More

J Am Podiatr Med Assoc 2013 May-Jun;103(3):204-7

St. Bartholomew's and Royal London Hospital, Queen Mary, University of London, UK.

Background: Injections, punctures, and aspirations of the first metatarsophalangeal joint are common interventions. Accurate intra-articular placement of the needle is a prerequisite for the achievement of desirable results and the avoidance of complications. We evaluated the rate of successful intra-articular injections and the influence of the degree of operator experience in achieving this success. Read More

Photochem Photobiol 2013 May-Jun;89(3):679-82. Epub 2013 Feb 19.

Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA.

We previously reported that photodynamic therapy (PDT) using intra-articular methylene blue (MB) could be used to treat arthritis in mice caused by bioluminescent methicillin-resistant Staphylococcus aureus (MRSA) either in a therapeutic or in a preventative mode. PDT accumulated neutrophils into the mouse knee via activation of chemoattractants such as inflammatory cytokines or chemokines. In this study, we asked whether PDT combined with antibiotics used for MRSA could provide added benefit in controlling the infection. Read More

J Shoulder Elbow Surg 2012 Dec 3;21(12):1694-7. Epub 2012 Apr 3.

Department of Orthopedics, University of Zurich, Balgrist, Zurich, Switzerland.

Background: Injections of the acromioclavicular joint (ACJ) are performed routinely in patients with ACJ arthritis, both diagnostically and therapeutically. The aim of this prospective controlled study was to estimate the frequency of successful intra-articular ACJ injections with the aid of sonographic guidance versus non-guided ACJ injections.

Materials And Methods: A total of 80 cadaveric ACJs were injected with a solution containing methylene blue and subsequently dissected to distinguish intra- from peri-articular injections. Read More

Equine Vet J 2012 Nov 15;44(6):674-8. Epub 2012 Feb 15.

University Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Dublin 4, Ireland.

Reasons For Performing Study: Diagnosis and treatment of pathologies involving synovial structures in the shoulder region are technically difficult. Ultrasound-guided (UG) injection techniques have been shown to be highly accurate, safe and reliable for various structures in human and equine patients.

Objectives: To develop easy-to-use and reliable UG injection techniques for the infraspinatus bursa (IB), bicipital bursa (BB) and scapulohumeral joint (SHJ) and to compare them with conventional 'blind' methods. Read More

Tech Hand Up Extrem Surg 2011 Dec;15(4):243-6

Department of Orthopedics, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.

The ganglion is the most common soft tissue mass of the hand and wrist. Over the past 10 to 15 years, there has been a growing interest in arthroscopic treatment of dorsal wrist ganglions. Proposed advantages of arthroscopy include greater motion (particularly wrist flexion), improved cosmesis, and potential to identify/treat other intra-articular pathology. Read More

J Trauma 2011 Nov;71(5):E110-3

Brooke Army Medical Center, Fort Sam Houston, Texas, USA.

Objectives: The purpose of this study was to investigate the amount of fluid required and the sensitivity of the saline load test to identify an intra-articular arthrotomy of the elbow.

Methods: A cadaveric study was conducted using 36 thawed, fresh-frozen forequarter amputations. An elbow arthrotomy was made in the posterocentral arthroscopic portal site with a 4. Read More

Arch Orthop Trauma Surg 2011 Jun 16;131(6):759-63. Epub 2010 Dec 16.

Pediatric Orthopedic Unit, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria.

Introduction: Injections into the subtalar joint may be performed for diagnostic or therapeutic reasons. The anterolateral approach is most commonly utilised for this purpose. We evaluated the success of an intra-articular puncture by using the anterolateral in comparison to the posterolateral approach. Read More

Equine Vet J 2010 Sep;42(6):512-8

Equine Diagnostic Centre, University of Bristol, UK.

Reasons For Performing Study: Evidence-based information is limited on distribution of local anaesthetic solution following perineural analgesia of the palmar (Pa) and palmar metacarpal (PaM) nerves in the distal aspect of the metacarpal (Mc) region ('low 4-point nerve block').

Objectives: To demonstrate the potential distribution of local anaesthetic solution after a low 4-point nerve block using a radiographic contrast model.

Methods: A radiodense contrast medium was injected subcutaneously over the medial or the lateral Pa nerve at the junction of the proximal three-quarters and distal quarter of the Mc region (Pa injection) and over the ipsilateral PaM nerve immediately distal to the distal aspect of the second or fourth Mc bones (PaM injection) in both forelimbs of 10 mature horses free from lameness. Read More

J Bone Joint Surg Br 2010 Jan;92(1):176-8

Institute of Anatomy, Medical University of Graz, Austria.

Injection or aspiration of the ankle may be performed through either an anteromedial or an anterolateral approach for diagnostic or therapeutic reasons. We evaluated the success of an intra-articular puncture in relation to its site in 76 ankles from 38 cadavers. Two orthopaedic surgical trainees each injected methylene blue dye into 18 of 38 ankles through an anterolateral approach and into 20 of 38 through an anteromedial. Read More

Foot Ankle Int 2009 Sep;30(9):886-90

Department of Orthopaedics, University of Rochester Medical Center, NY 14642, USA.

Background: Ultrasound has been increasingly utilized in procedures involving intra-articular injections. This study's purpose was to compare the accuracy of intra-articular injections of the foot and ankle using palpation versus dynamic ultrasound in a cadaver model.

Materials And Methods: Fourteen lightly embalmed cadaver specimens without notable osteoarthritis were used. Read More