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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

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

Foot Ankle Int 2009 Mar;30(3):239-42

Yale University School of Medicine, Foot & Ankle Service, Orthopaedic Surgery, Yale Physicians Building, 800 Howard Avenue, New Haven, CT 06520, USA.

Background: Ultrasonography is an emerging imaging modality which affords dynamic, real-time, cost-effective and surgeon controlled visualization of the foot and ankle. The purpose of this study was to evaluate the accuracy of ultrasound guided injections for common injection sites in the foot and ankle.

Materials And Methods: In 10 fresh cadaver feet, ultrasound guidance was utilized to inject a methylene blue-saline mixture into (1) the first MTP joint, (2) the second MTP joint, (3) the tibiotalar joint, (4) the Achilles peritendinous space, (5) the flexor hallucis longus sheath, (6) the posterior tibial tendon sheath, and (7) the subtalar joint. Read More

J Clin Rheumatol 2009 Apr;15(3):103-5

Department of Orthopaedic Surgery, Assaf Harofeh Hospital, Zerrifin, Israel.

Background: Intraarticular injections of the hip have traditionally required sonographic or fluoroscopic guidance assistance. Previous studies report high failure rates with injections based solely on anatomic landmarks.

Objectives: To examine the accuracy of a lateral injection technique in osteoarthritic patients without using image assistance. Read More

Rheumatology (Oxford) 2008 Oct 25;47(10):1503-5. Epub 2008 Jul 25.

Department of Traumatology, Medical University of Graz (MUG), Auenbruggerplatz 7a, A - 8036 Graz, Austria.

Objective: Physicians and specialists routinely perform IA punctures and injections on patients with joint injuries, chronic arthritis and arthrosis to release joint effusion or to inject drugs. The purpose of this study was to investigate the frequencies of intra- and peri-articular cannula positioning during this procedure.

Methods: A total of 300 cadaveric finger joints were injected with a methyl blue-containing solution and subsequently dissected to distinguish intra- from peri-articular injections. Read More

Pharmacol Biochem Behav 2008 Nov 30;91(1):128-33. Epub 2008 Jun 30.

Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados-Sede Sur, Calz. de los Tenorios 235, Col. Granjas Coapa, C.P. 14330, México D.F., Mexico.

The mechanism of action underlying the "analgesic activity" of diazepam remains unclear. In this study, the possible participation of the GABA/benzodiazepine receptor and the nitric oxide-cyclic GMP (NO-cGMP) pathway was assessed utilizing the pain-induced functional impairment model in the rat (PIFIR). Nociception was induced by an intra-articular injection of 15% uric acid. Read More

Knee Surg Sports Traumatol Arthrosc 2007 May 6;15(5):573-7. Epub 2006 Dec 6.

Department of Orthopaedic Surgery and Traumatology, Vakif Gureba Training Hospital, Istanbul, Turkey.

Although intra-articular knee injection is not a complicated procedure, it could be difficult to assess whether the tip of the needle lies free in the joint or is embedded in synovium or other intra-articular soft tissues. The purpose of this study was to evaluate the accuracy rate of intra-articular injection using anteromedial (AM), anterolateral (AL), lateral midpatellar (LMP), and medial midpatellar (MMP) portals in cadavers. In this study 156 knees of 78 fresh cadavers were included. Read More

Vet Surg 2005 Nov-Dec;34(6):539-42

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA.

Objective: To evaluate the accuracy of a new technique for perineural injection of the lateral palmar nerve and to determine frequency of inadvertent injection into the carpal synovial sheath with this technique.

Study Design: Prospective experimental study.

Animals: Thirty equine cadaver forelimbs. Read More

J Shoulder Elbow Surg 2005 Mar-Apr;14(2):145-8

The Permanente Medical Group, Roseville, CA 95661, USA.

Subacromial bursa injection is commonly performed via an anterolateral or posterior approach. No study has compared the accuracy rates of these approaches. Twenty cadaveric shoulders were injected with radiocontrast in the subacromial bursa via an anterolateral approach and twenty via a posterior approach. Read More

J Arthroplasty 2004 Oct;19(7):858-61

Department of Orthopaedic Surgery, Sports Medicine Institute, State University of New York at Buffalo, 14214, USA.

This study's purpose was to evaluate the reliability of knee injection sites with low-volume (2-3 cc) injection typical of viscosupplementation. This was a prospective study of 131 knees randomly assigned to 3 injection groups before to knee arthroscopy: SM-superomedial, superolateral, and lateral joint line (LJL). Needles were inserted to the hub, and aspiration was attempted before injection with 3 cc diluted methylene blue (MB). Read More

Expert Opin Investig Drugs 2004 Aug;13(8):903-32

Campbell University School of Pharmacy, Buies Creek, NC, USA.

Administration of antifungals by routes other than that for which the agent was designed or approved have been utilised in attempts to provide directed therapy, reduce adverse effects and improve drug penetration into selected infection sites, such as the central nervous system, lungs and peritoneum. The most widely investigated agent utilising a novel method of drug delivery is amphotericin B. Dose forms for this agent include topicals (aerosol, nasal spray, irrigations, pastes, absorbable sponges, impregnated bone cement and gelatin), oral dosage forms (solutions, suspensions, tablets and so on) and ophthalmic preparations (drops, ointments and injections). Read More

Equine Vet J 2004 May;36(4):324-30

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA.

Reasons For Performing Study: Sacroiliac joint osteoarthritis has been recognised as a significant cause of poor performance in competition and racehorses. Reliable diagnostic tools are currently lacking. The diagnosis has been based typically on exclusion of other possible causes of poor performance, back pain and hindlimb lameness. Read More

Clin Rheumatol 2003 Dec 21;22(6):391-2. Epub 2003 Oct 21.

Erasme Hospital, University of Brussels, 808 route de Lennick, 1070 Brussels, Belgium..

The aim of this study was to determine the threshold for detecting knee effusion by ultrasound (US). Five knee specimens from embalmed cadavers were studied. Intra-articular injection of saline, blood and synovial fluid was performed under ultrasound control and methylene blue dye instillation. Read More

Clin Orthop Relat Res 2001 Oct(391):192-7

Orthopaedic Surgery Service, William Beaumont Army Medical Center, El Paso, TX 79920-5001, USA.

This study tests the hypotheses that the hip can be injected safely and reliably, using anatomic landmarks, without fluoroscopic guidance. Fifteen human cadavers (30 hips) were injected, each receiving one anterior hip injection and one lateral hip injection with methylene blue dye. Anatomic dissections were done on all 30 specimens to determine the rate of success and the proximity of the needle to the neurovascular structures about the hip with each approach. Read More

J Hand Surg Am 1997 Sep;22(5):897-900

Department of Orthopaedic Surgery, University of California, San Francisco, USA.

A controlled, randomized single-blinded study was performed on the thumbs and little fingers of 20 cadaver hands. The digits were randomly divided into 2 groups. In the transthecal group, 2 mL of 0. Read More

Eur J Pharmacol 1994 Jan;251(2-3):173-9

Department of Pharmacology, Faculty of Medicine of Ribeirão Preto, U.S.P., Brazil.

Indomethacin, a typical cyclo-oxygenase inhibitor, acts as an analgesic by preventing the hyperalgesia induced by prostaglandins during inflammation. Analgesics of the dipyrone type directly block the sensitization of nociceptors. In the present investigation, the analgesic effect of diclofenac was compared with that of indomethacin in two algesimetric tests which permit discrimination between the two types of analgesic: the rat knee joint incapacitation and the rat paw hyperalgesia tests. Read More

Vet Surg 1989 Mar-Apr;18(2):146-50

Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square 19348.

Three techniques for inducing analgesia of the proximal metacarpal region were evaluated for the frequency of inadvertent injection into the middle carpal and carpometacarpal joints. Using methylene blue solution as a marker dye and 30 fresh cadaver specimens each, three clinicians performed either 30 infiltrations at the origin of the suspensory ligament (method A), 30 palmar and palmar metacarpal nerve blocks at the proximal end of the metacarpus (method B), or 30 palmar and palmar metacarpal nerve blocks at the distal aspect of the accessory carpal bone (method C). The frequency of inadvertent injection into the distal carpal joints was 37, 17, and 0% for methods A, B, and C, respectively. Read More

Invest Radiol 1987 Jun;22(6):462-6

A canine model was used to determine the feasibility of preoperative, angiographic staining of bowel segments. Because methylene blue (MB) is contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency or unstable hemoglobins, two alternate dyes, isosulfan blue (lymphazurin) and fluorescein were also studied. These three dyes were injected into 27 different mesenteric arterial branches in seven dogs following transfemoral catheterization. Read More

Acta Chir Orthop Traumatol Cech 1970 Feb;37(1):19-24

J Oral Surg 1970 Feb;28(2):99-100

Verh Dtsch Ges Rheumatol 1969 ;1:425-9