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Distal Biceps Tendon Tears: Diagnosis and Treatment Algorithm.

JBJS Rev 2021 Jul 14;9(7). Epub 2021 Jul 14.

Department of Orthopaedic Surgery, Unity Health, St. Joseph's Health Centre, Toronto, Ontario, Canada.

»: Distal biceps tendon (DBT) tears occur most commonly in middle-aged men after a sudden, forced eccentric contraction of the flexed elbow.

»: An understanding of the multiple risk factors, mechanisms, and pathophysiological causes is essential for proper and timely diagnosis.

»: High clinical suspicion and routine physical examination with appropriate special examination tests, including the hook test, the passive forearm pronation test, the biceps crease interval test, and the bicipital aponeurosis flex test, can help with rapid and accurate diagnosis and guide appropriate and timely management. Read More

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The Comma Sign: The Coracohumeral Ligament and Superior Glenohumeral Ligament Exhibit Similar Quantitative Characteristics With Terminal Confluence at the Subscapularis Insertion.

Arthrosc Sports Med Rehabil 2021 Jun 21;3(3):e645-e649. Epub 2021 Mar 21.

University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

Purpose: The purpose of this morphologic cadaveric study was to quantitatively define the composition of the previously described comma tissue along with its relation to the subscapularis tendon insertion.

Methods: Fresh frozen cadaveric shoulder specimens were included for analysis. The coracohumeral ligament (CHL) was exposed at its origin along the base of the coracoid process and freed laterally along its course to the lesser tuberosity adjacent to the bicipital groove. Read More

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The Lesser Tuberosity Osteotomy Exposure for Total Shoulder Arthroplasty.

JBJS Essent Surg Tech 2021 Jan-Mar;11(1). Epub 2021 Feb 11.

Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.

Background: The lesser tuberosity osteotomy (LTO) is a commonly employed technique for mobilizing the subscapularis tendon during anatomic total shoulder arthroplasty that is performed through a deltopectoral approach. During this procedure, the lesser tuberosity is osteotomized from the proximal aspect of the humerus while maintaining the strong tendon-to-bone attachment of the subscapularis tendon insertion. After the shoulder arthroplasty is performed, the lesser tuberosity osseous fragment is then resecured to the proximal aspect of the humerus with heavy nonabsorbable suture, which allows for direct bone-to-bone compression and healing of the fragment to the proximal aspect of the humerus. Read More

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February 2021

Bicipital origin and the course of the plantaris muscle.

Anat Cell Biol 2021 Jun;54(2):289-291

Department of Anatomy, College of Medicine, University of Ulsan, Seoul, Korea.

The plantaris muscle (PM) has a small fusiform muscle belly and a long slender tendon sandwiched between the soleus (SM) and gastrocnemius muscle (GM). During routine dissection for research, an additional PM in the popliteal region of a 75-year-old Korean female was discovered. Two distinct PMs were present, the superior PM (sPM) and inferior PM (iPM). Read More

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Relationship of clinical measures with humeral torsion in young adults: a pilot study.

J Man Manip Ther 2021 May 24:1-7. Epub 2021 May 24.

Department of Physical Therapy, University of Dayton, Dayton, OH, USA.

Purpose: Humeral retroversion alters range of motion and has been linked to injury risk. Clinically,palpation of the bicipital groove is used to quantify humeral torsion, but the accuracy of this procedure has not been fully examined. The purpose of this study was to investigate the relationship between clinical and diagnostic ultrasound (US) assessment of humeral torsion while considering shoulder position of the participant and clinical expertise of the examiner. Read More

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Magnetic Resonance Arthrography in Rugby Players Undergoing Shoulder Stabilization for Glenohumeral Instability: Professionals Have Higher Frequencies of More Pathologies.

Arthrosc Sports Med Rehabil 2021 Apr 23;3(2):e543-e547. Epub 2021 Feb 23.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: To quantify the magnetic resonance arthrography (MRA) findings in rugby players during preoperative workup for anterior surgical stabilization for glenohumeral instability.

Methods: All patients who underwent glenohumeral instability surgery in our institution between 2008 and 2018 were considered for inclusion. Rugby players were identified using the patient's medical notes, with subsequent identification of all professional players. Read More

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Subpectoral versus suprapectoral biceps tenodesis yields similar clinical outcomes: a systematic review.

J ISAKOS 2021 May 20. Epub 2021 May 20.

Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA

Importance: Arthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are two surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior to posterior (SLAP) tears. There is insufficient knowledge regarding the clinical superiority of one technique over the other.

Objective: To systematically review the literature in order to compare the clinical outcomes and safety of ABT and OBT for treatment of LHBT or SLAP pathology. Read More

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Needle Arthroscopy of the Scapulohumeral Joint and Bicipital BURSA in Horses: An Ex Vivo Study.

J Equine Vet Sci 2021 06 24;101:103432. Epub 2021 Feb 24.

São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, São Paulo, Brazil.

To evaluate the feasibility of performing needle arthroscopy of the scapulohumeral joint and bicipital bursa in standing horses by using the thoracic limbs of euthanized horses. To that purpose, this experimental study was designed. Ten thoracic limbs, five left and five right from euthanized horses were retained in an upright position to simulate a standing horse. Read More

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Arthroscopic Biceps Tenodesis by Bicortical Drilling Technique.

Arthrosc Tech 2021 Apr 2;10(4):e941-e948. Epub 2021 Mar 2.

Department of Orthopaedics, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.

Pain arising from the long head of biceps tendon can cause significant disability of the shoulder. In young and physically demanding patients, biceps tenodesis is advised, in which the biceps tendon is cut from the native origin and fixed distally. Many methods have been proposed for this. Read More

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Biomarkers of lipid metabolism in patients with juvenile idiopathic arthritis: relationship with disease subtype and inflammatory activity.

Pediatr Rheumatol Online J 2021 May 3;19(1):66. Epub 2021 May 3.

Department of Pediatrics, Universidade Federal de São Paulo, Rua Borges Lagoa, 802 - Vila Clementino, São Paulo, SP, CEP: 04038-001, Brazil.

Background: To describe the biomarkers of lipid metabolism in children and adolescents with polyarticular and systemic JIA and to relate them to diseases subtypes, diseases activity markers, and nutritional status.

Methods: A cross-sectional study including 62 JIA patients was performed. The following variables were evaluated: disease activity and medications used, body mass index, height for age (z-score), skin folds (bicipital, tricipital, subscapular and suprailiac), food intake based on three 24-h food recalls, lipid profile (total cholesterol (CT), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG) and non-HDL (N-HDLc), glycemia and insulin, erythrocyte sedimentation rate (ESR), ultrasensitive C-reactive protein (us-CRP) and apolipoproteins A-I and B (Apo A-I and Apo B). Read More

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Development and Validation of an Intraoperative Nomogram to Predict Breast Cancer-Related Lymphedema Based on the Arm Lymphatics Distribution.

Ann Surg Oncol 2021 Apr 23. Epub 2021 Apr 23.

Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.

Background: Preoperatively determining those patients who are at high risk of encountering breast cancer-related lymphedema (BCRL) is still not well understood.

Objective: This study aimed to develop a simple intraoperative nomogram for BCRL, incorporating a protective factor.

Methods: Overall, 320 breast cancer patients at Zhongnan Hospital (training set) and 221 patients at Dongfeng General Hospital (external validation cohort) treated between November 2017 and December 2018 were included. Read More

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Evaluation of the subscapularis split created with passive rotation during arthroscopic dynamic anterior stabilization (DAS): A cadaveric study.

Orthop Traumatol Surg Res 2021 Apr 15:102934. Epub 2021 Apr 15.

Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Faculty of Medicine, University of Geneva, Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland. Electronic address:

Introduction: The purpose of the present study was to analyze the ability to create a subscapularis split by passive rotation of the arm during dynamic anterior stabilization (DAS) and to analyze the new geometry of the long head of the biceps LHB.

Hypothesis: The hypothesis was that this passive simple technique can create subscapularis split without additional dissection giving rise to new position of LHB with a new stabilization function.

Material And Methods: A technique of subscapularis split using the LHB was used in 12 fresh-frozen human cadaveric shoulders. Read More

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The biomechanical role of the lacertus fibrosus of the biceps brachii Muscle.

Surg Radiol Anat 2021 Mar 22. Epub 2021 Mar 22.

Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles ULB, Brussels, Belgium.

Purpose: The lacertus fibrosus (LF) is involved in various surgeries. However, the biomechanical contribution of the LF remains unclear. The aim of this study was to determine the role of the lacertus fibrosus on the elbow and forearm kinematics and on the biceps brachii muscle lever arms. Read More

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Associations between wheelchair user's shoulder pain index and tendinitis in the long head of the biceps tendon among female wheelchair basketball players from the Japanese national team.

Asia Pac J Sports Med Arthrosc Rehabil Technol 2021 Apr 16;24:29-34. Epub 2021 Feb 16.

Department of Orthopaedic Surgery, Kasumigaura Rehabilitation Orthopaedic Surgery Clinic, 2-18-4 Koiwatahigashi, Tsuchiura, Ibaraki, 300-0834, Japan.

Background: Among injuries in wheelchair athletes, shoulder injury is the most common. An easy and valid assessment tool is required to monitor the shoulder status in wheelchair athletes anytime. The present study aimed to investigate the association of wheelchair user's shoulder pain index (WUSPI) with physical examinations for tendinitis in the long head of the biceps tendon (LHBT) and range of motion (ROM) of shoulder movements among female wheelchair basketball players from the Japanese national team. Read More

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The "Sandwich Tenodesis": An Arthroscopic Technic for Combined Soft-Tissue and Bony Fixation of the Long Head of the Biceps.

Arthrosc Tech 2021 Feb 16;10(2):e555-e559. Epub 2021 Jan 16.

Clinique Maussins Nollet, Paris, France.

Pathology of the long head of the biceps can contribute to substantial shoulder pain. After nonoperative treatment has failed, either open or arthroscopic tenotomy or tenodesis can be recommended depending on age, occupation, function, and cosmetic preference. While classic tenodesis techniques rely on tendon-to-bone fixation, multiple studies have shown superior healing results for fixation between similar types of tissue, such as tendon-to-tendon. Read More

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February 2021

The bicipital groove as a landmark for humeral version reference during shoulder arthroplasty: a computed tomography study of normal humeral rotation.

J Shoulder Elbow Surg 2021 Mar 3. Epub 2021 Mar 3.

Sir Charles Gairdner Hospital, Nedlands, WA, Australia.

Background: Accurate reproduction of humeral version is important in shoulder arthroplasty. Traditional referencing relative to the transepicondylar axis (TEA) is prone to error as it is absent on preoperative imaging and inaccurately reproduced intraoperatively. The bicipital groove is present on preoperative imaging and in the operative field and thus may be a useful landmark for accurate reproduction of humeral version. Read More

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Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications.

Am J Sports Med 2021 04 26;49(5):1152-1159. Epub 2021 Feb 26.

NYU Langone Health, New York, New York, USA.

Background: The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity.

Purpose: To compare the location of the PIN on magnetic resonance imaging (MRI) relative to bicortical drill pin instrumentation for suspensory button fixation via the anterior single-incision approach in varying positions of forearm rotation. Read More

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Implant-Free Subpectoral Biceps Tenodesis Is Biomechanically at Higher Risk of Spiral Fracture of the Humerus Compared With Implant-Free Suprapectoral Biceps Tenodesis.

Arthrosc Sports Med Rehabil 2021 Feb 26;3(1):e73-e78. Epub 2020 Dec 26.

Southern California Orthopedic Institute, Van Nuys, California, U.S.A.

Purpose: To compare the likelihood of spiral fracture of the humerus using torsional load to failure after intraosseous biceps tenodesis at the position of the arthroscopic suprapectoral tenodesis versus the subpectoral meta-diaphyseal location.

Methods: Eight matched pairs of humeri were dissected. Unicortical tenodesis holes were drilled, either at the bottom of the bicipital groove (group 1) or just below the pectoralis major tendon insertion (subpectoral) in the humeral diaphysis (group 2). Read More

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February 2021

Technique description: Incisionless ultrasound-assisted biceps tenotomy in dogs.

Open Vet J 2021 01 22;10(4):457-464. Epub 2020 Dec 22.

Faculty of Veterinary Medicine, University of Calgary, 11877 85th St NW, Calgary, Alberta, T3R 1J3, Canada.

Background: Bicipital tendinitis and/or tendinopathy is a common cause of forelimb lameness in dogs, particularly in larger and more active patients. Although conservative treatment aimed at resolving discomfort and preserving the tendon remains the primary therapeutic goal, in certain cases it is necessary to surgically transect the tendon to eliminate pain and lameness. Transection of the tendon can be performed by open arthrotomy, arthroscopically, or percutaneously using a scalpel blade. Read More

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January 2021

Long-term outcome following cranial biceps brachii tendon transposition in a dog with a traumatic cranial scapulohumeral luxation.

Open Vet J 2021 01 19;10(4):400-406. Epub 2020 Nov 19.

Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.

Background: Cranial luxation of the scapulohumeral has been rarely reported in dogs and there is limited information available regarding surgical management of this condition, particularly with respect to long-term functional outcomes.

Case Description: This report describes the successful resolution of a chronic traumatic cranial scapulohumeral joint luxation in a dog that was stabilized by cranial transposition of the biceps brachii tendon of origin. At surgery, an osteotomy of the greater tubercle was performed and a trough was made in the exposed bed of the osteotomy. Read More

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January 2021

Anatomical variations of the superficial ulnar artery: case series observed on historical specimens prepared by Ludwik Karol Teichmann.

Folia Morphol (Warsz) 2021 Feb 12. Epub 2021 Feb 12.

Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland.

Background: In this report we present a series of cases representing variant origin and course of the ulnar artery, namely the superficial ulnar artery, observed during the review of collection of historical specimens prepared in the 19th century by the prominent Polish anatomist Ludwik Karol Teichmann and his collaborators, exhibited in the Anatomy Museum of Jagiellonian University Medical College.

Results: Three distinct variants of the superficial ulnar artery were found on anatomical specimens of the upper limb with arteries injected by using Teichmann's method. In case No. Read More

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February 2021

Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model.

Orthop J Sports Med 2021 Jan 21;9(1):2325967120977538. Epub 2021 Jan 21.

Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that "groove pain" may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove. Read More

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January 2021

The Loop Tenodesis Procedure-From Biomechanics to First Clinical Results.

J Clin Med 2021 Jan 23;10(3). Epub 2021 Jan 23.

Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.

(1) Introduction: Several surgical therapy options for the treatment of pathologies of the long biceps tendon (LHB) have been established. However, tenotomy, as well as established tenodesis techniques, has disadvantages, such as cosmetic deformities, functional impairments and residual shoulder pain. This study presents the first clinical and structural results of the recently introduced loop tenodesis procedure for the LHB, developed to overcome these issues. Read More

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January 2021

Proximal Biceps Tenodesis Incorporated into Supraspinatus Repair: A Case Series and Technical Description.

Orthop J Sports Med 2021 Jan 13;9(1):2325967120975354. Epub 2021 Jan 13.

Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA.

Background: Biceps tendon pathology is commonly associated with rotator cuff tears. A multitude of different biceps tenodesis techniques have been studied, with limited clinical data on arthroscopic biceps tenodesis techniques incorporated into rotator cuff repairs.

Purpose: To evaluate the outcomes of an arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair. Read More

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January 2021

Endoscopic anatomy of distal biceps tendon insertion and bicipitoradial bursa: a cadaveric study.

Authors:
Deepak N Bhatia

J Shoulder Elbow Surg 2021 Aug 21;30(8):1759-1767. Epub 2021 Jan 21.

Shoulder and Upper Limb Surgery, SPORTSMED, Mumbai, India; Department of Orthopaedic Surgery, Seth GS Medical College and King Edward VII Memorial Hospital, Mumbai, India. Electronic address:

Background: Distal biceps endoscopy has emerged as a minimally invasive alternative to open procedures for distal biceps tendon (DBT) pathology. The purpose of this study was to systematically describe the static and dynamic appearance and variations of the DBT insertional region using a standardized endoscopic technique and dissection in healthy cadaveric elbows.

Methods: Endoscopic assessment of the DBT insertional region was performed using a standard proximal parabiceps portal in 20 fresh frozen cadaveric upper extremities. Read More

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The effect of bicipital groove morphology on the stability of the biceps long head tendon.

Arch Orthop Trauma Surg 2021 Aug 23;141(8):1325-1330. Epub 2021 Jan 23.

Department of Orthopaedics and Traumatology, Gazi University School of Medicine, Ankara, Turkey.

Background: Long head of biceps tendon (LHBT) instability is an important source of pain and disability for the shoulder. Supraspinatus and subscapularis tendons contribute to the formation of the biceps pulley system, which maintains biceps stability during shoulder movements. The aim of this study is to evaluate the effect of morphology of bicipital groove on the stability of LHBT. Read More

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Topographic anatomy of structures liable to compress the median nerve at the elbow and proximal forearm.

Orthop Traumatol Surg Res 2021 04 19;107(2):102813. Epub 2021 Jan 19.

Service de Chirurgie Orthopédique et Traumatologique, Unité de Chirurgie de la Main, Hôpital Trousseau, CHRU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France. Electronic address:

Introduction: Several structures liable to compress the median nerve have been described around the elbow and proximal forearm. Signs of deficit justify surgical exploration and decompression by exoneurolysis. Better knowledge of the locations of these structures would ensure reliable and effective exploration. Read More

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Management of muscle trigger points causing subacromial pain using dry needling technique - a case report.

J Pak Med Assoc 2020 Dec;70(12(A)):2270-2272

Department of Physical Therapy, University of Lahore, Pakistan.

We present a case of a 22-year-old university sportsman who presented at a private hospital in Lahore in December 2018 with complaint of severe pain in the anterolateral aspect of the right shoulder after playing cricket. On palpation, greater tubercle of the right shoulder was found to be tender along with the muscle belly of supraspinatus. A muscle trigger point was identified during palpation, while painful arc was also present on abduction. Read More

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December 2020

Floating Subscapularis Tear: A Variation of the Partial Subscapularis Tear.

Authors:
Kotaro Yamakado

J Funct Morphol Kinesiol 2020 Feb 5;5(1). Epub 2020 Feb 5.

Department of Orthopaedics/Sposrts medicine, Fukui General Hospital, Fukui 9108561, Japan.

A variation of subscapularis tear has been identified, named floating subscapularis, where the tendon is completely detached from the lesser tuberosity but is continuous with the tissue covering the bicipital groove. An accurate diagnosis can be made using arthroscopic observation with passive external and internal rotation of the affected shoulder, which shows mismatched movement between the humerus and the subscapularis tendon. The purpose of this study is to examine the prevalence of this particular tear pattern. Read More

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February 2020

Ultrasound-Guided Biceps Tendon Sheath Injections Frequently Extravasate Into the Glenohumeral Joint.

Arthroscopy 2021 Jun 13;37(6):1711-1716. Epub 2021 Jan 13.

Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A.

Purpose: To evaluate the frequency of glenohumeral joint extravasation of ultrasound (US)-guided biceps tendon sheath injections.

Methods: Fifty shoulders with a clinical diagnosis of bicipital tenosynovitis pain received a US-guided biceps sheath injection with anesthetic, steroid, and contrast (5.0 mL mixture) followed immediately by orthogonal radiographs to localize the anatomic distribution of the injection. Read More

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