Foot and Ankle

The most commonly requested peritendinous injections in the foot and ankle, in our experience, are in patients with chronic achillodynia, or those with medial or lateral ankle pain due to posterior tibial or peroneal tendinosis tenosynovitis, respectively. The large majority of patients FIGURE 2 Iliopsoas tendon sheath injection. (A) Transverse sonogram obtained over the anterior capsule (c) of the hip in a patient with a snapping iliopsoas tendon. A small bursal fluid collection (*) is seen...

Preoperative Evaluation of the Patient

We have already emphasized the importance of reviewing any available imaging studies to assess the indication for the biopsy, as well as to select an appropriate guiding technique and plan the route of access and the final target. Equally important, the patient must be screened for systemic conditions and medications that may interfere with the performance of the biopsy. Often, this preoperative contact can be established over the telephone. Any pertinent clinical information relating to past...

Biceps Tendon

Anterior shoulder pain with radiation into the arm may be secondary to bicipital tendonitis and or tenosynovitis (22). The biceps tendon can be palpated, but the sheath, if nondistended may offer less than 2 mm clearance to place a needle (22). This is complicated by the caudal extension of the subacromial subdeltoid bursa, which may overlie the bicipital tendon sheath (23). A nonimage-guided injection could therefore result in delivery into an extratendinous synovial space, or possibly result...

Cervical Facet Block Introduction

Chronic neck and shoulder pain as well as pain in the occiput may originate from the cervical zygapophyseal or facet joints (1,2,3). The sequential distention of normal facet joints with saline or contrast produces a segmentally distinctive pattern of pain distribution in the posterior occiput, neck, and shoulder of the injected side (4). Pain receptors in the synovium and capsule of the facets joints from C3 to C7-T1 are innervated by the medial branch of the dorsal ramus of the segmental...

Chemistry

The basic structure of steroids consists of a 21-carbon steroid molecule (Fig. 2). The major biologically active glucocorticoid is cortisol (hydrocortisone). Steroids with an 11-ketone group (cortisone and prednisone) are biologically inactive until reduced to a 11-hydroxial compound (hydrocortisone and prednisolone, respectively) (18). Therefore, preparations such as cortisone and prednisone, which require bioactivation in the liver, can only be used systemically. Hence, cortisone and...

J

FIGURE 5 Seventy-eight-year-old man with metastatic lung cancer. The patient had a known posterior metastasis to the third cervical vertebrae that did not respond to radiotherapy. (A) Computed tomography scan prior to radiofrequency (RF) ablation shows osteolysis of the left lamina with an associated soft-tissue mass. (B) RF ablation was performed under conscious sedation without any neurological side effects due to the distance between the electrode and the cord and the presence of pulsating...

William B Morrison

Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A. Needle localization, predominantly using hookwire needles, has been used for preoperative localization of breast lesions and pulmonary nodules (1-6). This technique is advantageous because the needle can be precisely positioned using imaging guidance. The hook at the end of the wire (Fig. 1) immobilizes it so that the patient can be transported to the surgical suite for excision of the lesion. This...

Patient Indications and Selection

Patients with chronic occipital, neck, shoulder, or interscapular pain are candidates for intra-articular or medial branch block, if their pain follows the typical distribution as has been shown from previous clinical studies on normal volunteers and patients with head, neck, and shoulder pain (4,9,13). In patients with whiplash, the prevalence of chronic neck pain and headache was found to be as 54 , most commonly arising at the C2-C3 and C5-C6 levels (7). Posterior occipital pain is most...

Cervical Epidural Block Introduction

Occipital Nerve Block Fluoro

The use of epidural steroids in the cervical spine to treat chronic neck and upper extremity pain has been reported since 1984 (22). The translaminar route without fluoroscopic control has been utilized in most series (22-26). A criticism of this technique is the difficulty in assuming that the needle placement is in the epidural space as well as the risk of intradural puncture. More recently, the use of fluoroscopy and contrast media epidurography have been advocated by Johnson et al. to...

Benzodiazepams

Benzodiazepams are usually the best form of sedative hypoxic agents with predominant anxiolytic and relaxation effects and no direct analgesic effects. These agents cause amnesia with loss of memory of the procedure and help to relieve patient anxiety (20,21). Benzodiazepams cause anxiolysis, sedation, amnesia, suppression of seizure activity, and, if the dose is high enough, unconsciousness and respiratory depression. At its lowest concentrations, benzodiazepams produce only anxiolysis. High...

Clear Cell Chondrosarcoma

This uncommon histologic variant contains tumor cells with abundant clear cytoplasm and little matrix. Involvement of the epiphysis is common. Although the cells have abundant clear cytoplasm with sharply defined cell borders, the growth pattern is still lobular. Nuclei are large and may be binucleated. The limited matrix production is chondroid and calcifications may be present 55,56 . FIGURE 14 Dedifferentiated chondrosarcoma. There is an abrupt transition between the low-grade chondrosarcoma...

Preoperative Evaluation Choice of Imaging Modality for Guidance

Although the basic technique for imaging-guided bone and soft-tissue biopsy has not undergone substantial changes, the proliferation of imaging modalities has added new emphasis on preoperative planning. Often, patients are referred for a biopsy with imaging studies obtained at different institutions, with reports generated by radiologists not directly connected with the receiving hospital. Therefore, before even attempting to schedule the patient, all images and reports should be collected,...