Category Archives: Rehabilitation

Selective Nerve Root Block

Diagnostic Nerve Root Block Because of the overlap pattern of dermatomal innervation and the anatomic variants of spinal nerves, clinical history and physical examination alone are often not sufficient to accurately diagnose the segmental level of a spinal nerve lesion. In addition, current imaging studies and electrodiagnostic tests have limited sensitivity and specificity in reaching […]

Subtalar (Talocalcaneal) Joint Injection

Indications Subtalar joint injection is used to treat inflammation secondary to rheumatoid arthritis and other inflammatory arthritides. Techniques After informed consent is obtained, the patient is placed in the prone position with the feet extending over the end of the examination table and the foot flexed to about 90 degrees. The location of the subtalar […]

Fluoroscopic Guidance and Contrast

Fluoroscopic guidance and contrast enhancement are essential for accuracy when performing epidural injections (43). Published data show that even in experienced hands, epidural injections without fluoroscopic and contrast-enhanced guidance (i.e., “blind injections”) often result in inaccurate placement (Table 68-3) (43). These misplacements include the needle being inadvertently positioned into the subarachnoid, intravascular (Table 68-4), or […]

Tibiotalar Joint Injection

Tiếng Việt >> Indications Tibiotalar joint injection is a useful therapeutic procedure with inflammation secondary to osteoarthritis, rheumatoid arthritis, or chronic pain from instability. Pain most often occurs with ankle extension and flexion with weight bearing. Techniques After informed consent is obtained, the patient is placed in the supine position with the leg extended and […]

Anserine Bursa Injection

Indications Anserine bursa injection is a useful diagnostic and therapeutic procedure in bursitis resulting from osteoarthritis or direct trauma. Pain is noted inferior to the anterior medial surface of the knee when climbing stairs. Pain is reproduced with the knee in flexion-extension while internally rotating the leg. Techniques After informed consent is obtained, the patient […]

Caudal Lumbar Epidural Injections

Caudal lumbar epidural injections are performed by inserting a needle through the sacral hiatus into the epidural space at the sacral canal (Figs. 68-9 and 68-10). The patient is placed in a prone position. The legs are slightly abducted and feet turned inward to separate the gluteal fold to facilitate palpation of the sacral cornu. […]

Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) is not really an arthropathy because it spares synovium, articular cartilage, and articular osseous surfaces. It is a fairly common ossification process involving ligamentous and tendinous attachments to bones and occurs in 12% of the elderly (55). It most commonly affects the thoracic spine but also may involve the pelvis, […]

Transforaminal Epidural Injection

Comment In one systematic review comparing transforaminal, interlaminar, and caudal ESIs, the authors concluded that there was moderate evidence for long-term (>6 weeks) relief of lumbar radicular pain using the transforaminal and caudal approaches, but limited evidence using the interlaminar approach (30). The authors also concluded that there was moderate evidence for relief of cervical […]

Calcium Pyrophosphate Dehydrate Deposition Disease

It is also known as pseudogout and has the classic triad of pain, cartilage calcification, and joint destruction. Chondrocalcinosis at the knee, wrist, or symphysis pubis is virtually diagnostic of calcium pyrophosphate dehydrate deposition disease (CPPD) (Fig. 6-42). FIGURE 6-42. Chondrocalcinosis. Frontal radiograph of the right knee. Calcifications (arrows) are present within the medial and […]

Knee Joint Injection

Tiếng Việt >> Indications Intraarticular corticosteroid injection of the knee joint is used to treat noninfective inflammatory joint disease secondary to rheumatoid arthritis, seronegative spondyloarthritides, or the chondrocalcinosis inflammatory phase of osteoarthritis. Techniques After informed consent is obtained, the patient is placed in the sitting position with the knee flexed to 90 degrees. The patellar […]