Echographie des ligaments radio-carpien et inter-carpien dorsaux du poignet (étude anatomique, aspects échographiques normaux et pathologiques)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Skeletal Radiol

To compare the efficacy of the transforaminal approach (TFA) versus the interlaminar approach (ILA) for CT-guided epidural steroid injection (CTESI) in the treatment of persistent lumbosacral radicular pain (LRP > 6 weeks) with long-term follow-up. Patients were prospectively assessed for pain by visual analogue scale (VAS) and functional disability (Oswestry Disability Index, (ODI)) before treatment, then 6 weeks (6W), 6 months (6 M), and 5 years (5Y) after CTESI. Overall, n = 237 patients (TFA, n = 71 and ILA, n = 166) were included, and 96 patients had 5 years of follow-up. Both groups showed a statistically significant improvement in VAS and ODI values at 6W (TFA, n = 60 and ILA, n = 146, P < 0.001 for both), at 6 M (TFA, n = 34 and ILA, n = 96, P < 0.001 for both), and at 5Y (TFA, n = 32 and ILA, n = 64, P < 0.001 for both). No significant differences were observed between the two approaches in VAS or ODI decreases at 6W (P = 0.38 and P = 0.33 respectively), 6 M (P = 0.13 and P = 0.51 respectively), or 5Y (P = 0.15 and P = 0.57 respectively). No major complications were noted. Outcomes after CTESI by ILA approaches are similar to those by TFA for the treatment of persistent LRP

The Median Nerve at the Carpal Tunnel … and Elsewhere

The median nerve (MN) may be affected by various peripheral neuropathies, each of which may be categorized according to its cause, as either an extrinsic (due to an entrapment or a nerve compression) or an intrinsic (including neurogenic tumors) neuropathy. Entrapment neuropathies are characterized by alterations of the nerve function that are caused by mechanical or dynamic compression. It occurs because of anatomic constraints at specific locations including sites where the nerve courses through fibro-osseous or fibromuscular tunnels or penetrates a muscle. For the diagnosis of peripheral neuropathies, physicians traditionally relied primarily on clinical fi ndings and electrodiagnostic testing with electromyography. However, if further doubt exists, clinicians may ask for an additional imaging evaluation

Retrospective Analysis of Responders and Impaired Patients with Knee Osteoarthritis Treated with Two Consecutive Injections of Very Pure Platelet-Rich Plasma (PRP)

Objectives: To assess the effectiveness of two consecutive intraarticular injections of PRP to treat knee osteoarthritis (KOA), discriminating between responders and impaired patients. Methods: This retrospective study included 73 consecutive patients who were referred for two intra-articular PRP injections (one week apart) for treating symptomatic moderate/severe KOA. Biological characterization of the PRP, including platelets, leukocytes and erythrocytes, was evaluated. Patient’s subjective symptoms were recorded before the treatment and 1 year after the second injection using pain VAS and WOMAC scores. Responders were defined by an improvement of 10 points on WOMAC. Results: At a 1-year follow up, we found 36 (49.3%) patients who fulfilled the criteria of responders, and 21 (28.8%) patients were impaired. A statistically and clinically significant global improvement of −29.2 ± 14.3 (p p = 0.027). However, the average pain score remained stable with no significant differences after 1 year (p = 0.843). No clinical complications or severe adverse events after the PRP injections were reported. Conclusion: The present study suggests that two intra-articular injections of 10 mL of very pure PRP provide pain and functional improvement in symptomatic KOA

MRI in chronic groin pain: sequence diagnostic reliability compared to systematic surgical assessment

International audienc

Arthro-IRM du poignet en traction : comment faire ?

L’arthrographie par résonance magnétique (arthro-IRM) est une technique efficace pour l’étude des ligaments intrinsèques et extrinsèques du poignet ainsi que du fibrocartilage triangulaire du carpe (triangular fibrocartilage complex [TFCC]) [1, 2]. Alors que l’arthro-scanner (arthro-TDM) est supérieur pour l’analyse de l’os cortical et du cartilage grâce à sa résolution spatiale supérieure, l’arthro-IRM permet une meilleure évaluation de l’os médullaire et des tissus mous, notamment des ligaments et des tendons, grâce à sa meilleure résolution en contraste [1]. L’arthro-IRM est particulièrement précise pour la détection d’une rupture du TFCC avec une sensibilité et une spécificité de 85 % et de 76 % par rapport à l’IRM standard (sensibilité et spécificité de 17 % et 79 %) [3, 4]. Des manœuvres de traction inspirées par les techniques d’arthroscopie ont été précédemment développées pour l’imagerie de l’épaule, de la hanche, du genou et même pour l’arthro-IRM métatarso-phalangienne [5, 6, 7, 8]. Guntern et al. ont étudié 12 arthro-IRM de poignet avec et sans traction et ont mis en évidence une augmentation significative de la largeur des interlignes articulaires radio-carpien et luno-capital lors de la traction axiale ainsi qu’une meilleure couverture du cartilage articulaire par le produit de contraste [5]. Cerny et al. ont étudié 20 arthro-IRM du poignet et ont conclu que la traction axiale pouvait améliorer la détection et la caractérisation des ruptures des ligaments scapho-lunaire et luno-triquétral en élargissant l’interligne articulaire et en augmentant la quantité de produit de contraste dans l’articulation [6]

Combined intra-tendinous injection of Platelet Rich Plasma and bevacizumab accelerates and improves healing compared to Platelet Rich Plasma in tendinosis: comprehensive assessment on a rat model

Purpose: the aim of our study was to assess the potential of combined intratendinous injection of an anti-angiogenic drug: bevacizumab (AA) and Platelet Rich Plasma (PRP) to treat tendinopathy in a murine model of patellar and Achilles tendinopathy, and to evaluate its local toxicity. Material and method: twenty rats (80 patellar and Achilles tendons) were used for the study. We induced tendinosis (T+) in 80 tendons (patellar=40 and Achilles=40) by injecting under ultrasonography (US) guidance Collagenase 1® (day 0 = D0). Clinical examination was performed at D3, immediately followed by either PRP and AA (AAPRPT+, n=40) or PRP (PRPT+ n=40, control) US-guided intratendinous injection. Follow-up at D6, D18 and D25 using clinical, US and histology, and comparison between the 2 groups were performed. To study AA+PRP toxicity, we looked for necrosis or rupture on the 40 AAPRPT+. Results: all AAPRPT+ showed better joint mobilization compared to PRPT+ at D6 (p=0.03), D18 (p=0.04) and D25 (p=0.02). Similar results were found regarding US and histology, with smaller collagen fiber diameters (D6, p≤0.017, D25, p≤0.015), less disorganization and fewer neovessels (D25, p=0.004) in AAPRPT+ compared to PRPT+. No AA+PRP local toxicity was discovered in histology assessment. Conclusion: our study suggests that combined injection of AA and PRP in tendinosis accelerates and improves tendon’s healing compared PRP used alone, with no local toxicity