• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.2
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• pp.61-65
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• 2012

Purpose: The aim of this study was to evaluate the effectiveness of ultrasound-guide steroid injection according to Morton's neuroma size. Materials and Methods: From October 2008 to September 2011, 17 patients (23 cases) diagnosed with Morton's neuroma were investigated. All cases were female and mean age was 52.6 years old. Neuroma were measured by the horizontal and longitudinal length of the mass and underwent ultrasound-guided steroid (5 mg dexamethasone) injection. The efficacy of the injection was determined by Visual Analogue Scale pain score and patient satisfaction(subdivided 4 group-much improved, improved, not improved, aggrevation) Results: 7 of 23(30.4%) cases showed much improved and improved satisfaction and mean longitudinal and horizontal length were $0.71{\pm}0.39cm$ and $0.47{\pm}0.24cm$, respectively. 16 of 23(69.6%) cases showed not improved and aggrevation satisfaction and mean longitudinal and horizontal length were $0.83{\pm}0.42cm$ and $0.54{\pm}0.14cm$, repectively. There was a significant difference in VAS and patient satisfaction in case longitudinal and horizontal length were smaller than 0.5 cm and 0.4 cm. (p<0.05) Conclusion: The ultrasonography is a important modality in diagnosis and treatment of morton's neuroma. Ultrasound-guide steroid injection is effective in case longitudinal and horizontal length were smaller than 0.5 cm and 0.4 cm, respectively.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.731-736
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• 2005

Purpose : Acute pyogenic osteomyelitis is uncommon in children. Delayed diagnosis and inappropriate treatment are leading to growth failure and deformation. We review the clinical manifestations and treatment of acute osteomyelitis in children according to age. Methods : A retrospective analysis was made of 32 patients who underwent antibiotic management or operation between Aug 1989 and Dec 2003 for acute pyogenic osteomyelitis in age from 0 to 15 years old. Results : The study group was composed of 21 boys and 11 girls. The subjects were divided into four groups according to age : 0-1 yr(n=6), 1-5 yr(n=11), 6-10 yr(n=8), and 11-15 yr(n=7). Nineteen cases were diagnosed in Winter. Femur was the most common infected site(37.5%). There were no predisposing factor in 17 patients, and 7 of 15 patients had trauma history. Sepsis was important predisposing factor in neonates. The chief complaints were pain, swelling and fever. S. aureus(61%) is the most common organism. Twenty-nine patients were treated with operation and concomitant antibiotics. Two cases had sequelae in follow-up period : One is avascular necrosis of femur and the other is discrepancy of leg length. Conclusion : In our review, because of poor prognosis in septic neonates, we recommend to treat actively neonatal sepsis and prevent or detect osteomyelitis early. Because most of patients were diagnosed and treated in orthopedic surgery, the rate of operation was too high. So, protocol for further evaluation and management of acute osteomyelitis in pediatric patients were needed.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.113-119
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• 2014

Purpose: This study was to evaluate effect and efficiency of S1 selective nerve root block using ultrasonography-guided compared with fluoroscopy-guided for lumbar disc herniation or spinal stenosis patients. Materials and Methods: Between February 2012 and December 2013, 38 patients who were with lower leg radiating pain for more than 1months and underwent S1 selective spinal nerve root block in our institution, were reviewed. They divided into two groups: Group A included 18 patients with ultrasonography-guided and Group B included 20 patients with fluoroscopy-guided. Treatment effectiveness was assessed using a visual analogue scale (VAS) and the Korea Modified Oswestry Disability Index (K-MODI). They were evaluated its preoperatively, postoperatively and 1 month later. We were recorded whole procedure time. Results: VAS was improved from 7.4 to 4.7 at 1 month in group A and from 7.39 to 4.36 at 1month in group B. K-MODI was improved from 72.8 to 43.3 at 1month in group A and from 73.8 to 44.1 at 1month in group B. Whole procedure time were $477.53{\pm}115.02s$, $492.47{\pm}144.38s$ in group A, group B, respectively. But there was no significant difference in VAS and K-MODI between two groups. Conclusion: Ultrasonography-guided sacral nerve root block is effective and accurate method in sacral radiating pain.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.105-112
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• 2014

Purpose: Ultrasound-guided epidural caudal block for low back pain and radiating pain is often performed in the treatment of outpatients. However, this procedure has a failure rate of up to 25% even when it performed by an experienced physician. The authors investigate the effectiveness of Ultrasound-guided epidural caudal block in patients related to disc herniation or spinal stenosis. Materials and Methods: Ultrasound-guided caudal epidural block was performed in 55 outpatients with LBP and radiating pain. Patient was placed in the prone position and sonographic image of sacral hiatus was obtained using linear probe. A 22-gauge needle was advanced into the sacrococcygeal membrane under ultrasound guidance and then medication was injected into the caudal epidural space. There were 31 cases of disc herniation, and 24 cases of spinal stenosis. Patients were evaluated by Visual Analog Scale (VAS) pain score at pre-treatment, post-treatment, 2 weeks and 4 weeks by telephone interviews. Results: 53 of the 55 cases (96.4%) of needle insertion into the sacral canal under ultrasound guidance were successful. Gender was not significantly different between disc herniation group and spinal stenosis group. But there was a significant age difference between disc herniation group ($42.3{\pm}10.8$), and spinal stenosis group ($62.8{\pm}15.1$) [p<0.001]. The VAS score at pre-treatment, post-treatment, 2 weeks, 4 weeks in disc group were 6.84, 3.1, 1.8 & 1.77. The VAS score at pre-treatment, post-treatment, 2 weeks, 4 weeks in spinal stenosis group were 6.88, 3.58, 4.33 & 4.88. The VAS score in both groups was significantly improved after the procedure (p<0.001). Over time, the two groups were statistically significant differences in VAS score after adjusting for age (p<0.001). Conclusion: Ultrasound-guided caudal epidural block seems to provide a high success rate and a significantly better response in disc group than spinal stenosis group.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.77-83
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• 2014

Purpose: The purpose of current study was to evaluate the validity of the existing radiological classifications as a diagnostic modality for predicting characteristics of calcific deposition in calcific tendinitis of the shoulder joint. For that purpose, we determined the inter-observer reliability for evaluating diagnostic precisions of the classification and also evaluated diagnostic accuracy of predicting the toothpaste type calcific deposition. Materials and Methods: We performed retrospective study with total 26 patients surgically treated with calcific tendinitis of the shoulder joint from March 2010 to October 2013. Two independent observers reviewed preoperative radiographs of shoulder joints, and classified the characteristics of calcific depositions according to the criteria of Gartner, DePalma and Patte. Cohen's kappa were calculated for each classifications to evaluate inter-observer reliability. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were determined for type of calcific depositions with Gartner type III, DePalma type I, and Patte type II for predicting toothpaste type calcific deposition. Results: The values of Cohen's kappa were the highest in the classification of Patte, 0.62, and the values for the classifications of DePalma and Gartner were 0.56 and 0.36, respectively. The sensitivities for predicting toothpaste type calcific deposition in Gartner Type III, DePalma type I and Patte type II were 83.3%, 91.7%, and 58.3%, respectively. Specificities were 85.7% 50.0% and 64%, positive likelihood ratios were 5.833, 1.833 and 1.633, negative likelihood ratios were 0.194, 0.167 and 0.648, and diagnostic odds ratios were 30.00, 11.00 and 2.52, respectively. Conclusion: There were no radiologic classifications of calcific tendinitis which has both high precision and accuracy. Further studies with other diagnostic modalities such as ultrasonography are needed for predicting characteristics of calcific deposition in calcific tendinitis of the shoulder joint.

• The Journal of the Korea Contents Association
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• v.10 no.6
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• pp.323-328
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• 2010

If a patient wearing arm sliding due to shoulder dislocation or fracture is impossible with abduction, the velpeau view is performed instead of superior-inferior axial projection view. However, it aggravates the patient's pain because it is difficult for the patient with dislocation or fracture to pull back the shoulders. Therefore, I suggest a new method of the 'modified velpeau view' that allows patients to lower their heads at examination. In order to investigate the easiness of fixing posture at examination and clinical utility, I conducted a study comparing the bone structures at the velpeau view and those at the modified velpeau view depending on wall-bucky and the patients' leaning forward angle ($30^{\circ},\;45^{\circ},\;60^{\circ}\;and\;75^{\circ}$), with the subjects of 20 velpeau view-prescribed patients amongst who had come to my hospital suspected of dislocation of shoulder or fracture and 30 healthy people from October of 2009 to January of 2010. Department of radiologists and orthopedics specialists evaluated the pictures for scales 0 to 5(best grade) under the given criteria. As a result of comparison in bone structures depending on wall-bucky and the leaning-forward angle in the group of healthy people, the velpeau view and the modified velpeau showed a similar diagnostic utility at $45^{\circ}$ and $60^{\circ}$. The picture evaluation result for proving diagnostic value showed that the anterior and posterior of shoulder heads and the anterior and posterior of glenoid fossa could be observed in the velpeau view; on the other hand, besides these areas acromioclavicular joint and coracoid process could be viewed in the modified velpeau view. This result verified that the modified velpeau view could replace the velpeau view for its diagnostic value as an examination method. This result, moreover, suggests that the modified velpeau view needs to be studied and improved from a variety of perspectives not only for an alternative for patients having troubles with the velpeau view position but also for clinical application of new test method for diagnosis of shoulder disorders other than dislocation of shoulder or fracture.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.1
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• pp.9-14
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• 2012

Purpose: The purpose of the study was to evaluate the accuracy and clinical outcome of ultrasound-guided glenohumeral joint steroid injection on adhesive capsulitis. Materials and Methods: Patients who were diagnosed as adhesive capsulitis by MRI and physical examination and did not improve their symptom with physical therapy and NSAIDS treatment more than 6 months were included in the study. Patients who showed any other shoulder pathology or history if trauma were excluded from the study. 33 patients including 15 males and 18 females were enrolled in the study, the average age being 55.1 (age 42~72). Cocktail of steroid, lidocaine, saline and contrast medium injected inside shoulder glenohumeral joint using novel approach (which we called acromioclavicular approach) under ultrasound guidance. Clinical outcome was measured through passive range of motion and VAS scoring system. Results: Based on radiographic findings, cases were classified according to the leakage of contrast medium; perfect confinement of contrast-medium inside the capsule, partial leakage of the medium and contrast-medium found at outside the joint. Total 25 cases (76%) out of 33 cases showed perfect confinement of contrast-medium inside the glenohumeral joint. Partial leakage was observed in 6 cases (18%), and contrast medium was observed outside of the glenohumeral joint in 2 cases (6%). Perfect-confinement group showed $111^{\circ}$($80{\sim}140^{\circ}$) of forward flexion and $48^{\circ}$($0{\sim}90^{\circ}$) of external rotation before injection, and improved to $134^{\circ}$($90{\sim}150^{\circ}$) of forward flexion and $70^{\circ}$($30{\sim}90^{\circ}$) of external rotation after injection (p<0.01). Partial leakage showed $120^{\circ}$($90{\sim}150^{\circ}$) of forward flexion and $70^{\circ}$($10{\sim}90^{\circ}$) of external rotation before injection, and improved to $139^{\circ}$($135{\sim}140^{\circ}$) of forward flexion and $78^{\circ}$($50{\sim}90^{\circ}$) of external rotation after injection (p<0.01). VAS score improved from 7.1 (score 3~9) to 2.6 (score 0~5) (p<0.01) in perfect confinement group, from 7.5 (score 7~9) to 3.3 (score 2~4) (p<0.01) in partial leakage group. Two group showed no significant difference. Conclusion: Accuracy of Acromioclavicular approach was 94% which is better than any other methods published so far. Partial leakage of the injection material did not show inferior result compared to perfect injection.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.1
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• pp.1-8
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• 2012

Purpose: The purpose of this study is to report the preliminarily result of the radiologic disappearance of the calcific material, regardless of the size, type or location, on one-time ultrasonographic (US) assisted needling for calcific tendinitis of the shoulder. Materials and Methods: From March to August 2011, 46 patients (47 shoulders) with symptomatic calcific tendinitis were treated by one-time US assisted needling. Initially, a diagnostic US was performed with patient to determine the locations, numbers and sizes of calcific deposits. After 1% lidocaine local anesthesia, the calcific material was punctured with an 18-gauge needle under US monitoring. If no calcific material was aspirated after 2 or 3 additional attempts, the deposits was performed multiple puncture to achieve decompression. And then all patients were performed subacromial corticosteroid injection. All patients were followed up 4 weeks after procedure. To assess the radiologic disappearance after one-time US assisted needling, simple radiographs of the treated shoulder were performed and size, dense, and morphology of the calcific deposits were compared with those in baseline radiographs. For clinical evaluations, visual analogue scale for pain and function (PVAS and FVAS), and American Shoulder and Elbow Surgeons (ASES) score were assessed. Results: There were 11 male and 35 female patients with the mean age of 53.8 years (28-71). The morphology of the calcific deposits were 31 type A and 16 type B by French Arthroscopic Society classification and mean size was $2.9{\pm}6.7$ mm before the procedure. At 4 weeks after the index procedure, the radiographic unchanged group was included in 10 cases and changed group was 37 cases. No intergroup difference for the clinical results after the procedure was evident, but group FAS classification before the procedure was significantly different (p=0.011). Conclusion: At 4 weeks after one-time US assisted needling for calcific tendinitis of the shoulder, the radiographic size- or dense-changed cases were showed in 79%, regardless of the size, type or location of the calcific material. But the radiographic nearly or complete disappearance were showed in only 21%.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.3 no.1
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• pp.15-20
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• 2010

Purpose: The goal of this study is to find out how useful ultrasonography is in measuring amount of effusion within the knee joint in comparison with physical examination and simple radiography. Materials and Methods: We evaluated total 60 cases which were suspicious for joint effusion. Average age was 61.3 years. The group was consisted of 22 males and 38 females, and 24 obese people and 36 non-obese people. Stroke test and patella floating test were done as physical examination. Amount of joint effusion was classified into 3 groups in simple lateral radiographic view and ultrasonography was used for recheck-up. Results: 39 cases were found positive in stroke test, and patella floating was shown in 20 cases. In simple lateral radiographic view, 47 cases of grade I, 7 cases of grade II and 3 cases of grade III were checked. Average $7.67{\pm}2.90mm$ amount of effusion was checked by ultrasonography. Amount of fluid in stroke test, patella floating test and simple lateral radiographic view showed close correlation with ultrasonography. Gender did not seem to affect physical examination, but strong correlation was found in female in simple radiography. Obese group showed closer relationship with all 3 exams compared with non-obese group. Physical examination was relatively effective with nonobese group, but not with obese group. And it was not easy to measure the amount of fluid with simple radiographic view, but we could obtain objective data from ultrasonography by measuring the amount of effusion dynamically. Conclusion: We concluded that more objective data was obtained with ultrasonography in comparison with physical examinations and simple radiography in the aspect of measuring amount of joint fluid.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.2 no.2
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• pp.85-89
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• 2009

Purpose: To analyze the clinical outcome after ultrasound guided multiple dry needlings and local steroid injection for acute calcific tendinitis of shoulder. Materials and Methods: Twenty patients with acute episode of pain by calcific tendinitis of shoulder with average age 58.2 (50~70 years) and follow-up of 18 months in average (range, 12~24) were included in study. There were 18 patients with right and 2 with left sided involvement. All patients had calcific deposits in the supraspinatus tendon. All patients underwent standardized nonoperative treatment protocol, consisting of 5~12 MHz high resolution ultrasound guided multiple dry needlings with 18 guage needle, followed by 2% lidocaine 1cc and 40 mg/ml depomedrol 1cc injection at site of calcific tendinitis. The outcome was assessed by UCLA shoulder score, range of motion and VAS score. A statistical analysis with ANOVA and Tukey's post-hoc test with the significance level at 5% was performed using SAS 9.1 software (SAS Institute, Cary, NC). Results: All patients got continuous relief of pain right after the procedures until final follow-up. Before the procedures, the UCLA scores were fair in 15 patients and poor in 5. After the procedures, the UCLA scores were excellent in 16 patients and good in 4. All cases revealed no limitation of shoulder function. The average VAS score decreased from 8.9 before the procedures to 0.5 at final follow-up (p<0.0001). No complication was encountered. Conclusion: An ultrasound guided local steroid injections following multiple dry needlings would be one of the useful treatment modality for the acute calcific tendinitis of shoulder.