Ultrasound-guided viscosupplementation of subacromial space in elderly patients with cuff tear arthropathy using a high weight hyaluronic acid: prospective open-label non-randomized trial.

OBJECTIVE: To assess if ultrasound (US)-guided viscosupplementation can reduce pain and improve function in elderly patients with cuff tear arthropathy. PATIENTS AND METHODS: Ninety-three patients aged over 65 with grade 3 or above cuff tear arthropathy were included in this prospective open-label non-randomized trial. Institutional review board approval and informed consent were obtained. Thirty-three patients received intra-articular injections of sodium hyaluronate under US guidance. Sixty patients constituted the control group. Shoulder joint function was assessed with Constant scores (CS) and pain with a visual analogue scale (VAS). RESULTS: Compared with controls, treated patients reported a significant decrease in symptoms at 1 (mean CS 66±3.1 vs 37±6.9; mean VAS 1.9±1.2 vs 6.9±2.2), 2 (mean CS 65±3.2 vs 35±7.2; mean VAS 1.7±1.2 vs 6.8±2.5), 3 (mean CS 66±3.4 vs 33 6.1; mean VAS 2.3±1.2 vs 6.6±1.9), and 4 (mean CS 62±3.0 vs 34±6.5; mean VAS 3.3±1.4 vs 7.8±3.1) months, p<0.001. After 5 months there were no differences. CONCLUSION: US-guided viscosupplementation is a beneficial therapeutic option in the first months of treatment.

Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients.

OBJECTIVES: The purposes of this study were to describe a technique for treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy) using ultrasound guidance and to report the results of treatment. METHODS: Twenty consecutive patients (7 male and 13 female; age range, 23-66 years; mean, 39 years) with meralgia paresthetica confirmed by electromyography were treated with perineural injection of 1 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of mepivacaine, 2%, under direct ultrasound guidance. Main outcome measures included the technical success of the procedure, visual analog scale score for the lateral femoral cutaneous nerve (pain, burning sensation, and paresthesia), and visual analog scale global quality of life score. RESULTS: Technical success (successful nerve block at the distribution of the lateral femoral cutaneous nerve) was achieved in all patients. Five patients felt slight sharp pain during needle insertion. The symptoms in 16 patients (80%) diminished progressively after the first week. The 4 remaining patients (20%) required a further perineural injection. The symptoms disappeared in all patients 2 months after injection (mean visual analog scale score ± SD for lateral femoral cutaneous neuropathy at baseline, 8.1 ± 2.1; at 2 months, 2.1 ± 0.5; t = 6.2; P < .001). The mean visual analog scale quality of life scored decreased from 6.9 ± 3.2 to 2.3 ± 2.5 (t = 5.3; P < .002). CONCLUSIONS: Treatment of meralgia paresthetica with ultrasound-guided perineural injections resulted in substantial symptom relief in most patients 2 months after injection. Randomized placebo-controlled trials of this treatment should be considered in the future.