Ultrasound-guided injection of the ankle joint: cadaveric investigation of the anterolateral approach.

OBJECTIVE: Injection of the tibiotalar (TT) joint is commonly performed in clinical practice under ultrasound (US) guidance using an anteromedial approach. However, in some patients, this approach may be technically challenging due to post-traumatic and/or degenerative bony changes. Therefore, the aim of this cadaveric investigation was to demonstrate the feasibility of the ultrasound-guided (USG) injection of the ankle joint via the anterolateral sulcus (ALS) by confirming the dye placement/distribution inside the articular space. Likewise, the safety of the procedure has also been evaluated by measuring the distance between the needle and the intermediate dorsal cutaneous nerve of the foot. DESIGN: A descriptive laboratory study with eight embalmed cadaveric ankles using the Fix for Life (F4L) method was performed at the setting of an academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced into the TT joint through the ALS under US guidance, i.e., in-plane anterior-to-posterior approach. With the objective to confirm its correct placement, the needle was kept in situ and-to demonstrate the location of the dye inside the articular space-all eight ankles were injected with 3 mL of green color dye. Thereafter, a layer-by-layer anatomical dissection was performed on all four cadavers. RESULTS: The position of the needle's tip within the ALS was confirmed in all specimens. Accurate placement of the dye inside the articular space of the ankle was confirmed in seven of the eight cadaveric ankles, with 87.5% of accuracy. Herewith, unintentional spilling of the dye within the superficial soft tissues was reported in two of the eight ankles (25.0%). The mean distance between the needle and the intermediate dorsal cutaneous nerve of the foot, measured in all eight procedures, was 3 cm. CONCLUSION: USG injection of the ALS using the in-plane, anterior-to-posterior approach can accurately place the injectate inside the articular space. CLINICAL RELEVANCE: This cadaveric investigation described the accuracy and potential pitfalls of USG injection of the ankle via the anterolateral approach which represents an alternative technique in patients with reduced accessibility of the anteromedial recess due to degenerative and/or post-traumatic bony changes.

Ultrasound-guided injection of the achilles paratenon: A cadaveric investigation.

BACKGROUND: Injections around the Achilles tendon (AT) are commonly performed in clinical practice to manage non-insertional Achilles tendinopathy, but the presence/distribution of the injectate with relation to its sheath has not been assessed specifically. Accordingly, the aim of this cadaveric investigation was to demonstrate the feasibility of Achilles paratenon injection under ultrasound guidance - by confirming the exact needle positioning as well as the dye distribution inside the paratenon lumen. METHODS: A descriptive laboratory study with three human cadaveric specimens (one fresh cadaver and two cadavers embalmed using the Fix for Life (F4L) method) was performed in a tertiary-care academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced inside the Achilles paratenon under ultrasound guidance i.e. in-plane medial-to-lateral approach. With the objective to confirm its correct placement, the needle was kept in situ on the right AT of the fresh cadaver. Likewise, to demonstrate the location of the dye inside the lumen of Achilles paratenon, the other five ATs - four on the embalmed cadavers and one on the fresh cadaver - were injected with 5 mL of green color dye. After removal of the needle, a layer-by-layer anatomical dissection was performed on all three cadavers. RESULTS: On the right AT of the fresh cadaver, the position of the needle's tip within the Achilles paratenon was confirmed. Accurate placement of the dye inside the paratenon lumen was confirmed in four (80%) ATs, one of the fresh and three of the embalmed cadavers. No spread inside the crural fascia compartment or between the AT and the Kager's fat pad was observed. Herewith, unintentional spilling of the dye within the superficial soft tissues of the posterior leg was reported in the left AT of one of the two embalmed cadavers (20%). CONCLUSIONS: Ultrasound-guided injection using the in-plane, medial-to-lateral approach can accurately target the lumen of Achilles paratenon.

Technological advances and digital solutions to improve quality of life in older adults with chronic obstructive pulmonary disease: a systematic review.

BACKGROUND: Several technological advances and digital solutions have been proposed in the recent years to face the emerging need for tele-monitoring older adults with Chronic Obstructive Pulmonary Disease (COPD). However, several challenges have negatively influenced an evidence-based approach to improve Health-Related Quality of Life (HR-QoL) in these patients. AIM: To assess the effects of tele-monitoring devices on HR-QoL in older adults with COPD. METHODS: On November 11, 2022, PubMed, Scopus, Web of Science, and Cochrane were systematically searched for randomized controlled trials (RCTs) consistent with the following PICO model: older people with COPD as participants, tele-monitoring devices as intervention, any comparator, and HR-QoL as the primary outcome. Functional outcomes, sanitary costs, safety, and feasibility were considered secondary outcomes. The quality assessment was performed in accordance with the Jadad scale. RESULTS: A total of 1845 records were identified and screened for eligibility. As a result, 5 RCTs assessing 584 patients (423 males and 161 females) were included in the systematic review. Tele-monitoring devices were ASTRI telecare system, WeChat social media, Pedometer, SweetAge monitoring system, and CHROMED monitoring platform. No significant improvements in terms of HR-QoL were reported in the included studies. However, positive effects were shown in terms of the number of respiratory events and hospitalization in patients telemonitored by SweetAge system and CHROMED platform. DISCUSSION: Although a little evidence supports the role of tele-monitoring devices in improving HR-QoL in older patients, positive effects were reported in COPD exacerbation consequences and functional outcomes. CONCLUSION: Tele-monitoring solutions might be considered as sustainable strategies to implement HR-QoL in the long-term management of older patients with COPD.

Assessing/Imaging the Subcoracoid Space: From Anatomy to Dynamic Sonography.

In the pertinent literature, standardized sonographic protocols have been widely described to evaluate the different compartments of the shoulder. However, the subcoracoid space is a complex anatomical region-usually not included/described in basic ultrasound approaches. Accordingly, starting from its anatomy, we describe a two-phase dynamic ultrasound protocol to scan the subcoracoid space. This way, we aim to optimize the diagnosis and management of patients with anterior shoulder pain and subcoracoid effusion.

Impact of exercise training on muscle mitochondria modifications in older adults: a systematic review of randomized controlled trials.

BACKGROUND: Previous evidence showed that cellular aging is a multifactorial process that is associated with decline in mitochondrial function. Physical exercise has been proposed as an effective and safe therapeutical intervention to improve the mitochondria network in the adult myocytes. AIMS: The aim of this systematic review of randomized controlled trials (RCTs) was to assess the exercise-induced muscle mitochondria modifications in older adults, underlining the differences related to different exercise modalities. METHODS: On November 28th, 2021, five databases (PubMed, Scopus, Web of Science, Cochrane, and PEDro) were systematically searched for RCTs to include articles with: healthy older people as participants; physical exercise (endurance training (ET), resistance training (RT), and combined training (CT)) as intervention; other different exercise modalities or physical inactivity as comparator; mitochondrial modifications (quality, density and dynamics, oxidative, and antioxidant capacity) as outcomes. The quality assessment was performed according to the PEDro scale; the bias risk was evaluated by Cochrane risk-of-bias assessment tool. RESULTS: Out of 2940 records, 6 studies were included (2 assessing ET, 2 RT, 1 CT, and 1 both ET and RT). Taken together, 164 elderly subjects were included in the present systematic review. Significant positive effects were reported in terms of mitochondrial quality, density, dynamics, oxidative and antioxidant capacity, even though with different degrees according to the exercise type. The quality assessment reported one good-quality study, whereas the other five studies had a fair quality. DISCUSSION: The overall low quality of the studies on this topic indicate that further research is needed. CONCLUSION: RT seems to be the most studied physical exercise modality improving mitochondrial density and dynamics, while ET have been related to mitochondrial antioxidant capacity improvements. However, these exercise-induced specific effects should be better explored in older people.

Anatomy and ultrasound imaging of the tibial collateral ligament: A narrative review.

Medial knee pain is commonplace in clinical practice and ultrasound assessment of the tibial collateral ligament-medial meniscus complex is increasingly becoming a valuable examination tool in the outpatient setting. In the pertinent literature, basic sonographic protocols have been proposed to evaluate the medial compartment of the knee joint. Using high-frequency ultrasound probes and high-level ultrasound machines; we matched the histo-anatomical features of the tibial collateral ligament-medial meniscus complex and its different sonographic patterns in physiological/pathological conditions to define a standardized (layer-by-layer) sonographic approach. Moreover, high-sensitive power Doppler assessments have also been performed to evaluate the nearby microcirculation. Modern ultrasound equipment appears to provide optimal "sonographic dissection" of the tibial collateral ligament-medial meniscus complex for its various physiological/pathological patterns. Likewise, high-sensitive power Doppler allows clear visualization of the microcirculation as regards the local ligamentous and capsular structures. In clinical practice, using adequate technological equipment, a detailed sonographic assessment of the tibial collateral ligament-medial meniscus complex can be performed. High-frequency B-mode ultrasound imaging and high-sensitive power Doppler perfusion patterns can be matched/integrated with the clinical findings to optimize the management of patients with medial knee pain.

Physicians´ perceptions of working in mass vaccination sites during COVID-19 pandemic.

BACKGROUND: This survey was aimed to obtain the characteristics of physicians operating in mass vaccination sites (MVS), emphasizing their motivation to work there. METHOD: We conducted a nationwide cross-sectional internet-based survey involving physicians operating in MVS during the COVID-19 pandemic. The questionnaire comprised demographic characteristics and questions regarding the perception of physicians working in MVS. RESULTS: In total, 140 questionnaire responses were analysed. There were 98 female (70 %) and 42 male (30 %) physicians. Fifty-five were residents (39.3 %), and 85 were attending physicians (60.7 %). As the main motivation for participating in MVS, residents (43.6 %) reported a financial benefit, while moral responsibility was more common in attending physicians (50.6 %), (p0.05). Physician burnout was more prevalent (32 %) in those study participants, who worked in MVS as part of their work duty. 48 % of these physicians expressed no willingness to work in MVS in the future. All the respondents, who reported the professional experience as their main motivation to work in MVS expressed their will to work in MVS again. CONCLUSIONS: The financial aspect was the most important motivational factor among residents, while moral responsibility was decisive for the attending physicians. Physicians, who participated in MVS as a work duty presented both the most prevalent self-perceived burnout syndrome (32 %) and the hesitancy (48 %) to work in MVS again in the future (Tab. 4, Ref. 15) Keywords: mass vaccination site, COVID-19; healthcare workers, vaccination, SARS-CoV-2, coronavirus.

Non-pharmacologic treatment of insomnia in primary care settings.

INTRODUCTION: Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a non-pharmacologic approach should be preferred in most cases. Although generally considered first-line treatment, the non-pharmacologic approach is often underestimated by both patients and physicians. OBJECTIVE: To provide primary care physicians an up-to-date approach to the non-pharmacologic treatment of insomnia. METHODS: PubMed, Web of Science, and Scopus databases were searched for relevant articles about the non-pharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. MAIN MESSAGE: Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and non-pharmacologic approaches, while the latter should be generally considered first-line treatment. A primary care physician may opt to refer the patient to a subspecialist for refractory cases. CONCLUSIONS: This paper provides an overview of current recommendations and up-to-date evidence for the non-pharmacologic treatment of insomnia. This article emphasizes the importance of cognitive-behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered, eg, light therapy, aromatherapy, music therapy, and herbal medicine.

Contrast-enhanced Ultrasonography for the Diagnosis of Frozen Shoulder.

INTRODUCTION: Adhesive capsulitis (AC), also known as frozen shoulder, is challenging for diagnosis, particularly in early stages. A promising tool is contrast-enhanced ultrasonography (CEUS), which has been successfully applied on musculoskeletal ultrasonography. METHODS AND RESULTS: Two antecedent studies reported the application of CEUS on AC patients although different methods were used. The first research team administered the contrast media intravenously to facilitate detection of microcirculation through observing different distributions of time-intensity curves between the affected and unaffected shoulders. The second study has introduced a pioneering approach, injecting the contrast media mixed with saline directly into the glenohumeral joint. The authors designated this novel method as "US arthrography". According to our best knowledge, this is the first study reporting the application of intraarticular CEUS in humans. CONCLUSION: Both presented studies reported CEUS to be capable of differentiating shoulders with AC from normal controls.

Working from home is associated with changes in sleep hygiene practice.

BACKGROUND: Sleep hygiene habits and self-reported sleep quality of those who work from home have yet to be fully understood. As working from home was widely implemented during the COVID-19 pandemic, the period might be a convenient model for studying the measures, as mentioned earlier. OBJECTIVE: This study aimed to assess sleep hygiene habits and self-reported sleep quality in people working from home in March 2020, when the COVID-19 pandemic began. METHOD: This study was designed as a cross-sectional web-based survey. An anonymous questionnaire consisted of sociodemographic variables and questions about personal habits, e.g., exercise activities and caffeine consumption. The outcome measures to assess sleep hygiene and sleep quality were the Sleep Hygiene Index (SHI) before and after the home office (HO) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: A total of 204 responses were received. The prevalence of significant sleep disturbance (PSQI > 5) was 51 %. The mean PSQI and SHI scores were 6.15±3.385 and 17.67±7.836, respectively. PSQI and SHI showed a significant mutual positive correlation at the level of significance p < 0.001. The total score for SHI was similar before and after working from home (p = 0.982). However, differences were observed in its components. CONCLUSION: The total score on SHI did not change when compared before and during HO. However, working from home was associated with sleep hygiene malpractice in some individual components of SHI. On the other hand, some aspects of sleep hygiene behavior improved during HO.

Ultrasound examination for injury of the wrist extensor retinaculum.

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Ultrasound imaging of the transversus nuchae muscle: a potential entrapment site for the lesser occipital nerve.

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Ultrasound Imaging of the Articularis Genus Muscle: Implications for Ultrasound-Guided Suprapatellar Recess Injection.

Elucidating its dynamic interaction within the knee joint, this exploration delves into the awareness regarding the articularis genus muscle for ultrasound-guided suprapatellar recess injections. While injections into the infrapatellar recess may proceed without ultrasound guidance, we highlight concerns regarding the potential cartilage injury. In contrast, especially with ultrasound guidance, suprapatellar recess injections significantly mitigate this risk, especially in the case of collapsed recess. Originating from the distal femur and vastus intermedius, the articularis genus muscle influences the tension of the suprapatellar recess during knee motion. Sonographically identifying this muscle involves visualizing the slender linear structure of the suprapatellar recess, with guidance on differentiation from the vastus intermedius. We provide a succinct approach to ultrasound-guided suprapatellar recess injections, emphasizing needle insertion techniques and strategies to prevent fluid accumulation. In conclusion, this study serves as a concise clinician's guide, underscoring the significance of the articularis genus muscle's sonoanatomy in ultrasound-guided suprapatellar recess injections. Ultimately, procedural precision and patient safety can be advanced in this aspect.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Ankle/Foot.

ABSTRACT: In this dynamic scanning protocol, ultrasound examination of the ankle is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.

Influence of hand grip strength test and short physical performance battery on FRAX in post-menopausal women: a machine learning cross-sectional study.

BACKGROUND: Impaired physical performance and muscle strength are recognized risk factors for fragility fractures, frequently associated with osteoporosis and sarcopenia. However, the integration of muscle strength and physical performance in the comprehensive assessment of fracture risk is still debated. Therefore, this cross-sectional study aimed to assess the potential role of hand grip strength (HGS) and short physical performance battery (SPPB) for predicting fragility fractures and their correlation with Fracture Risk Assessment Tool (FRAX) with a machine learning approach. METHODS: In this cross-sectional study, a group of postmenopausal women underwent assessment of their strength, with the outcome measured using the HSG, their physical performance evaluated using the SPPB, and the predictive algorithm for fragility fractures known as FRAX. The statistical analysis included correlation analysis using Pearson's r and a decision tree model to compare different variables and their relationship with the FRAX Index. This machine learning approach allowed to create a visual decision boundaries plot, providing a dynamic representation of variables interactions in predicting fracture risk. RESULTS: Thirty-four patients (mean age 63.8±10.7 years) were included. Both HGS and SPPB negatively correlate with FRAX major (r=-0.381, P=0.034; and r=-0.407, P=0.023 respectively), whereas only SPPB significantly correlated with an inverse proportionality to FRAX hip (r=-0.492, P=0.001). According to a machine learning approach, FRAX major ≥20 and/or hip ≥3 might be reported for an SPPB<6. Concurrently, HGS<17.5 kg correlated with FRAX major ≥20 and/or hip ≥3. CONCLUSIONS: In light of the major findings, this cross-sectional study using a machine learning model related SPPB and HGS to FRAX. Therefore, a precise assessment including muscle strength and physical performance might be considered in the multidisciplinary assessment of fracture risk in post-menopausal women.