المؤلفون: Simon Rio, Guillaume Coiffier, Benoit Le Goff, Pascal Guggenbuhl, François Robin, Christelle Darrieutort-Laffite, Jean-David Albert

المساهمون: CHU Pontchaillou [Rennes], Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)

المصدر: Joint Bone Spine
Joint Bone Spine, 2020, 87 (4), pp.364-365. ⟨10.1016/j.jbspin.2019.11.006⟩
Joint Bone Spine, Elsevier Masson, 2020, 87 (4), pp.364-365. ⟨10.1016/j.jbspin.2019.11.006⟩

مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Steroid injection, Injections, Epidural, caudal hiatus epidural injection, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, medicine, Humans, Lower lumbar radicular pain, 030212 general & internal medicine, Prospective Studies, ultrasound-guided, Radiculopathy, Ultrasonography, Interventional, 030203 arthritis & rheumatology, Lumbar Vertebrae, business.industry, Joint bone, medicine.disease, Ultrasound guided, 3. Good health, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Radicular pain, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Observational study, Steroids, Radiology, business, Low Back Pain

الوصف: International audience; Lower lumbar radicular pain is a benign and frequent condition, mostly induced by disk herniation or osteoarthritis. The management of lower lumbar radicular pain is a public health problem, with multimodal management. Lumbar epidural steroid injections are considered as a treatment but their effectiveness remains controversial, with conflicting results. Injection via the caudal hiatus route (CH) under ultrasound (US) guidance has gained popularity because of accessibility or US equipment, absence of irradiation, feasibility and very few complications reported.A pragmatic prospective observational two-center (Rennes and Nantes University Hospitals) study was performed to evaluate the effectiveness of a single steroid (cortivazol) epidural injection delivered under US guidance via the CH on lower lumbar radicular pain. The primary outcome for success was achieving a numerical pain rating scale score (NPRS ≤ 3/10 at day 30 (D30) after epidural injection. The secondary endpoints were achieving a NPRS ≤ 3/10 at D30 without opiates and NSAIDs, level of analgesic and NSAIDs consumption, absence from work and occurrence of adverse events. Factors related to efficacy were not well established.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a5a5b79217b011b702095c1b7fbd0af0Test
https://univ-rennes.hal.science/hal-02442527/documentTest

المؤلفون: Paul Arnolfo, Yves Maugars, Benoit Le Goff, Jean-Marie Berthelot, Christelle Darrieutort-Laffite, Joëlle Glémarec

المصدر: Joint bone spine. 88(1)

مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Lasègue test, Physical examination, Neurological examination, Sitting, 03 medical and health sciences, Sciatica, 0302 clinical medicine, Lumbar, Physical medicine and rehabilitation, Rheumatology, medicine, Humans, Medical history, 030212 general & internal medicine, Range of Motion, Articular, 030203 arthritis & rheumatology, Leg, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, Lumbosacral Region, Test (assessment), medicine.symptom, business, Intervertebral Disc Displacement

الوصف: Diagnosis of sciatica mainly relies on pain reproduction by stretching of the lumbar roots since neurological examination and medical history are usually not sufficient to guarantee diagnosis. The Lasegue test is the most popular method, which starts with the straight leg-raising test (SLR). However it is not perfect, and is not always well performed or interpreted. Passive ankle dorsiflexion at the end of the SLR (Bragard test) is more sensitive, but can also remain normal in some cases of sciatica. Other stretching tests can help to recognise lumbar root damage in patients with poorly defined pain in a lower extremity: firstly, the Christodoulides test, i.e. reproduction of L5 sciatic pain by a femoral stretch test; secondly, the Slump test, performed on a patient in a sitting position, by slowly extending their painful leg then passively bending their neck (or the opposite); and thirdly, the Bowstring test, which requires, at the end of the Lasegue test, once the knee has been slightly flexed, pressing on the course of the peroneal and/or tibial nerves in the popliteal fossea to try and reproduce the exact pain felt by the patient. The combination of all these tests takes less than 2 minutes, and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica. This article is a review of the limitations of the Lasegue/SLR tests and of the efficacy of these other tests for stretching the lumbar roots.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::46a9eab49f1988767c89d527d2609134Test
https://pubmed.ncbi.nlm.nih.gov/32561431Test

المؤلفون: A. Hamel, P. Corre, Christelle Darrieutort Laffite, B. Le Goff, B. Champs

المساهمون: Hôtel-Dieu

المصدر: Journal of Stomatology, Oral and Maxillofacial Surgery
Journal of Stomatology, Oral and Maxillofacial Surgery, Elsevier Masson, 2019, 120, pp.67-70. ⟨10.1016/j.jormas.2018.10.008⟩

مصطلحات موضوعية: musculoskeletal diseases, TMJ disorders, [SDV]Life Sciences [q-bio], Imaging technic, Injections, Intra-Articular, 03 medical and health sciences, 0302 clinical medicine, Cadaver, Daily practice, Humans, Medicine, In patient, 030223 otorhinolaryngology, Ultrasonography, Interventional, Ultrasonography, Temporomandibular Joint, business.industry, 030206 dentistry, Temporomandibular Joint Disorders, medicine.disease, 3. Good health, Temporomandibular joint, In plane, medicine.anatomical_structure, Otorhinolaryngology, Surgery, Oral Surgery, business, Nuclear medicine

الوصف: Ultrasonography of the temporomandibular joint is a non-invasive imaging technic, easy to perform in daily practice. It can be used for diagnosis and to guide intra-articular injections. The objective was to validate a longitudinal in-plane US injection approach of the joint and assess its accuracy. We performed a study in 13 non-embalmed cadavers. The injection was done under real-time US guidance using a needle inserted in-plane with an angulation of 30°and positioned under the capsule until the injection was feasible without resistance. The intra-articular injection was successful in all cases and confirmed by a liquid backflow in 96% of cases. The median duration between skin puncture and the intra-articular injection was 23 seconds. Our technique allows a direct visualization of the needle throughout its course to the joint with a high accuracy. Other studies will be needed to confirm its feasibility and usefulness in patients with TMJ disorders.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1902922cc1b83d28483972a256b6e321Test
https://hal.archives-ouvertes.fr/hal-03486615/file/S2468785518302192.pdfTest

المؤلفون: B. Le Goff, Christelle Darrieutort-Laffite, D Huguet

المصدر: Poster Presentations.

مصطلحات موضوعية: musculoskeletal diseases, Subluxation, Pathology, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Ultrasound, Arthroscopy, musculoskeletal system, medicine.disease, Biceps, Tendon, medicine.anatomical_structure, Bicipital groove, Medicine, Rotator cuff, Radiology, Tendinopathy, business

الوصف: Background Disorders of the long head of the biceps brachii tendon (LHBt) are commonly recognized as a source of shoulder pain. Ultrasound (US) is thought to be of limited value in the diagnosis of partial-thickness tear and non-tear abnormalities of the LHBt because of the difficulty to assess its intra-articular proximal portion. Brasseur recently described that placing the arm in extension/external rotation increased LHBt intra-articular portion visibility. Objectives The goal of this study was to determine if the systematic assessment of the intra-articular portion of the tendon, from the rotator interval to its glenoid insertion, with the arm placed in extension/external rotation could increase US sensitivity. Methods This was a cross-sectional study. All patients referred for the treatment of a rotator cuff disease (rupture, tendinopathy, calcific deposit) with an available MRI were included. US was performed blinded from the results of the clinical or MRI using a Sonosite Edge with a 6–13 MHz probe. LHBt was studied at different level: in the bicipital groove, at the rotator interval, over the upper pole of the humerus head to its insertion on the superior glenoid tubercule. To increase the visibility of the proximal portion, we placed the arm in extension/external rotation as described by Brasseur [1]. Diagnosis of tendinopathy were tendon enlargement, hypoechogenicity and an increase in the interfibrillar distance. Subluxation or dislocation of the LHBt was defined as a partial or total loss of contact between the tendon and its groove. Tearing of tendon was defined as discontinuity or absence of tendon fibers. Fluid collection was defined as an anechoic ring around the tendon >2 mm. Abnormalities of the LBHt on MRI was retrieved from the report. LBHt abnormalities detected on arthroscopy were used as the gold standard. Results We included 129 patients, 57 female (44%), and mean age 54 years (33–73). Seventy-five (58%) had a rotator cuff tear and 54 (42%) a tendinopathy. Arthroscopy found LHBt pathological changes in 39% of the case. The summary of the findings obtained with MRI, US (distal and proximal) and arthroscopy are summarised in table 1. We calculated the sensitivity/specificity of MRI and US (at the proximal and distal level) in the detection of LHBt changes using arthroscopy as gold standard (Table 2). Conclusions US has a good specificity but a poor sensitivity in the detection of LHB tendon changes even when a systematic and carreful study of the proximal part of the tendon is undertaken. If detection of distal changes of the tendon in the inter-tubercular groove seems feasible with US, the involvement of the more proximal, intra-articular part of the tendon remains challenging. MRI sensitivity remains also poor. Overall, arthroscopy still remains the gold standard to detect LHB tendon intra-articular pathology. References Brasseur, The biceps tendons: from the top and from the bottom. Journal of ultrasound (2012) 15, 29–38. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::054ead33d1d05137cd6dffd0a19438a2Test
https://doi.org/10.1136/annrheumdis-2017-eular.4468Test

المؤلفون: Olivier Hamel, Benoit Le Goff, Joëlle Glémarec, Christelle Darrieutort-Laffite, Yves Maugars

المصدر: Joint Bone Spine. 81:130-136

مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Facet (geometry), Lumbar Vertebrae, Nerve root, business.industry, Ultrasound, Thoracolumbar fascia, Anatomy, musculoskeletal system, Rheumatology, Iliolumbar ligament, medicine.anatomical_structure, Internal medicine, medicine.ligament, Erector spinae muscles, Humans, Medicine, Lumbar spine, Radiology, business, Ultrasonography

الوصف: Ultrasonography of the bones and joints has gained considerable ground in the field of rheumatology over the past decade and is now used in everyday practice both for diagnostic purposes and to guide local injections. However, the use of ultrasonography is virtually confined to the peripheral joints, whereas spinal diseases make a major contribution to rheumatology practice. Studies have established that ultrasonography of the lumbar spine is feasible. Adequate equipment and familiarity with spinal sonoanatomy are required. In this update, we suggest starting with a systematic examination of the lumbar spine to assess the various anatomic structures, from the thoracolumbar fascia superficially to the posterior part of the vertebras at the deepest level. The ligaments, erector spinae muscles, facet joints, and transverse processes can be visualized. Ultrasonography can serve to guide injections into the facet joints, about the nerve roots, and into the iliolumbar ligaments; as well as to identify relevant landmarks before epidural injection. Although diagnostic applications are more limited at present, systematic studies of abnormal ultrasonography findings will allow evaluations of the potential usefulness of ultrasonography for diagnosing spinal disorders. The depth of the spinal structures limits the ability to obtain high-resolution images. However, future technical improvements in ultrasound transducers and machines, together with the growing number of physicians trained in ultrasonography, can be expected to benefit the development of spinal ultrasonography in the near future.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::61c26fff0314359e0a744ed99b80aab3Test
https://doi.org/10.1016/j.jbspin.2013.10.009Test

المؤلفون: B. Le Goff, Joëlle Glémarec, Christelle Darrieutort-Laffite, Y. Maugars, A. Colombey

المصدر: Annals of the Rheumatic Diseases. 75:854.1-854

مصطلحات موضوعية: musculoskeletal diseases, 0301 basic medicine, medicine.medical_specialty, Facet (geometry), Immunology, General Biochemistry, Genetics and Molecular Biology, Facet joint, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, Iodinated contrast, Joint capsule, medicine, Immunology and Allergy, Fluoroscopy, 030203 arthritis & rheumatology, medicine.diagnostic_test, business.industry, Surgery, Vertebra, 030104 developmental biology, medicine.anatomical_structure, Arthrogram, Nuclear medicine, business

الوصف: Background Facet joint-mediated pain has been identified as a common cause of lumbar pain. Steroid injections are currently made to treat them, they are usually performed under fluoroscopy or computed tomography guidance. Ultrasound (US) is also appropriate to study facet joints and some studies showed feasibility and efficacy of facet joint injections performed under US-guidance through a transversal approach. On a longitudinal view, facet joints are easy-to-identify as a series of lumps with the joint capsule appearing as a thin hypoechoic line that envelops the joint. Objectives Considering the good visibility of these joints and their capsule on the longitudinal view, we studied the feasibility of US-guided facet joint injections using a longitudinal inline approach. Methods Patients referred to our rheumatology department to receive facet joint injections under fluoroscopy were included. To realize the injection, we first located the accurate lumbar level on a longitudinal median view going through the spinous processes. Facet joints were identified as previously described placing the probe 2–3 cm away from the median line. Then, the needle was inserted to reach the hypoechoic line corresponding to the capsule or, if not visible, the top of the lump formed by the inferior articular process of the superior vertebra overlying the superior articular process of the vertebra below it. When we obtained the bone contact, we injected iodinated contrast medium followed by cortivazol. Finally, we made a lumbar X-ray to analyze the needle position and the quality of the arthrography. The first objective was to assess the number of injections realized in front of the joint. For secondary objectives, we assessed the number of accurate arthrography, the duration of the procedure and the occurrence of adverse events. During US examination, the visibility of the capsule and the presence of osteophytes were collected. Results Thirty-eight patients have been included by two operators. We excluded four patients because of a poor visibility of the spinal structures. Mean age was 58,4 years (range, 30–82) and mean BMI was 25,2 kg/m 2 (range, 18–34). US showed osteophytes in 42% and the joint capsule was inconstantly visible (25%). One-hundred and forty-four injections were performed (72 at the L4-L5 level and 72 at the L5-S1 level) and 141 X-ray were analyzed. One-hundred and twenty-three injections (87%) were accurately realized in front of the joint, i.e. in front of the inferior articular process of the superior vertebra. However, a proper arthrogram was obtained in only 35 cases (25%). Mean procedure duration was 8.5 minutes for four injections. Six patients (18%) reported transient pain exacerbation and no severe complication occurred during the first month after the procedure. Conclusions With a longitudinal inline approach, US-guided facet joint injections were feasible and 87% injections were realized right in front of the joint. However, we obtained a correct arthrogram in only 25%. The depth of the target-point, the inconstant visualization of the capsule and the obliquity of the needle probably explain this result. Additional studies will be necessary to improve the accuracy of the technique. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::fa34206a99abef4991856bc5249a2c58Test
https://doi.org/10.1136/annrheumdis-2016-eular.3648Test