Objective: The objective of this study is to assess the efficacy and safety of repeated sodium polynucleotide (Conjuran^Ⓡ) treatments in patients with knee osteoarthritis. Methods: The study was conducted by retrospectively examining 45 patients who repeated the treatment course of 5 injections of Conjuran^Ⓡ twice within 6 months. For each course, pain reduction by the change of 100-mm Weight-Bearing-Pain Visual-Analog-Scale was compared with before administration until 6 months after administration. Improvement by Clinical Global Impression (CGI) and Patient Global Impression (PGI) were also investigated, as well as adverse reactions. Results: Pain analysis after administration of Conjuran^Ⓡ confirmed that VAS decreased by 51.6% until 6 months (p<0.001), and after that the effect was lost and was repeat for the 2^nd course. In the 2^nd, VAS continued to decrease by 58.7% compared to before the 1^st course (p<0.001). Analysis of CGI, 88.9% of patients improved after the 1^st and 84.4% of patients improved after the 2^nd. In the PGI results, symptoms improved in 86.7% of patients after the 1^st and 82.2% after the 2^nd. No significant adverse event was reported. Conclusion: The safety and efficacy results of patients receiving Conjuran^Ⓡ for 2^nd treatment courses were similar to those for 1^st treatment course. In addition, the effect lasts for up to 6 months after administration, and the pain reduction effect is lost thereafter, so it is recommended to apply it at 6-month intervals if additional treatment is needed. Conjuran^Ⓡ is an intra-articular injection that is effective in reducing knee pain and can be used repeatedly without adverse reactions.

Various injectable agents are used for nerve and musculoskeletal pain control. We want to review these injectable agents and several examples under ultrasonographic guidance. Ultrasound (US) can depict of various anatomical structures, such as muscles, tendons, ligaments, nerve roots, and vessels, all over the body. The use of US during injection is increasing due to its quick and easy application for guided injection with higher accuracy compared to the blind technique. The aim of this review article is to get accustomed to various injectables, and to get to know about several US-guided intervention technique.

The facet joints are a common source of chronic spinal pain. Blocks of the nerves supplying the facet joints are validated tools in the diagnosis and treatment for facet joint pain. These interventions are typically performed with fluoroscopic guidance. However, the target, which is the nerve, is radiolucent and cannot be identified with fluoroscopy. Recently, several ultrasound guided techniques in the domain of spinal pain have been emerging because ultrasound is useful in visualization of the inner structures, is portable, and is not associated with the radiation exposure. This paper reviews a variety of techniques for ultrasound guided interventions for the medial branch block which has been reported in treating axial pain originating from the facet joint.

Muscle pain can be caused by various causes and it deteriorates the patient’s function and quality of life. Intramuscular stimulation therapy, performed under the concept of myofascial pain syndrome, is an effective treatment for relieving somatic pain in skeletal muscles through muscle relaxation, improving the limited range of motion of joints, enhancing muscle strength, and improving accompanying autonomic nervous system symptoms. Dry needling, trigger point injection, and intramuscular electrical stimulation are typical methods of intramuscular stimulation, and they must be safely performed by experienced practitioners. The mechanism, clinical use, efficacy, and precautions of intramuscular stimulation therapy will be reviewed in this article. Although additional supplementation of the academic evidence of intramuscular stimulation is still needed through experimental research, it is expected that the clinical application area can be expanded.

Chronic expanding hematoma (CEH) is a hematoma that increases in size, usually occurring after trauma or surgery, more than a month after initial bleeding. Thighs and upper limbs are the most common sites of CEH. Only a few cases of CEH have been reported in the amputation stump site since CEH itself is a rare disease.We experienced a case of a 59-year-old man who underwent transtibial amputation and suffered from recurrent non-infectious hematoma. For the treatment of CEH, the patient underwent an open bursectomy, followed by bony spur removal surgery. However, CEH recurred, and the pain was only managed by intermittent aspiration and compression. We report a long journey of managing painful CEH of the transtibial amputation stump.

Ultrasound imaging of the musculoskeletal system is widely used for diagnosis and treatment. Pathologies occurring in the knee joint and the distal femur are among the challenging areas for ultrasound diagnosis due to their complex structural nature. However, advancements in ultrasound technology have made it possible to assess and diagnose superficial structures using ultrasound. Moreover, ultrasound-guided procedures have gained significant popularity due to their advantages in terms of efficacy and safety. This paper aims to explore the ultrasound findings of commonly occurring conditions in the knee joint and proximal femur and discuss ultrasound-guided interventions that can be performed in these areas for treatment.

Iatrogenic spinal cord injury resulting from direct needle injection is an exceedingly uncommon occurrence, mainly owing to the spinal cord’s protection by surrounding bony structures, with only a few exceptions, and its location a few centimeters beneath the skin. This study presents a case of a 27-year-old female who experienced cervical spinal cord injury following acupuncture treatment around the C3–4 region. The patient reported tingling paresthesia and persistent pain in her left arm for 1 month postinjection, with magnetic resonance imaging (MRI) revealing a syringomyelia in the direction of the injection. As determined at the follow-up, after undergoing 3 months of conservative treatments, including cervical intervention, medication, and education, her pain was reduced by approximately half. Cervical injections should be administered by a knowledgeable specialist well versed in musculoskeletal anatomy and potential complications, aided by radiological examination.

This review journal focuses on using ultrasound-guided root block in spondylotic radiculopathy, exploring its therapeutic potential, safety advantages, and validation challenges. C-arm guided transforaminal epidural steroid injection (C-TFESI) has constantly shown effective treatment outcomes for spondylotic radiculopathy. However, C-TFESI has been associated with rare significant adverse events, including cervical cord and brain infarction. Advancements in musculoskeletal ultrasonography have sparked efforts to apply this technique in spondylotic radiculopathy treatment. The distinct advantages of ultrasound, particularly in soft tissue discrimination and vascular visualization, have positioned it as a valuable tool in minimizing the risk of significant complications like spinal cord and brain infarction following cervical spinal injection procedures. Numerous studies have reported the potential and efficacy of ultrasound-guided cervical root block, establishing it as a safe and effective therapeutic approach. However, further validation is warranted to address the limitations and gaps in the current knowledge, particularly regarding the risk of vascular injection.

The sacroiliac joint (SIJ) is known to account for 14.5∼30% of chronic low back pain patients with non-radicular symptoms. Diagnosing SIJ-related pain is challenging, as initial symptoms often resemble those of other causes of low back pain. Pain may radiate from below the fifth lumbar vertebra to the thigh, making it essential to differentiate from lumbar facet joint, hip joint, lumbar disc, and surrounding muscle problems. There are no single symptoms or physical exams that definitively diagnose SIJ pain. Clinically, if a patient shows positive findings in three or more different physical exams related to the SIJ and experiences more than 75% symptom improvement following a local anesthetic injection under fluoroscopic guided injection, SIJ pain can be suspected. This review aims to provide a comprehensive overview of the SIJ as a source of pain, covering its anatomy, functions, pathologic injury mechanisms, and diagnostic approaches.

Carpal tunnel syndrome is a very common and important disease caused by entrapment of the median nerve in the carpal tunnel. With the widespread use of high-resolution ultrasound, ultrasound is being used usefully in the diagnosis of carpal tunnel syndrome. Compared to electrodiagnostic study, ultrasound examinations are easier and, above all, non-invasive. In addition, ultrasound-guided injection can be performed alone or in combination with ultrasound examination. In the case of nerve hydrodissection, which has recently been spotlighted as a treatment for carpal tunnel syndrome, it is the procedure that could not be attempted before without ultrasound equipment. In this paper, through a comprehensive review of meta-analysis literatures, we look back at the value of ultrasound as a diagnostic tool for carpal tunnel syndrome and the effect of ultrasound-guided injection to get an objective perspective and gain new insights. The usefulness of ultrasound will be largely divided into applications of ultrasound-guided injection, diagnosis, and sonoelastography.