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.

Clinically, evaluation and procedures using ultrasound are expanding in the field of neuromusculoskeletal disorders, and ultrasound is also actively used for hip and thigh pain. This review delineates the normal ultrasound findings of lateral and posterior aspects of the hip joint and thigh. Furthermore, it covers ultrasound findings of commonly occurring soft tissue diseases and nerve entrapment, along with ultrasound-guided injections.

Patients with pelvic or sacral pain can be easily encountered in outpatient clinic settings. Since the cause of pain can be originated from the lumbar spinal region, or sometimes directly from the pelvis or sacral region, it is essential to differential diagnose where the pain is coming from. Caudal epidural steroid injection, sacroiliac joint injection, and piriformis injection are not only therapeutic, but are often used diagnostically, therefore they would be more useful in the outpatient clinic. Ultrasound-guided injections have similar clinical effects and the advantage of having shorter procedure times and no radiation exposure compared with fluoroscopic image-guided injection. Therefore, it is recommended to safely perform pelvic or sacral injections using ultrasound guidance.

Carpal Tunnel Syndrome is the most common entrapment neuropathy. Treatment for carpal tunnel syndrome varies according to the severity of the disease, ranging from conservative treatment to surgical intervention. Conservative treatments such as steroid injection within carpal tunnel are helpful for most patients with mild to moderate carpal tunnel syndrome. However, in the case of the most commonly used steroid injection, the effect is short or limited within 6 months. In this paper, I will review ultrasound-guided nerve hydrodissection for carpal tunnel syndrome, which has recently attracted attention.

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.

Objective: Flatfoot is a very common condition in pediatric rehabilitation that can cause various symptoms. Therefore, objective evaluation and effective management of flatfoot is important. The resting calcaneal stance position (RCSP) angle has been widely used as an indicator of flatfoot. This study followed up the RCSP angle in children with flatfoot who were prescribed biomechanical foot orthoses (BFOs), to determine whether BFOs significantly improved flatfoot. Methods: We included 77 children who were diagnosed with flatfoot and prescribed BFOs. We followed up and compared the RCSP angle using the paired t-test. In addition, the patients divided into two groups according to RCSP angle improvement to determine whether any significant indicators were present in the group with greater improvement. Results: The mean age of 77 children was 11.05 years, with 50 boys and 27 girls. The RCSP angle improved by 3.25 and 2.78 degrees on the right and left sides, respectively, with the paired t-test showing a significant improvement in the RCSP angle (p≤0.001). 40 and 37 exhibited an RCSP angle improvement of more and less than 4 degrees, respectively, with the paired t-test also confirming a significant improvement in the RCSP angle (p≤0.001). However, independent t-tests revealed no significant differences in all indicators between the two groups. Conclusion: This study confirmed that wearing BFO in children with flatfoot can improve the RCSP angle. Our findings showed that RCSP angles improved regardless of other factors. Further studies providing more data and including a control group are needed.

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.

Objective: Shoulder pain is a common post-mastectomy complication. This research aims to evaluate the role of shoulder structure changes in developing shoulder pain in post-mastectomy patients and determine ultrasonographic findings. Methods: Medical records of post-mastectomy patients with ipsilateral shoulder pain were reviewed. Ultrasonographic findings, visual analogue scale (VAS), Shoulder Pain and Disability Index (SPADI), age, body mass index, time from mastectomy, operation type, lymph node dissection type, presence of lymphedema, and radiation therapy were checked. Results: Of 40 patients, rotator cuff tear, subacromial-subdeltoid bursitis, calcific tendinitis, biceps brachii tendon sheath fluid accumulation, and tendinopathy were seen in ultrasonography. Age was statistically higher in the rotator cuff tear group than non-rotator cuff tear group. Time from mastectomy, VAS, and SPADI were statistically correlated with biceps brachii sheath fluid accumulation. Shoulders with tendinopathy developed pain shortly after surgery. VAS and SPADI were statistically correlated with presence of subscapularis or supraspinatus tendinopathy. Nine of thirteen patients (69.2%) with subscapularis tendinopathy had post-mastectomy lymphedema. Only two of fifteen (18.2%) patients with supraspinatus tendinopathy had a history of radiation therapy. Conclusion: Shoulder pain and rotator cuff tendinopathy may occur soon after surgery; therefore, shoulder range of motion exercises and muscle strengthening exercises are necessary in the early days after surgery. Elderly patients have a risk of rotator cuff tear, which physicians should pay more attention to. Even though there is no history of lymphedema and radiation therapy, shoulder lesions may occur. Therefore, prevention of shoulder pain in all patients after breast cancer surgery is needed.

Spinal manipulation therapy (SMT) is commonly used to treat various musculoskeletal pains; however, it is associated with several complications. Mild complications resolve quickly; however, on rare occasions, they may cause severe complications that persist indefinitely. Here, we present a case of cervical myelopathy caused by a spinal manipulation. A 52-year-old man with a history of cervical radiculopathy at C4–7 underwent manipulation, performed by an unlicensed practitioner. After the manipulation, he explained abrupt muscle weakness in all four extremities. He was diagnosed with cervical myelopathy and had to undergo emergency surgery. Through this case, we aim to emphasize the role of doctors, with regard to spinal manipulation. Physicians must supervise the pre-evaluation of patients, manipulation, and post-manipulation monitoring, and the complications of SMT should be immediately reported.