LATERAL FEMORAL CUTANEOUS NERVE STUDY (IRB APPROVED)
Purpose: To determine the most ideal angle at which the ultrasound probe should be held for optimal visualization of this difficult to see nerve. Being able to visualize the nerve will allow providers to correctly diagnose and treat Meralgia Paresthetica.
Background and Significance: Meralgia Paresthetica is the most common pathology affecting the lateral femoral cutaneous nerve. This is a condition characterized by tingling, numbness and burning pain in the outer thigh. The cause of Meralgia Paresthetica is compression of the nerve that supplies sensation to the skin surface of the thigh. A physical and medical evaluation along with other imaging and often electrodiagnostic and nerve conduction studies are used to help diagnose this condition. Ultrasound is also a very useful diagnostic tool, but in the case of the lateral femoral cutaneous nerve it is very difficult to see under ultrasound thereby making a true diagnosis difficult. We propose that if we maneuver the ultrasound probe at a particular angle, we can more easily identify the nerve thereby arriving at a correct diagnosis and proper treatment for the patient.
Methods: For patients whom we suspect suffer from Meralgia Paresthetica, we will perform an ultrasound to confirm that we can see the nerve clearly and will document the angle of the ultrasound probe.
Status: Currently 15 patients have been enrolled with the plan to enroll 25-30.
CERVICAL FACET INJECTION STUDY (IRB APPROVED)
Purpose: To assess the accuracy of ultrasound-guided cervical facet injections for osteoarthritis and facet joint pain.
Background and Significance: The cervical facet joints are a common cause of neck pain. Injections of cervical facet joints are currently done with fluoroscopy, which involves radiation and requires the use of a contrast agent. Ultrasound guidance is being used to inject various joints and is a technique that can be used for the cervical facet joints as well. An ultrasound-guided technique avoids radiation and use of a contrast agent and thus is potentially safer, less expensive, more comfortable and effective than the fluoroscopic technique.
Methods: Dr. Bodor performed 60 ultrasound-guided cervical facet injections on 40 patients with fluoroscopy confirmation. All images were reviewed by Dr. Bodor and by an independent musculoskeletal radiologist. The results showed 93% and 90% accuracy respectively with using ultrasound.
Status: The paper will be written upon completion of other manuscripts and will be submitted to a clinical journal.
CARPAL TUNNEL FLOW STUDY (IRB APPROVED)
Purpose: Assessing the accuracy of ultrasound-guided carpal tunnel injections with fluoroscopy confirmation.
Background and Significance: Carpal Tunnel Syndrome and its respective treatments has been studied extensively for the past several years. Ultrasound guidance has become a common tool to use for accuracy, effectiveness and safety; however, different techniques has been developed. We believe our technique allows for the best possible visualization of the targeted structures. If our technique becomes the standard, ultrasound-guided carpal tunnel injections can be safely administered, with little to no pain and most importantly with the highest degree of accuracy, thereby ensuring maximum relief and avoiding possibly harmful targets/structures.
Methods: Patients identified as having carpal tunnel syndrome based on clinical and electrodiagnostic criteria will receive a corticosteroid + lidocaine + Isovue (contrast) injection proximal to the carpal tunnel, followed by fluoroscopic images to confirm the flow of the injectate into the correct location. The fluoroscopic images will be viewed by Dr. Bodor and the determination will be made as to whether the flow has reached the targeted area. The data will be reviewed by an independent musculoskeletal radiologist to confirm/deny our findings.
Status: 20 patients have been enrolled and plan to enroll 30 total.