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Existing Evidence on Ultrasound-Guided Injections in Sports Medicine

Daniels, Eldra W; Cole, David; Jacobs, Bret; Phillips, Shawn F
Office-based ultrasonography has become increasingly available in many settings, and its use to guide joint and soft tissue injections has increased. Numerous studies have been conducted to evaluate the use of ultrasound-guided injections over traditional landmark-guided injections, with a rapid growth in the literature over the past few years. A comprehensive review of the literature was conducted to demonstrate increased accuracy of ultrasound-guided injections regardless of anatomic location. In the upper extremity, ultrasound-guided injections have been shown to provide superior benefit to landmark-guided injections at the glenohumeral joint, the subacromial space, the biceps tendon sheath, and the joints of the hand and wrist. Ultrasound-guided injections of the acromioclavicular and the elbow joints have not been shown to be more efficacious. In the lower extremity, ultrasound-guided injections at the knee, ankle, and foot have superior efficacy to landmark-guided injections. Conclusive evidence is not available regarding improved efficacy of ultrasound-guided injections of the hip, although landmark-guided injection is performed less commonly at the hip joint. Ultrasound-guided injections are overall more accurate than landmark-guided injections. While current studies indicate that ultrasound guidance improves efficacy and cost-effectiveness of many injections, these studies are limited and more research is needed.
PMCID:5826008
PMID: 29511701
ISSN: 2325-9671
CID: 2974812

Is It Necessary to Follow Patients after Resection of a Benign Pancreatic Intraductal Papillary Mucinous Neoplasm? Discussion [Editorial]

Lillemoe, Keith D.; Farnell, Michael; Lynn, Richard; Cole, David; Yeo, Charles; Adams, David B.; Wolfgang, Christopher L.
ISI:000316727400030
ISSN: 1072-7515
CID: 4744422

A prospective observational evaluation of an anatomically guided, logically formulated airway measure to predict difficult laryngoscopy

Rucker, Joshua C; Cole, David; Guerina, Laarni R; Zoran, Nitai; Chung, Frances; Friedman, Zeev
CONTEXT: Difficulty during tracheal intubation is the most common cause of serious adverse respiratory events for patients undergoing anaesthesia. Current traditional bedside predictors of difficult laryngoscopy have poor sensitivity. A simple method to accurately predict difficult laryngoscopy could greatly improve patient safety. OBJECTIVES: This study examined a novel bedside predictor of difficult laryngoscopy that calculates a ratio of measurements directly affecting the ability to achieve the necessary line of vision (NLV) from the larynx to the operator (NLV ratio). DESIGN: This was a prospective observational study. SETTING: A single tertiary care surgical centre. PATIENTS: We enrolled 2046 patients scheduled for elective surgery under general anaesthesia with anticipated tracheal intubation. INTERVENTION: Prior to surgery, patients had their NLV ratio and standard airway measures recorded. The anaesthesiologist who performed the intubation was blind to the airway assessment and recorded the best view of the larynx according to the Cormack and Lehane scale. Difficult laryngoscopy was defined as a grade 3 or 4 view. MAIN OUTCOME MEASURE: The main outcome measure was the sensitivity and specificity of the NLV ratio measurement for predicting difficult laryngoscopy. RESULTS: Receiver operating characteristics curve analysis of the NLV ratio revealed an optimal sensitivity of only 41% and specificity of 77%. CONCLUSION: Although our novel measurement performed similarly to traditional bedside predictors of difficult laryngoscopy, the sensitivity was too low for the test to be clinically useful. Numerous factors which may be very difficult to predict at the bedside probably contributed to the poor performance of this novel measurement.
PMID: 22450528
ISSN: 1365-2346
CID: 2272032