Faculty Bibliography

A typical vasovagal response is characterized by bradycardia and paradoxical vasodilation. It is oftentimes self-limited and spontaneously reversible; however, severe cases can result in significant complications. This report describes a case of profound vasovagal syncope with subsequent cardiac arrest in the setting of receiving a trigger point injection. This patient presented to an outpatient clinic for ultrasound-guided left trapezius, levator scapulae, and rhomboid trigger point injections for relief of myofascial pain. One milliliter of 1% lidocaine was injected into the first trigger point when she stated she felt dizzy before becoming unresponsive without palpable peripheral pulses. The patient regained consciousness following cardiopulmonary resuscitation (CPR). Considering the frequency of office based pain procedures, it is important to recognize the potential serious complications associated with procedures frequently thought to be benign.

The purpose of this study was to report on a series of dancers who had undergone flexor hallucis longus (FHL) tenolysis/tenosynovectomy after having failed conservative management. Institutional human subjects committee approval was obtained prior to initiating this study. This study is a retrospective case series of 58 dancers and 63 ankles who underwent FHL tenolysis/tenosynovectomy via an open posteromedial approach by a single surgeon between 1993 and 2017. All patients were interviewed and charts reviewed. Collected variables included: preoperative and postoperative pain levels, time to return to dance, and subjective satisfaction with the procedure. Age, primary dance form, and level of dance were determined. Mean preoperative pain level decreased significantly postoperatively. Mean time to return to dance was 7.1 weeks. There was a 98% (62/63) return to dance at some level while 97% (61/63) of patients returned to dance symptom-free. There were no neurovascular or other major complications. Minor complications included stiffness at follow-up (6.3%, 4/63), superficial wound infection (3.1%, 2/63), and hypertrophic scar (4.8%, 3/63). Over 97% (61/63) of dancers considered the procedure a success and 98% (62/63) of dancers would repeat the procedure. This is one of the largest series reported of isolated FHL tenolysis/tenosynovectomy in dancers who have failed nonoperative management. Satisfactory pain relief and return to dance with a low complication rate may be expected from this surgical procedure. The results of this study can be used to help dancers and their providers make informed decisions about treatment in isolated FHL tendinitis.