Physical medicine and rehabilitation clinics of North America
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Chronic pelvic pain is a common condition. Establishing a diagnosis can be complicated by the interplay between various organ systems, including urologic, gynecologic, gastrointestinal, neurologic, endocrinological, psychological, and musculoskeletal. Frequently, the patient will have seen multiple providers and undergone multiple tests, as well as invasive procedures, before the musculoskeletal system is even considered in the differential diagnosis. Typically, the musculoskeletal and nervous systems become suspected culprits only once all other potential etiologies have been eliminated.
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Phys Med Rehabil Clin N Am · Feb 2018
ReviewRadiofrequency Denervation of the Cervical and Lumbar Spine.
Facet or zygapophysial joint pain is commonly seen in the aging population. Interventional procedures, such as facet joint nerve blocks, facet intraarticular injections, and radiofrequency denervation, are used for the diagnosis and treatment of axial spinal chronic neck and low back pain. The focus of this article is to understand how radiofrequency denervation works in the cervical and lumbar spine and to be able to properly select appropriate patients who might benefit from this safe and effective procedure.
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Phys Med Rehabil Clin N Am · Feb 2018
ReviewSafety and Complications of Cervical Epidural Steroid Injections.
Serious neurologic complications following cervical transforaminal epidural steroid injections (CTFESI) and cervical interlaminar epidural steroid injections (CILESI) have been reported. For CILESI, this is caused by aberrant needle placement or space-occupying lesions, such as hematoma or abscess. ⋯ Multiple safety techniques are used to mitigate the risk of these serious complications. The most common adverse events that occur following CTFESI or CILESI are procedural-related pain, steroid side effects, and vasovagal reactions, which are relatively minor and self-limited.
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Phys Med Rehabil Clin N Am · Feb 2018
ReviewCervical Epidural Steroid Injection: Techniques and Evidence.
Cervical epidural steroid injections are a common treatment of cervical radicular pain. Important safety considerations include attention to the possibility of spinal cord infarction and spinal epidural hematoma. ⋯ Cervical epidural steroid injections are effective for the short-term treatment of radicular pain. More rigorously designed clinical outcomes studies of both cervical interlaminar and transforaminal epidural steroid injections are needed.
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Phys Med Rehabil Clin N Am · Feb 2018
ReviewUltrasound-Guided Interventions of the Cervical Spine and Nerves.
High-resolution ultrasound (US) enables prompt depiction of muscles, tendons, ligaments, and peripheral nerves. It seems to be the best imaging modality for guiding perineural injections. ⋯ This article elaborates the regional anatomy and the use of US scanning and guidance for cervical interventions; for example, cervical root, superficial cervical plexus, stellate ganglion, cervical medial branch, greater occipital nerve, and third occipital nerve. The article aims to lead readers to practice US-guided cervical injections precisely and safely.