Physical medicine and rehabilitation clinics of North America
-
Phys Med Rehabil Clin N Am · Feb 2018
ReviewSonographic Guide for Botulinum Toxin Injections of the Neck Muscles in Cervical Dystonia.
Intramuscular botulinum toxin (BoTX) injection is the first-line treatment of cervical dystonia. Poor treatment outcomes and some side effects, however, have been reported after BoTX applications. ⋯ Ultrasound has been recommended because of its high capability in illustrating most of the neck muscles. This review article discusses how ultrasound imaging can be used to scan/access neck muscles, mainly from the perspective of BoTX injections.
-
Sacroiliac joint (SIJ) pain is an important cause of lower back problems. Multiple SIJ injection techniques have been proposed over the years to help in the diagnosis and treatment of this condition. ⋯ Various techniques for intraarticular injections, sacral branch blocks and radiofrequency ablation, both fluoroscopy guided and ultrasound guided are discussed in this paper. Less common techniques like prolotherapy, platelet rich plasma injections and botulism toxin injections are also discussed.
-
Lumbar epidural steroid injections under fluoroscopic guidance are used very commonly for the treatment of low back and lower extremity radicular pain. These procedures have been shown to be effective for pain relief in the short term and are relatively safe. The indications, evidence, and safety considerations for 2 different techniques-namely, interlaminar and transforaminal-are discussed.
-
Myofascial pelvic pain refers to pain in the pelvic floor muscles, the pelvic floor connective tissue, and the surrounding fascia. The cause is often multifactorial and requires treatment that encompasses multiple modalities. ⋯ A comprehensive musculoskeletal examination, including evaluation of the pelvic floor muscles, and history are key to diagnosing myofascial pelvic pain. Treatments include physical therapy, muscle relaxers, oral neuromodulators, cognitive-behavioral therapy, and pelvic floor muscle injections.
-
The history and physical examination are important keys to diagnosis and treatment of patients with chronic pelvic pain. The comprehensive history should include questioning regarding patient's pain complaint and a thorough history and review of any body system that may be involved, including neuromusculoskeletal, obstetric, gynecologic, gastrointestinal, urologic, dermatologic, infectious, oncologic, and psychiatric. The physical examination should also follow a focused systems-based approach and includes examination of gastrointestinal, dermatologic, neurologic, and musculoskeletal (including lumbosacral spine, sacroiliac joints, pelvis, and hips) systems, and the pelvic floor (internal and external examination, including neuromuscular anatomy).