ULTRASOUND-GUIDED SURGERY

CARPAL TUNNEL RELEASE (NOTE: THIS IS A PRELIMINARY OUTCOME STUDY)

Background: The original operations for carpal tunnel syndrome were done with an open surgical approach and general anesthesia. Arthroscopic techniques were then developed using regional anesthesia. At present the procedure can be done with the “camera” outside the body and the incision as small as 1 mm.

Rojo-Manaute and Associates did a randomized controlled study of ultrasound-guided versus mini-open (<2 cm incision) carpal tunnel release and found 2 to 3 times better function and lower pain scores at 1 week and 6 months with the ultrasound technique. We have done over 150 of these operations without significant complications.

Status: We continue to track outcomes following ultrasound-guided carpal tunnel release using the Sonex device and have completed 74 cases. Assessments are obtained pre-procedure, at 2 weeks, 1 month, 3 months, 6 months and 1 year.

SHOULDER INJURY FROM VACCINE ADMINISTRATION (SIRVA)

Purpose: The goal is to share with the medical community in the form of a retrospective chart review, our positive findings following ultrasound-guided ultrasonic debridement and aspiration for patients suffering from Shoulder Injury Related to Vaccine Administration, also known as SIRVA.

Background and Significance: Shoulder injury related to vaccine administration (SIRVA), likely occurs because of unintentional vaccine injection into the subdeltoid bursa, rotator cuff or underlying bone. Although it is rare relative to the number of vaccinations performed, many of those affected have ongoing symptoms despite various treatments. The procedure that was performed by Dr. Bodor was not experimental, but it is novel in that it helped patients with this particular condition/injury.

Methods: Dr. Bodor used high-frequency ultrasonography, sonopalpation and precise local anesthetic blocks to identify the suspected location of vaccine deposition in the infraspinatus and teres minor tendons of the rotator cuff in 5 patients with long-standing symptoms. He subsequently performed percutaneous ultrasound-guided ultrasonic debridement and aspiration of these tendon locations and in some cases the underlying bone hypothesizing that we’d be able to flush out the vaccine. Following the procedures, each of the patients experienced rapid resolution of symptoms and restoration of shoulder function.

Status: Dr. Bodor has done 14 procedures total and the outcomes are being tracked with the QDASH form at set time points (baseline, 2wks, 1mo, 3mos, 6mos, 1yr). A case series is to be published including 5 of the 10 cases.

Please see our SIRVA page for more information.

CASE STUDIES

• Exertional Compartment Syndrome - We performed a fasciotomy via an ultra-minimally invasive method, using an arthroscopic V-knife and ultrasound guidance. The patient reported resolution of pain and footdrop and was able to resume walking the next day.
• Debridement of osteophytes causing chronic pain following joint replacement using an ultrasonic device (Tenex). Procedures have been successfully performed in the hip and knee.
• Aspiration and debridement of calcium hydroxyapatite deposits from the rotator cuff in patients with chronic pain from calcific tendonitis using the Tenex device. Outcomes are being tracked at 2 weeks, 1 month, 3 months, 6 months and 1 year.