The spread of Injectate after ultrasound-guided lateral elbow injection – a cadaveric study
Abstract Background Injections into the tendinous portion of the common extensor origin are a common intervention in the treatment of Lateral Elbow Tendinopathy (LET). Clinical trials report a heterogeneous selection of injectate volumes and delivery techniques, with systematic reviews finding no cl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-07-01
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| Series: | Journal of Experimental Orthopaedics |
| Online Access: | http://link.springer.com/article/10.1186/s40634-018-0142-8 |
| _version_ | 1797331657223569408 |
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| author | Jonathan P. Evans Jeremy Metz Rahul Anaspure William J. Thomas Andrew King Vicki A. Goodwin Chris D. Smith |
| author_facet | Jonathan P. Evans Jeremy Metz Rahul Anaspure William J. Thomas Andrew King Vicki A. Goodwin Chris D. Smith |
| author_sort | Jonathan P. Evans |
| collection | DOAJ |
| description | Abstract Background Injections into the tendinous portion of the common extensor origin are a common intervention in the treatment of Lateral Elbow Tendinopathy (LET). Clinical trials report a heterogeneous selection of injectate volumes and delivery techniques, with systematic reviews finding no clear consensus. The aim of this study was to assess the intratendinous distribution and surrounding tissue contamination of ultrasound-guided injections into the Common Extensor Tendon (CET) of the elbow. Methods Twenty cadaveric elbows were injected by a Consultant Radiologist under Ultrasound guidance. Elbows were randomised to equal groups of 1 or 3 mls of methylene blue injection, delivered using single shot or fenestrated techniques. Following injection, each cadaver underwent a dry arthroscopy and dissection of superficial tissues. The CET was excised, set and divided into 1 mm sections using microtome. Each slice was photographed and analysed to assess spread and pixel density of injectate in four colour graduations. The cross-sectional area of distribution was calculated and compared between groups. Results In all 20 cadaveric samples, contamination of the joint was noted on arthroscopy and dissection. Injectate spread through over 97% of the cross-sectional area. No differences were found in intratendinous spread of injectate between differing volumes or techniques. Conclusion This study found that commonly used injection volumes and techniques distribute widely throughout cadaveric CETs. There was no improvement when the volume was increased from 1 to 3 mls or between single shot of fenestrated injection techniques. It should be noted that joint contamination using these techniques and volumes may be inevitable. |
| first_indexed | 2024-03-08T07:38:38Z |
| format | Article |
| id | doaj.art-f368e39cdc504974a38dd40e71f103bb |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-03-08T07:38:38Z |
| publishDate | 2018-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-f368e39cdc504974a38dd40e71f103bb2024-02-02T18:21:16ZengSpringerOpenJournal of Experimental Orthopaedics2197-11532018-07-01511810.1186/s40634-018-0142-8The spread of Injectate after ultrasound-guided lateral elbow injection – a cadaveric studyJonathan P. Evans0Jeremy Metz1Rahul Anaspure2William J. Thomas3Andrew King4Vicki A. Goodwin5Chris D. Smith6Royal Devon and Exeter NHS Foundation TrustWellcome Trust Biomedical Informatics Hub, University of ExeterRoyal Devon and Exeter NHS Foundation TrustRoyal Devon and Exeter NHS Foundation TrustRoyal Devon and Exeter NHS Foundation TrustNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical SchoolRoyal Devon and Exeter NHS Foundation TrustAbstract Background Injections into the tendinous portion of the common extensor origin are a common intervention in the treatment of Lateral Elbow Tendinopathy (LET). Clinical trials report a heterogeneous selection of injectate volumes and delivery techniques, with systematic reviews finding no clear consensus. The aim of this study was to assess the intratendinous distribution and surrounding tissue contamination of ultrasound-guided injections into the Common Extensor Tendon (CET) of the elbow. Methods Twenty cadaveric elbows were injected by a Consultant Radiologist under Ultrasound guidance. Elbows were randomised to equal groups of 1 or 3 mls of methylene blue injection, delivered using single shot or fenestrated techniques. Following injection, each cadaver underwent a dry arthroscopy and dissection of superficial tissues. The CET was excised, set and divided into 1 mm sections using microtome. Each slice was photographed and analysed to assess spread and pixel density of injectate in four colour graduations. The cross-sectional area of distribution was calculated and compared between groups. Results In all 20 cadaveric samples, contamination of the joint was noted on arthroscopy and dissection. Injectate spread through over 97% of the cross-sectional area. No differences were found in intratendinous spread of injectate between differing volumes or techniques. Conclusion This study found that commonly used injection volumes and techniques distribute widely throughout cadaveric CETs. There was no improvement when the volume was increased from 1 to 3 mls or between single shot of fenestrated injection techniques. It should be noted that joint contamination using these techniques and volumes may be inevitable.http://link.springer.com/article/10.1186/s40634-018-0142-8 |
| spellingShingle | Jonathan P. Evans Jeremy Metz Rahul Anaspure William J. Thomas Andrew King Vicki A. Goodwin Chris D. Smith The spread of Injectate after ultrasound-guided lateral elbow injection – a cadaveric study Journal of Experimental Orthopaedics |
| title | The spread of Injectate after ultrasound-guided lateral elbow injection – a cadaveric study |
| title_full | The spread of Injectate after ultrasound-guided lateral elbow injection – a cadaveric study |
| title_fullStr | The spread of Injectate after ultrasound-guided lateral elbow injection – a cadaveric study |
| title_full_unstemmed | The spread of Injectate after ultrasound-guided lateral elbow injection – a cadaveric study |
| title_short | The spread of Injectate after ultrasound-guided lateral elbow injection – a cadaveric study |
| title_sort | spread of injectate after ultrasound guided lateral elbow injection a cadaveric study |
| url | http://link.springer.com/article/10.1186/s40634-018-0142-8 |
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