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The Most Practical App on Ultrasound-Guided Chronic Pain Blocks

NYSORA Ultrasound-Guided Pain Blocks App describes the most practical and applicable techniques of ultrasound-guided pain medicine

Learn and review Ultrasound-guided chronic pain interventions, including joint injections and stimulation procedures.
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30+ Pain Blocks

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Case study: Subacromial impingement syndrome – Injection

A 45-year-old female patient came in reporting chronic left shoulder pain lasting for three months after a minor injury. The pain primarily centered around the upper arm and the supraspinous fossa, worsening notably at night. Additionally, incidental pain was present on shoulder abduction. Physical examination Painful arc present Neer’s test: Positive Hawkins-Kennedy test: Positive Ultrasound findings Supraspinatus tendon at the level of the superior facet of the greater tuberosity: Normal Long-axis view of the rotator cuff at the level of the superior facet of the greater tuberosity. Supraspinatus tendon at the level of the inferior facet of the greater tuberosity: Minimal bursal surface tear, intrasubstance tears Long-axis view of the rotator cuff at the level of the inferior facet of the greater tuberosity. Short-axis view of the supraspinatus tendon: Normal Short-axis view of the rotator cuff. Diagnosis The patient was diagnosed with subacromial impingement syndrome secondary to rotator cuff tendinopathy. Subacromial impingement syndrome results from compression, irritation, or inflammation of the rotator cuff tendons in the subacromial space. It causes shoulder pain, weakness, and limited shoulder mobility, often due to factors like repetitive overhead activities or structural issues. This narrowing of the subacromial space compresses the rotator cuff tendons and subacromial bursa.  In this particular case, the impingement was attributed to rotator cuff tendinopathy. Read more about the treatment, patient outcome, and other case studies in the US Pain App. Ready to elevate your knowledge? Tap HERE to download the go-to app for chronic pain procedures.

February 29, 2024

Case study: Acromioclavicular joint arthritis – Injection

A 65-year-old female manual laborer presents with a 4-month history of left shoulder pain. She complains of anteromedial shoulder pain exacerbated during external rotation and superior shoulder pain, particularly at night. Physical examination Painful arc present Tender acromioclavicular joint Scarf test: Positive O’Brien’s test: Positive Imaging Ultrasound Acromioclavicular (AC) joint space narrowing Capsular distension Osteophyte Transverse view of the AC joint space showing space narrowing, capsular distension, and an osteophyte. X-ray Rotator cuff arthropathy AC joint arthritis X-ray image of the left shoulder. Diagnosis The patient was diagnosed with AC joint arthritis. This condition is caused by deterioration of the cartilage in the AC joint due to frequent stress on the joint, commonly seen in the middle-aged population. Patients usually experience pain and tenderness at the top of the shoulder across the joint. Discover more about the treatment strategy, patient outcome, and other unique case studies in the US Pain App. Ready to expand your knowledge? Click HERE and get the ultimate app for chronic pain procedures.

February 1, 2024

Case study: Lumbar canal stenosis – Injection

A 63-year-old woman presents with chronic lower back pain, lasting for 2 years. She does not have any other health conditions and has not experienced any injuries. The patient suffers from continuous pain in her right lower limb, which worsens when she walks. Neither NSAIDs nor gabapentin have been effective in alleviating this pain. Physical examination Paramedian lower back pain Unable to walk straight due to paraspinal muscle spasm Straight leg raise test: Negative FABER test: Negative Femoral stretch test: Negative Imaging Ultrasound has no diagnostic value for lower back pain. X-ray lumbosacral spine Spondylotic changes of the lower lumbar vertebrae Right sacroiliac joint arthropathy X-ray image of the lumbosacral spine. MRI Bulging of L1-L5 discs, causing canal stenosis MRI imaging of the lumbar spine revealed multilevel disc collapse. Diagnosis The patient was diagnosed with lumbar canal stenosis, a condition known for causing leg and back pain. It is characterized by a narrowing in the vertebra’s central canal, lateral recess, or neural foramen. Discover more about the treatment strategy, patient outcome, and other unique case studies in the US Pain App. Ready to expand your knowledge? Click HERE and get the ultimate app for chronic pain procedures.

January 18, 2024

Case study: Golfer’s elbow – Injection

A 33-year-old woman has been experiencing pain in her right medial elbow for the past year, which began after a minor injury. Despite undergoing conservative treatment, including physical therapy and NSAIDs, her condition did not improve. She continues to have debilitating pain. Physical examination No redness or edema Tenderness over the medial epicondyle Polk’s test: Positive Ultrasound findings Minimal tears in the common flexor tendon at the insertion point onto the medial epicondyle. Long axis view of the common flexor tendon and medial epicondyle. Note the tears at the insertion point. Small effusion in the anterior joint recess of the elbow. Long axis view of the posterior elbow revealing a small effusion in the anterior joint recess. Diagnosis The patient was diagnosed with medial epicondylitis, also known as golfer’s elbow, which is characterized by chronic tendinosis of the wrist flexors and pronators that anchor to the medial epicondyle. The condition commonly develops due to repetitive movements involving pronation of the forearm or flexion of the wrist. Read more about the treatment, patient outcome, and other case studies in the US Pain App. Ready to elevate your knowledge? Tap HERE to download the go-to app for chronic pain procedures.

January 4, 2024

Case study: Cubital tunnel syndrome – Injection

A 65-year-old orthopedic surgeon presents with pain along the ulnar aspect of the right forearm and hand, lasting for one year. The patient does not report any weakness in these areas and has no comorbidities. He previously underwent an ulnar nerve hydrodissection, a procedure to relieve pressure around the nerve, which reduced the pain by 80%. However, due to persistent occasional pain along the ulnar border of the forearm, he presented for further treatment. Physical examination Pain was not associated with any activity and there were no relieving factors No redness or wasting of the forearm No hypothenar wasting No evidence of ulnar claw hand Tinel sign: Positive Sensation: Light touch and 2-point discrimination were normal Froment’s sign: Negative Ultrasound findings MRI imaging revealed an ulnar nerve entrapment at the level of the medial epicondyle. The reference value for a swollen nerve is set at ≥ 10 mm2, according to the meta-analysis by Chang et al. (2018).   Transverse view of the elbow in a neutral position at the level of the edial epicondyle. Here, the ulnar nerve measured 5.9 x 1.6 mm. UCL, ulnar collateral ligament. m   Transverse view of the elbow in a flexed position at the level of the medial epicondyle. Here, the ulnar nerve measured 3.1 x 6.8 mm.  Diagnosis The patient was diagnosed with cubital tunnel syndrome, which is caused by the compression of the ulnar nerve at the elbow. The ulnar nerve entrapment leads to numbness and pain in the forearm and specific fingers. It is the second most common neuropathy of the arm after carpal tunnel syndrome. Discover more about the treatment strategy, patient outcome, and other unique case studies in the US Pain App. Ready to expand your knowledge? Click HERE and get the ultimate app for chronic pain procedures.

December 21, 2023

Case study: Ilioinguinal neuralgia – Injection

A 65-year-old diabetic man presents with inguinodynia on the right side lasting for 4 months after an inguinal hernia repair. He complains of continuous dragging pain with episodes of shooting pain along the inguinal region, disturbing his sleep. There are no aggravating or relieving factors. Physical examination No redness, swelling, or warmth in the inguinal area Healthy surgical scar Normal hip and sacroiliac joint Straight leg raise test: Up to 80 degrees on the right side, no sign of disc-related pathology FABER test: Negative Ultrasound findings The integrity of the ilioinguinal nerve was examined using ultrasound. When scanning the flanks, the ilioinguinal nerve is located between the internal oblique and transversus abdominis muscles. Diagnosis The patient was diagnosed with ilioinguinal neuralgia. Ilioinguinal neuralgia often leads to pain in the lower abdomen and upper thigh, typically resulting from entrapment or injury to the nerve following surgeries in the lower abdominal area. Read more about the treatment, patient outcome, and other case studies in the US Pain App. Ready to elevate your knowledge? Tap HERE to download the go-to app for chronic pain procedures.

December 7, 2023

Case study: Mechanical lower back pain – Injection

A 45-year-old manual laborer presented with chronic lower back pain for a duration of 6 months. He has no comorbidities and conservative management with NSAIDs provides temporary relief. He reports occasional posterior thigh pain on the right side, without numbness or weakness. Physical examination Paramedian lower back pain Unable to walk straight due to paraspinal muscle spasm Straight leg raise test: 70° of flexion was possible bilaterally Femoral stretch test: Negative FABER test: Negative Hip pathology was ruled out clinically MRI findings Straightening of the lumbar spine Lower lumbar spondylosis Dehydrated discs at L3-L4, L4-L5, L5-S1 Disc bulge with neural foraminal narrowing at L5-S1 Normal sacroiliac joint Note: Ultrasound has no diagnostic value in this case. It is used to guide specific interventions (e.g., lumbar facet joint injection). Transducer and needle position for a lumbar facet joint injection. Diagnosis The patient was diagnosed with mechanical back pain. Lower back pain is commonly nonspecific or mechanical, originating from the spine, discs, or nearby tissues. Red flags like progressive motor/sensory loss, urinary issues, history of cancer, recent spinal procedures, and significant trauma necessitate further elevation or imaging. Imaging, reserved for suspected cases of cauda equina syndrome, malignancy, fracture, or infection, includes lumbar X-rays for fractures and MRI for neurological or soft tissue issues. Discover more about the treatment strategy, patient outcome, and other unique case studies in the US Pain App. Ready to expand your knowledge? Click HERE and get the ultimate app for chronic pain procedures.

November 10, 2023

Case study: Knee osteoarthritis – Injection

A 60-year-old female patient complains of persistent right knee pain lasting for more than six months. She experiences significant pain over the anterior and medial aspects of the knee, which worsens when she stands or squats. Taking NSAIDs offered some relief. She has no prior history of trauma, and her BMI is 30. Physical examination No swelling, warmth, or redness of the knee Crepitus on flexion and extension of the knee No deformities Minimal quadriceps wasting Normal gait Ultrasound findings Quadriceps tendon: Normal, small effusion in the suprapatellar recess Long axis view of the quadriceps tendon, which appears normal. A small effusion is seen in the suprapatellar recess. Medial meniscus: Extrusion Long axis view of the medial meniscus showing an extrusion. Patellar tendon: Normal Long axis view of the patellar tendon, which appears normal. Iliotibial band: Normal, small lateral meniscal cyst, likely not causing any pain Long axis view of the iliotibial band, which appears normal. A small lateral meniscal cyst can be seen. Diagnosis The patient was diagnosed with grade 3 knee osteoarthritis. Knee osteoarthritis, a condition commonly observed in the elderly, is categorized into primary (idiopathic degeneration) and secondary (due to factors like trauma, obesity, or rheumatoid arthritis). Typical symptoms encompass gradually worsening knee pain, stiffness, swelling, and a crackling sensation known as crepitus. Read more about the treatment, patient outcome, and other case studies in the US Pain App. Ready to elevate your knowledge? Tap HERE to download the go-to app for chronic pain procedures.

November 2, 2023

Case study: Cervical radiculopathy – Injection

A 50-year-old woman presented with radicular pain in her right upper limb that has persisted for 3 weeks and becomes especially severe at night. She hasn’t had any recent fever or injury incidents. However, she did lift a substantial weight recently. There have been no past episodes of similar pain. NSAIDs and gabapentin have been ineffective in alleviating her discomfort. Physical examination The pain started in the patient’s neck with severe pain around the shoulder, which radiated along the entire arm No aggravating or relieving factors No limb edema or wasting of small muscles of the hand The shoulder appeared normal during clinical examination Jackson’s compression test: Positive Spurling’s test: Positive Imaging X-ray: Early cervical spondylosis, indicated by osteophytes, facet degeneration, and foraminal narrowing. X-ray imaging of the cervical spine revealed early cervical spondylosis, indicated by osteophytes, facet degeneration, and foraminal narrowing. MRI: A paramedian disc bulge was identified at C5-C6, impinging on the anterior thecal sac. Another paramedian disc bulge was noted at C4-C5, but it probably isn’t the primary cause of significant symptoms.  MRI imaging revealed paramedian disc bulges at the C4-5 and C5-6 levels. Diagnosis The patient was diagnosed with C5 radiculopathy on the right side. Cervical radiculopathy occurs when nerve compression arises due to herniated discs or arthritic bone spurs. Symptoms like peripheral radiating pain, muscle weakness, or a tingling sensation can usually be linked to the specific impacted nerve root. Read more about the treatment, patient outcome, and other case studies in the US Pain App. Ready to elevate your knowledge? Tap HERE to download the go-to app for chronic pain procedures.    

October 19, 2023

Case study: Calcific tendinitis – Barbotage

A 60-year-old male came in with acute shoulder pain that has been especially severe at night for the past week. Despite taking NSAIDs, he experienced no alleviation. He has diabetes, which is well-managed, and there is no previous record of shoulder injuries or any other trauma. Physical examination The pain presented over the supraspinous fossa and deltoid muscle Movement was severely limited due to the pain Painful arc present Neer’s test: Positive Painful anteromedial shoulder on internal rotation Ultrasound findings Slightly solid appearing calcification of the subscapularis tendon Axial view of the shoulder showing a calcific subscapularis tendon. Axial view of the shoulder in external rotation showing a slightly solid calcification of the subscapularis tendon at the insertion onto the lesser tuberosity. Before planning an intervention, such as a barbotage, thorough anteroposterior imaging is needed to evaluate the feasibility of a barbotage.  A hard calcification will cast an acoustic shadow and may not be suitable for barbotage. Anteroposterior imaging of a calcific subscapularis tendon revealing an acoustic shadow, indicating a hard calcification. A calcification 1 cm in size, slightly solid in appearance and not casting an acoustic shadow is eligible for barbotage. Anteroposterior imaging of a calcific subscapularis tendon revealing a slightly solid appearing calcification. Diagnosis The patient was diagnosed with calcific tendinitis of the subscapularis tendon. Calcific tendinitis of the shoulder results from the deposition of calcium phosphate crystals in the rotator cuff tendons. Symptoms include sudden onset of shoulder pain, exacerbated pain when moving the shoulder, discomfort at night, and restricted shoulder mobility. Discover more about the treatment strategy, patient outcome, and other unique case studies in the US Pain App. Ready to expand your knowledge? Click HERE and get the ultimate app for chronic pain procedures.

October 5, 2023

Case study: Baker’s cyst – Injection

A 64-year-old man presented with persistent right knee pain that has been bothering him for the past 6 months. He described a growing discomfort in the anteromedial and posterior regions of his knee, especially when standing. His primary symptoms included morning stiffness and a noticeable decrease in his knee’s range of motion. Notably, there were no previous instances of knee-related trauma or interventions. The pain tended to ease with rest, but he found only minimal relief from NSAIDs. Physical examination Anterior and posterior knee swelling No redness Visible quadriceps wasting Palpable crepitus on flexion and extension of the knee Ultrasound findings Effusion of the suprapatellar recess: Suggestive of joint effusion with minimal synovial thickening Axial view of the suprapatellar recess showing an effusion. Effusion underneath the tibial attachment of the patellar tendon: Suggestive of deep infrapatellar bursitis Long axis view of the patellar tendon showing effusion underneath its tibial attachment. Short axis view of the patellar tendon showing effusion underneath its tibial attachment. Septated cystic appearance in the posterior knee: Baker’s cyst Axial view of the posterior knee showing a septated Baker’s cyst. Diagnosis The patient was diagnosed with a Baker’s cyst secondary to osteoarthritis of the knee. Baker’s cysts, also known as popliteal cysts, are fluid-filled swellings that develop at the back of the knee, frequently causing stiffness and discomfort. These cysts typically occur as a secondary condition to underlying knee issues (i.e., osteoarthritis or a meniscus tear), prompting the joint to generate excessive synovial fluid. Common symptoms encompass the presence of a lump, knee pain, and stiffness. Read more about the treatment, patient outcome, and other case studies in the US Pain App. Ready to elevate your knowledge? Tap HERE to download the go-to app for chronic pain procedures.

September 21, 2023

Case study: Meralgia paresthetica – Injection

A 65-year-old woman, a homemaker, has been experiencing persistent pain and numbness in her right thigh for the past 5 years. A recent L4-L5 disc surgery provided no relief, and notably, the patient doesn’t recall any prior trauma. Physical examination The pain presented over the anterolateral aspect of the thigh, not extending below the knee. Ultrasound findings Considering the patient’s symptoms and previous evaluations, there was suspicion of a lateral femoral cutaneous nerve (LFCN) entrapment, commonly referred to as meralgia paresthetica. Ultrasound examination revealed a swollen LFCN, particularly the anterior branch. Transverse view of the anterior thigh showing a slightly swollen lateral femoral cutaneous nerve (LFCN), especially the anterior branch.  Diagnosis The patient was diagnosed with meralgia paresthetica, which presents as tingling, numbness, or a burning sensation in the lateral thigh. These symptoms typically result from the compression of the LFCN. While most individuals experience it unilateral, there are cases of bilateral symptoms. Read more about the treatment, patient outcome, and other case studies in the US Pain App. Ready to elevate your knowledge? Tap HERE to download the go-to app for chronic pain procedures.

September 7, 2023
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Featuring tried-and-true US-guided Pain blocks techniques used by practitioners worldwide

Based on the world’s leading authority on ultrasound, Dr. Samer Narouze’s book “Atlas of Ultrasound-Guided Procedures in Interventional Pain Management” NYSORA’s US Pain App describes the most practical and applicable techniques of ultrasound-guided pain medicine.

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1. Third Occipital Nerve and Cervical Medial Branch Nerve Block
2. Cervical Zygapophyseal (Facet) Intra-Articular Injection
3. Cervical Nerve Root Block
4. Thoracic Paravertebral Block
5. Lumbar Facet Nerve Block and Intra-articular injection
6. Lumbar Nerve Root (Periradicular) Injections
7. Central Neuraxial Blocks
8. Caudal Epidural Injections
9. Sacroiliac Joint Injection
10. Transversus Abdominis Plane (TAP) Block
11. Celiac Plexus Block and Neurolysis
12. Ilioinguinal, Iliohypogastric, and Genitofemoral Nerve block
13. Piriformis Muscle Injection
14. Pudendal Nerve block
15. Ganglion Impar Injection
16. Superficial Trigeminal Nerve Blocks
17. Greater Occipital Nerve Block
18. Cervical Sympathetic Block
19. Lateral Femoral Cutaneous Nerve Block
20. Suprascapular Nerve Block
21. Intercostal Nerve Block
22. Subacromial/Subdeltoid Bursa Injections
23. Biceps Tendon Sheath (Biceps – Long Head) Injections
24. Acromioclavicular Joint Injections
25. Glenohumeral Joint Injections
26. Subscapularis Tendon/Subscapularis Bursa Injections
27. Sternoclavicular Joint Injections
28. Carpal Tunnel Injections
29. Trigger Finger Injections
30. Wrist Injections
31. Injections for Tendon Dysfunction
32. Elbow Injections
33. Intra-articular Hip Injections
34. Knee Injections
35. Atlanto-Axial and Atlanto-Occipital Joint Injections
36. Peripheral Nerve Stimulation
37. Occipital Stimulation
38. Groin Stimulation
39. Cervical Diskography and Intradiskal Procedures
Frequently asked questions

Ultrasound-guided nerve blocks are minimally invasive procedures used to administer local anesthetics or other medications near specific nerves under the guidance of ultrasound imaging. This technique allows for precise targeting of nerves to provide effective pain relief by interrupting the transmission of pain signals.

Ultrasound plays a critical role in pain management by providing real-time imaging guidance for various interventions, including nerve blocks, injections, and other procedures. It enables healthcare providers to visualize anatomical structures, accurately target the source of pain, and deliver treatments with precision, ultimately improving patient outcomes and safety.

An ultrasound-guided injection delivers medication, such as a local anesthetic or corticosteroid, to a specific target area under the guidance of ultrasound imaging. These injections can provide pain relief by reducing inflammation, blocking pain signals, or facilitating healing, depending on the underlying condition being treated.

Guided interventional procedures using ultrasound include a range of interventions aimed at diagnosing and treating pain conditions. Some common procedures include nerve blocks, joint injections, tendon sheath injections, trigger point injections, and spinal procedures such as epidural steroid injections or facet joint injections.

A diagnostic ultrasound in pain management involves using ultrasound imaging to assess and diagnose musculoskeletal and neuropathic pain conditions. It allows healthcare providers to visualize structures such as muscles, tendons, ligaments, nerves, and joints to identify abnormalities, injuries, or sources of pain accurately.