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Ultrasound-guided 5-in-1 injection: trigger point injections and nerve hydrodissections for non-specific upper back pain

Video Author: Tsung-Yung Tang; Shau-Gang Shyu; Chueh-Hung Wu
Published on: 11.12.2018

This video demonstrates an ultrasound-guided 5-in-1 injection for trigger point injection in the trapezius, levator scapulae and rhomboid muscles, and nerve hydrodissection of the spinal accessory nerve and dorsal scapular nerve for a patient with upper back pain with neuropathic characteristics.

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Ultrasound-guided 5-in-1 injection: trigger point injections and nerve hydrodissections for non-specific upper back pain
Creator: Tsung-Yung Tang; Shau-Gang Shyu; Chueh-Hung Wu
Duration: 2:19
This video demonstrates an ultrasound-guided 5-in-1 injection for trigger point injection in the trapezius, levator scapulae and rhomboid muscles, and nerve hydrodissection of the spinal accessory nerve and dorsal scapular nerve for a patient with upper back pain with neuropathic characteristics.
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Electromyographic needle examination of biceps brachii muscle in patient with respiratory synkinesis
Creator: Daniel M Cushman, MD
Duration: 0:16
This video demonstrates needle electromyography on a patient with respiratory synkinesis, with a needle in the right biceps brachii muscle. The first section of the video shows a relaxed patient, with the appearance of motor units associated with the inhalation phase of breathing. Next, the electromyographer asks her to take a deep breath with subsequent activation of numerous atypical motor units, which is done three times. For the last section, the patient holds her breath, and the motor unit stops firing.
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Ultrasound-guided injection of botulinum toxin for cricopharyngeal dysphagia
Creator: Yi-Chian Wang, Shaw-Gang Shyu, Chueh-Hung Wu, Tyng-Guey Wang
Duration: 1:52
This video showed the axial and sagittal ultrasound-guided injection to the cricopharyngeal muscle, and showed the videofluoroscopic swallowing study results before and after the injection.
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Sonographic Evaluation of the Posterior Inter-osseous Nerve in a Patient with Wrist Drop
Creator: Tze Chao Wee, Chueh-Hung Wu
Duration: 1:05
The video provides a brief background to the pa-tient’s presentation, management and follow up. This is accompanied by 2 clips showing the ultra-sound tracking of the affected posterior interosse-ous nerve and the sound side.
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Ultrasound Imaging for Dorsal Ulnar Cutaneous Neuropathy with Extensor Carpi Ulnaris Tendinopathy
Creator: Ke-Vin Chang
Duration: 1:00
The video demonstrated tracking a swollen extensor carpi ulnaris tendon with a thickened retinaculum. An enlarged nerve segment with loss of fascicular echotexture was observed, and was impinged by the thickened retinaculum.
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Ultrasound-guided Selective Cervical Root Injection for Post-herpetic Neuralgia.
Creator: The video demonstrated tracking the brachial plexus from the supraclavicular to root level and ultrasound guided injection to the cervical roots of C5 and C6.
Duration: 2:39
The video demonstrated tracking the brachial plexus from the supraclavicular to root level and ultrasound guided injection to the cervical roots of C5 and C6.
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Ultrasound-Guided Injection to the Fifth Cervical Spine Nerve Root Level
Creator: Carl PC CHEN
Duration: 4:08
This video shows how ultrasound-guided cervical nerve root block (US-CRB) is done to the 5th nerve root level. The objective of CRB is to place the needle in the intertubercular groove situated between the nerve root and the posterior tubercle.
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Ultrasonographic Technique for Imaging and Injecting the Superior Cluneal Nerve
Creator: Ke-Vin Chang
Duration: 3:07
The video demonstrates the anatomy of the superior cluneal nerve and the ultrasonographic technique for imaging and injecting the superior cluneal nerve.
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Adding a Transverse Scan in the Ultrasound Diagnosis of Extensor Tendinopathy
Creator: Yi-Chian Wang, Rachel J. Lew, Chia-Wei Lee, Yi-Pin Chiang
Duration: 3:37
Extensor Tendinopathy (Tennis Elbow) is a common term used to describe pathology of the forearm extensor tendons that converge to anchor the muscles to the lateral elbow. During traditional ultrasonography using the longitudinal scanning method, it is difficult to determine which component of the common extensor tendon (CET) is affected. This video presents the addition of a transverse scan to better visualize the tendons that join and form the CET. Two cases seen in our ultrasound clinic were demonstrated. The findings from the transverse scan helped to provide modifications of specific wrist and hand activities to facilitate recovery.
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VOL(ISSUE) CME - Title of ARTICLE - Video # - Title of VIDEO
Creator: Murat Karkucak
Duration: 1:51
AN ULTRASOUND VIDEO DEMONSTRATION FOR LUMBAR FACET JOINT INJECTION
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Tendon Sheath Fibroma with a Concomitant Morton’s Neuroma.
Creator: Ke-Vin Chang
Duration: 0:39
The image revealed a flattened compressible mass superficial to the flexor tendon on the 3rd metatarsophalangeal joint. Slightly relocating the transducer toward the heel, we found another mass emerging from the 3rd intermetatarsal space, a common region for Morton’s neuroma. Under dynamic tracking, the connecting stalk between the intermetatarsal mass and the lesion overlying the 3rd toe flexor tendon might be considered as another hint for tendon-sheath related pathology. Its heteroechoic appearance and hypervasculairty were compatible with submetatarsal bursitis.
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Dynamic Ultrasonography of the Intra-articular Long Head Biceps Tendon and Superior Labrum - Video #1 - Tracking of the LHBT from the bicipital groove to the proximal insertion
Creator: Ming-Yen Hsiao, Chen-Yu Hung, Ke-Vin Chang, Levent Özçakar
Duration: 0:29
Tracking of the the long head of the biceps tendon from the bicipital groove to the proximal insertion of the superior labrum.
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Dynamic Ultrasonography of the Intra-articular Long Head Biceps Tendon and Superior Labrum - Video #2- Dynamic imaging the LHBT at the proximal insertion
Creator: Ming-Yen Hsiao, Chen-Yu Hung, Ke-Vin Chang, Levent Özçakar
Duration: 0:12
Dynamic examination of the the long head of the biceps tendon at the proximal insertion is performed by supinating and pronating the forearm while keeping the upper arm fixed.
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Dynamic Ultrasonography of the Intra-articular Long Head Biceps Tendon and Superior Labrum - Video #3 - Dynamic stress test of the LHBT
Creator: Ming-Yen Hsiao, Chen-Yu Hung, Ke-Vin Chang, Levent Özçakar
Duration: 0:11
Dynamic stress test of the the long head of the biceps tendon by applying an inferior distraction force to the humerus.
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Ultrasonography of the Anterior Cruciate Ligament: Not an Easy Structure in Knee Joint Imaging- Video 1-ACL flexion extension
Creator: Ming-Yen Hsiao, Ke-Vin Chang , Levent Özçakar
Duration: 1:01
Dynamic ultrasonography of anterior cruciate ligament from knee flexion to extension and extension to flexion.
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Ultrasonography of the Anterior Cruciate Ligament: Not an Easy Structure in Knee Joint Imaging- Video 2- ACL anteromedial bundle
Creator: Ming-Yen Hsiao, Ke-Vin Chang , Levent Özçakar
Duration: 0:15
Dynamic ultrasonography of anteromedial bundle of anterior cruciate ligament with a simultaneous anterior drawer test
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Ultrasonography of the Anterior Cruciate Ligament: Not an Easy Structure in Knee Joint Imaging- Video 3- ACL posterolateral bundle
Creator: Ming-Yen Hsiao, Ke-Vin Chang , Levent Özçakar
Duration: 0:15
Dynamic ultrasonography of posterolateral bundle of anterior cruciate ligament with a simultaneous anterior drawer test
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VOL(ISSUE) CME - Title of ARTICLE - Video # - Title of VIDEO
Creator: Thiru M. Annaswamy, Kimberly Davis, Corey Armstead
Duration: 0:06
Needle electromyography in low cervical paraspinal muscles of a patient with EMG disease demonstrate increased insertional activity and myotonic discharges at 2 different sweep speeds; 20ms (video 1) and 500ms (video 2). Video 1: 20ms sweep displays a myotonic discharge that can appear as fibrillations and positive sharp waves or complex repetitive discharges. Video 2: 500ms sweep reveals the “wax and wane” characteristic specific to myotonic discharges. Myotonic discharges can have variable appearance and sound depending on sweep speed. By definition discharges need to last over 500ms and in 3 or more areas outside of an endplate.
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VOL(ISSUE) CME - Title of ARTICLE - Video # - Title of VIDEO
Creator: Thiru M. Annaswamy, Kimberly Davis, Corey Armstead
Duration: 0:29
Needle electromyography in low cervical paraspinal muscles of a patient with EMG disease demonstrate increased insertional activity and myotonic discharges at 2 different sweep speeds; 20ms (video 1) and 500ms (video 2). Video 1: 20ms sweep displays a myotonic discharge that can appear as fibrillations and positive sharp waves or complex repetitive discharges. Video 2: 500ms sweep reveals the “wax and wane” characteristic specific to myotonic discharges. Myotonic discharges can have variable appearance and sound depending on sweep speed. By definition discharges need to last over 500ms and in 3 or more areas outside of an endplate.
Play Video | + Favorites
Dynamic Ultrasound Imaging for Ulnar Nerve Subluxation and Snapping Triceps Syndrome
Creator: Hung-Jui Chuang, Ming-Yen Hsiao, Chueh-Hung Wu, Levent Özçakar
Duration: 1:29
Ulnar nerve subluxation or snapping triceps syndrome is the condition of anterior sliding of the ulnar nerve or part of the triceps muscle over the medial epicondyle during elbow flexion. This video presents the real-time dynamic visualization of the entire process of ulnar nerve subluxation and snapping triceps during joint movement of the elbow using ultrasonography.
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Ultrasound-guided 5-in-1 injection: trigger point injections and nerve hydrodissections for non-specific upper back pain
Creator: Tsung-Yung Tang; Shau-Gang Shyu; Chueh-Hung Wu
Duration: 2:19
Show More 
Show Less 
This video demonstrates an ultrasound-guided 5-in-1 injection for trigger point injection in the trapezius, levator scapulae and rhomboid muscles, and nerve hydrodissection of the spinal accessory nerve and dorsal scapular nerve for a patient with upper back pain with neuropathic characteristics.
Play Video | + Favorites
Electromyographic needle examination of biceps brachii muscle in patient with respiratory synkinesis
Creator: Daniel M Cushman, MD
Duration: 0:16
Show More 
Show Less 
This video demonstrates needle electromyography on a patient with respiratory synkinesis, with a needle in the right biceps brachii muscle. The first section of the video shows a relaxed patient, with the appearance of motor units associated with the inhalation phase of breathing. Next, the electromyographer asks her to take a deep breath with subsequent activation of numerous atypical motor units, which is done three times. For the last section, the patient holds her breath, and the motor unit stops firing.
Play Video | + Favorites
Ultrasound-guided injection of botulinum toxin for cricopharyngeal dysphagia
Creator: Yi-Chian Wang, Shaw-Gang Shyu, Chueh-Hung Wu, Tyng-Guey Wang
Duration: 1:52
Show More 
Show Less 
This video showed the axial and sagittal ultrasound-guided injection to the cricopharyngeal muscle, and showed the videofluoroscopic swallowing study results before and after the injection.
Play Video | + Favorites
Ultrasound Imaging for Dorsal Ulnar Cutaneous Neuropathy with Extensor Carpi Ulnaris Tendinopathy
Creator: Ke-Vin Chang
Duration: 1:00
Show More 
Show Less 
The video demonstrated tracking a swollen extensor carpi ulnaris tendon with a thickened retinaculum. An enlarged nerve segment with loss of fascicular echotexture was observed, and was impinged by the thickened retinaculum.
Play Video | + Favorites
Ultrasound-guided Selective Cervical Root Injection for Post-herpetic Neuralgia.
Creator: The video demonstrated tracking the brachial plexus from the supraclavicular to root level and ultrasound guided injection to the cervical roots of C5 and C6.
Duration: 2:39
Show More 
Show Less 
The video demonstrated tracking the brachial plexus from the supraclavicular to root level and ultrasound guided injection to the cervical roots of C5 and C6.
Play Video | + Favorites
Ultrasonographic Technique for Imaging and Injecting the Superior Cluneal Nerve
Creator: Ke-Vin Chang
Duration: 3:07
Show More 
Show Less 
The video demonstrates the anatomy of the superior cluneal nerve and the ultrasonographic technique for imaging and injecting the superior cluneal nerve.
Play Video | + Favorites
Adding a Transverse Scan in the Ultrasound Diagnosis of Extensor Tendinopathy
Creator: Yi-Chian Wang, Rachel J. Lew, Chia-Wei Lee, Yi-Pin Chiang
Duration: 3:37
Show More 
Show Less 
Extensor Tendinopathy (Tennis Elbow) is a common term used to describe pathology of the forearm extensor tendons that converge to anchor the muscles to the lateral elbow. During traditional ultrasonography using the longitudinal scanning method, it is difficult to determine which component of the common extensor tendon (CET) is affected. This video presents the addition of a transverse scan to better visualize the tendons that join and form the CET. Two cases seen in our ultrasound clinic were demonstrated. The findings from the transverse scan helped to provide modifications of specific wrist and hand activities to facilitate recovery.
Play Video | + Favorites
VOL(ISSUE) CME - Title of ARTICLE - Video # - Title of VIDEO
Creator: Murat Karkucak
Duration: 1:51
Show More 
Show Less 
AN ULTRASOUND VIDEO DEMONSTRATION FOR LUMBAR FACET JOINT INJECTION
Play Video | + Favorites
Dynamic Ultrasonography of the Intra-articular Long Head Biceps Tendon and Superior Labrum - Video #1 - Tracking of the LHBT from the bicipital groove to the proximal insertion
Creator: Ming-Yen Hsiao, Chen-Yu Hung, Ke-Vin Chang, Levent Özçakar
Duration: 0:29
Show More 
Show Less 
Tracking of the the long head of the biceps tendon from the bicipital groove to the proximal insertion of the superior labrum.
Play Video | + Favorites
Dynamic Ultrasonography of the Intra-articular Long Head Biceps Tendon and Superior Labrum - Video #2- Dynamic imaging the LHBT at the proximal insertion
Creator: Ming-Yen Hsiao, Chen-Yu Hung, Ke-Vin Chang, Levent Özçakar
Duration: 0:12
Show More 
Show Less 
Dynamic examination of the the long head of the biceps tendon at the proximal insertion is performed by supinating and pronating the forearm while keeping the upper arm fixed.
Play Video | + Favorites
Dynamic Ultrasonography of the Intra-articular Long Head Biceps Tendon and Superior Labrum - Video #3 - Dynamic stress test of the LHBT
Creator: Ming-Yen Hsiao, Chen-Yu Hung, Ke-Vin Chang, Levent Özçakar
Duration: 0:11
Show More 
Show Less 
Dynamic stress test of the the long head of the biceps tendon by applying an inferior distraction force to the humerus.
Play Video | + Favorites
Ultrasonography of the Anterior Cruciate Ligament: Not an Easy Structure in Knee Joint Imaging- Video 1-ACL flexion extension
Creator: Ming-Yen Hsiao, Ke-Vin Chang , Levent Özçakar
Duration: 1:01
Show More 
Show Less 
Dynamic ultrasonography of anterior cruciate ligament from knee flexion to extension and extension to flexion.
Play Video | + Favorites
Ultrasonography of the Anterior Cruciate Ligament: Not an Easy Structure in Knee Joint Imaging- Video 2- ACL anteromedial bundle
Creator: Ming-Yen Hsiao, Ke-Vin Chang , Levent Özçakar
Duration: 0:15
Show More 
Show Less 
Dynamic ultrasonography of anteromedial bundle of anterior cruciate ligament with a simultaneous anterior drawer test
Play Video | + Favorites
Ultrasonography of the Anterior Cruciate Ligament: Not an Easy Structure in Knee Joint Imaging- Video 3- ACL posterolateral bundle
Creator: Ming-Yen Hsiao, Ke-Vin Chang , Levent Özçakar
Duration: 0:15
Show More 
Show Less 
Dynamic ultrasonography of posterolateral bundle of anterior cruciate ligament with a simultaneous anterior drawer test
Play Video | + Favorites
VOL(ISSUE) CME - Title of ARTICLE - Video # - Title of VIDEO
Creator: Chen-Yu Hung
Duration: 0:41
Show More 
Show Less 
Demonstration of the dynamic stress test of both the normal and injured wrists as well as the Doppler ultrasound imaging of the injured TFCC.
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Video Gallery: Ultrasound-guided Injection Treatment for Carpal Tunnel Syndrome (AJPMR-D-15-00112)
Creator: Jia-Pei, Hong, MD, Henry L. Lew, MD, PhD, Chih-Hong, Lee, MD, Simon F.T. Tang, MD,
Duration: 2:06
Show More 
Show Less 
The authors demonstrated ultrasound-guided technique in treating carpal tunnel syndrome to avoid damaging the median nerve and adjacent soft tissue. Since the median nerve goes deeper at distal hamate level, distal approach may provide larger space for initial needle insertion. Under long-axial view, the whole stretch of median nerve could be visualized when the needle progressed proximally in the access of in-plane.
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VOL(ISSUE) CME - Title of ARTICLE - Video # - Title of VIDEO: Ultrasound-Guided Glenohumeral Joint Injection – Using the Posterior Approach
Creator: Carl PC CHEN
Duration: 2:14
Show More 
Show Less 
Injection treatment to the glenohumeral joint is often needed to treat shoulder problems such as adhesive capsulitis. This can be done through blind palpation technique, fluoroscopic or musculoskeletal ultrasound guidance. In recent years, ultrasound has been proven to increase the accuracy of needle placement into the glenohumeral joint.
Glenohumeral joint injection can be done through the anterior rotator interval approach or the posterior approach techniques. The posterior injection technique offers an easier and a more effective approach to the glenohumeral joint with less extravasation rate as compared with the anterior approach. The video demonstrates how the posterior injection approach is done through ultrasound guidance.
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Sonographic Examination of Knee Ligaments
Creator: YI-Pin Chiang
Wen-Hsiang Tsai
Rachel Lew
Duration: 4:26
Show More 
Show Less 
This video briefly reviewed the anatomy and sonographic appearance of knee ligaments, including two collateral ligaments and two cruciate ligaments. Ultrasound guided injection and aspiration for the knee joint was also demonstrated.
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Demonstration of the ReWalk
Creator: Alberto Esquenazi, MD
Duration: 0:52
Show More 
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Video demonstration of a patient using ReWalk. The ReWalk is a lower limb powered exoskeleton that allows thoracic or lower level motor-complete individuals with SCI to walk independently.
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Dynamic Ultrasound Imaging for the Iliotibial Band/Snapping Hip Syndrome
Creator: Kai-Shiang Chang, Yu-Hsuan Cheng, Chueh-Hung Wu, Levent Özçakar
Duration: 4:10
Show More 
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This video shows the dynamic images for the iliotibial band snapping hip syndrome, which could not be detected by the MRI exam. If an individual has lateral hip pain and correlated history, dynamic ultrasound imaging is the best modality to diagnose iliotibial band snapping hip syndrome.
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VOL 93 (ISSUE 2) February 2014 - Ultrasound Guided Caudal Epidural Injection Technique
Creator: Carl PC Chen, MD, PhD, Henry L Lew, MD, PhD, Simon FT Tang, MD
Duration: 5:07
Show More 
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Ultrasound Guided Caudal Epidural Injection Technique
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VOL 91 (ISSUE 7) July 2012: Ultrasound-Guided Injection Treatment of Retrocalcaneal Bursitis
Creator: Ngok-Kiu Chu, MD Henry L. Lew, MD, PhD
Duration: 3:35
Show More 
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Ultrasound examination, anatomy, description, and ultrasound-guided injection treatment of retrocalcaneal bursitis
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Ultrasound-Guided Diagnosis and Treatment of Plantar Fasciitis
Creator: Chih-Kuang Chen, MD, Henry L. Lew, MD, PhD.
Duration: 4:09
Show More 
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From an upcoming issue of the American Journal of Physical Medicine & Rehabilitation
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Ultrasound-Guided Examination and Injection of the Shoulder
Creator: Yi-Pin Chiang, MD, Chien-Fei Feng, MD, and Henry L. Lew, MD, PhD
Duration: 4:12
Show More 
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With the July issue of the Journal we are launching a new regular feature: the Video Gallery. The purpose of this Gallery is to combine text with video in the presentation and discussion of a topic of interest in musculoskeletal medicine. The first publication is authored by Chiang and collaborators who made a fantastic effort to write the text and produce the video in a relatively short period of time so we could include it in this issue of the Journal. This first “combined media publication” focus on the use of ultrasound for the examination of the rotator cuff and injection of the subacromial and subdeltoid bursa. Thanks to the effort of the Publisher LWW, the video can be accessed using your smartphone camera QR reader App to scan and capture the QR Code included with the print version of the article or by visiting our website at www.AJPMR.com. I hope you will appreciate this new feature and send us your comments and suggestions for future topics and use of electronic media.

Walter R. Frontera, MD, PhD
Editor-in-Chief
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