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Abstract Introduction  This review article addresses the best evidence currently available for therapeutic injection therapy for conditions targeting the spine and sacroiliac joints. The article is presented by spinal region. Controversies and areas of interest for further studies are identified. Discussion  There is conclusive evidence supporting the effectiveness of the caudal approach for the administration of epidural steroid injections for patients with low back pain from a variety of causes. In general, there is moderate-to-strong evidence supporting the use of transforaminal therapeutic epidural injections for lumbar nerve-root compression and facet injections for joint pain arising from these joints in the cervical, thoracic and lumbar spine, but further subgroup analysis is needed to help predict which specific patients may receive the most benefit from these procedures. Conclusion  No randomized controlled trials, meta-analyses or systematic reviews addressing the effectiveness of therapeutic sacroiliac joint injections have been found. For some injections, corticosteroids may not provide better outcomes compared to local anesthetic injections alone. [ABSTRACT FROM AUTHOR]

Abstract Objective  The aim of this study was to differentiate septic from non-septic arthritis by measuring lactate concentration with 1H magnetic resonance spectroscopy (HMRS) and by estimating total protein content with the assessment of T 2 values. Materials and methods  In 30 patients with acute arthritis, synovial fluid was aspirated. Lactate concentrations were analyzed with single voxel HMRS at 1.5 T. T 2 relaxation times were mapped with a multi-spin echo sequence. All samples underwent microbiological testing and routine laboratory analysis to quantify lactate concentration and total protein content. Values obtained in septic and non-septic arthritis were compared with a Mann–Whitney U test. Results  Synovial fluid from patients with septic arthritis (n = 10) had higher concentrations of lactate (11.4 ± 4.0 mmol/L) and higher total protein content (51.8 ± 10.7 g/L) than fluid obtained in non-septic arthritis (n = 20; 5.2 ± 1.1 mmol/L and 40.4 ± 6.9 g/L, respectively, p T 2 relaxation times (as an indicator of total protein content) were moderately correlated to laboratory-confirmed lactate concentration (r 2 = 0.71) and total protein content (r 2 = 0.73). Markedly increased lactate concentrations (>6 mmol/L) in combination with low T 2 values ( Conclusion  Spectroscopic measurements of lactate concentration in combination with the estimation of protein content using T 2 may be of value in the differentiation of septic from non-septic arthritis. [ABSTRACT FROM AUTHOR]

Abstract  The posterolateral corner (PLC) is a complex functional unit, consisting of several structures, which is responsible for posterolateral stabilization. The PLC is not consistently defined in the literature. However, most descriptions include the popliteal tendon (PT), the lateral collateral ligament (LCL), the popliteofibular ligament (PFL) and the posterolateral capsule, which is reinforced by the arcuate ligament (AL) and the fabellofibular ligament (FFL). Knowledge of PLC anatomy, including its variations, and understanding of the biomechanics is important for correct diagnosis of PLC injuries. An overlooked PLC injury can result in chronic instability, chronic pain, and, eventually, in secondary osteoarthritis. Damage to the PLC also has an adverse effect on the outcome of cruciate ligament repair. Isolated lesions of the PLC are rare. PLC lesions are typically associated with injuries of the cruciate ligaments, the menisci, bone and soft tissue. In the acute phase, clinical findings can be difficult to interpret due to pain and swelling. Magnetic resonance (MR) imaging potentially demonstrates the entire spectrum of PLC injuries and associated lesions of the knee, including those that may be overlooked during clinical examination or arthroscopy. [ABSTRACT FROM AUTHOR]