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Clinical impact of diagnostic image-guided injections for musculoskeletal pain work-up in adolescent and adult patients at a children’s hospital: initial results

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Abstract

Objective

To assess the clinical impact of diagnostic musculoskeletal (MSK) injections on treatment decision-making in adolescent and adult patients at a children’s hospital.

Materials and methods

Retrospective study in patients who underwent diagnostic MSK injections by fluoroscopy or ultrasound (US) between 8/2020 and 3/2023 at a children’s hospital. Patients received ropivacaine and triamcinolone acetonide at pain site, reporting quantitative FACES pain score prior to, immediately following, and 2–3 days following injection. Impact on patient care was subsequently assessed.

Results

A total of 109 diagnostic fluoroscopic or US MSK injection referrals (mean: 17.6 years old) were included, most commonly hip (76.2%), ankle (9.2%), and iliopsoas tendon sheath (8.3%). Pain improvement occurred in 89.0% immediately and 67.9% 2–3 days after MSK injection, with net 84.4% exhibiting improvement based on pain scores and clinical exams. When there was pain improvement at the site of injection, there was a statistically higher incidence of operative intervention or additional therapeutic injections compared with the cohort that did not have symptom improvement (88% versus 35.3%, P < 0.0001). For the 15.6% (N = 17) of referrals that did not have pain improvement, 17.6% (n = 3) ultimately had an operative intervention at a separate site from the diagnostic injection, as an alternative etiology for the pain was found.

Conclusion

Image-guided MSK injections play an important role in the management of musculoskeletal disorders. 84.4% of referrals experienced symptom relief, improving confidence for treatment decision-making. Importantly, 15.6% of patients were found to have an alternative etiology for symptoms, altering management altogether.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    Evelyn Tran

  2. Department of Orthopaedic Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Scott Rosenfeld

  3. Department of Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Esther Ngan & J. Herman Kan

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  1. Evelyn Tran
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  2. Scott Rosenfeld
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Correspondence to Evelyn Tran.

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Tran, E., Rosenfeld, S., Ngan, E. et al. Clinical impact of diagnostic image-guided injections for musculoskeletal pain work-up in adolescent and adult patients at a children’s hospital: initial results. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04635-1

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