원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현

원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 지도김석원교수 이논문을석사학위논문으로제출함 2013 년 7 월 12 일 연세대학교대학원 의학과 남상현

남상현의석사학위논문으로인준함 심사위원김석원인 심사위원오진록인 심사위원강태영인 연세대학교대학원 2013 년 7 월 12 일

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Fig 1. Ultrasound examination of distal radioulnar joint (A)Wrist and hand position for ultrasound examination of distal radioulnar joint (arrow head:ulnar head). the transducer position bridging the space between Lister s tubercle and the ulnar head. (B) Lister s tubercle (arrow) is located on the left side (radial), whereas the ulnar head (UH) is on the right side (ulnar). From left to right, one can see the third extensor compartment, fourth extensor compartment and extensor digiti minimi.the DRUJ space lies between the extensor digiti minimi and the ulnar head (arrow head). - 4 -

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Table 2. Comparison of VNS,DASH, MMWS and ROM by injection guidance from baseline to 3,6 and 12 months Group Baseline 3 months 6 months 12 month VNS US 6.7±1.4 2.6±0.9 2.7±0.9 3.2±1.0 Palpation 6.5±1.6 2.9±1.0 3.2±0.8 3.7±0.8 DASH US 45.7±9.1 22.1±5.4 13.1±3.3 14.9±4.2 Palpation 44.8±9.8 22.6±5.7 14.0±4.0 16.8±3.9 MMWS US 57.4±6.9 73.1±4.7 83.9±3.1 81.3±4.8 Palpation 56.3±5.8 72.6±4.8 81.2±2.8 78.8±3.6 Pronation US 62.7±5.1 83.1±3.9 82.4±5.9 81.2±4.7 Palpation 62.3±4.8 82.7±4.1 80.5±5.2 77.6±4.4 Supination US 63.1±4.8 82.1±3.9 84.7±5.2 85.1±6.3 Palpation 63.2±5.1 81.8±4.1 83.5±5.1 84.8±5.7 Values are mean±standard deviation. *p< 0.05 before vs after p<0.05 US vs Palpation VNS Verbal Numeric Pain scale, DASH The Disability of the Arm, Shoulder, and Hand questionnaire, MMWS The modified Mayo wrist score, ROM range of motion - 8 -

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Factor OR 95% CI P value Age 1.047 0.998-1.097 0.058 BMI(kg/ m2 ) 1.038 0.845-1.276 0.722 Injection method 1.432 0.873-1.801 0.043 Duration 1.121 0.963-1.304 0.140-10 -

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Effect of Ultrasound-Guided Corticosteroid Injections in the distal radioulnar joint disorder. Retrospective study 1 year follow up The aim of this study was to conduct a retrospective study on the long-term benefits and accuracy rate of the ultrasound (US) guided vs. palpation guided intraarticular (IA) injections for the treatment of distal radioulnar joint (DRUJ) disorder. From March 2009 to May 2012, 88 patients received US (n=41) or palpation (n=47) guided steroid injection for DRUJ disorder. Outcomes were measured with a the Disability of the Arm, Shoulder, and Hand questionnaire (DASH), Verbal Numeric pain Scale(VNS), Modified Mayo wrist score (MMWS), range of motion (ROM) and accuracy rate between two group. 1.25 ml of mixed material (0.5ml Omnipaque + 1% lidocaine 0.25ml + triamcinolone 20mg 0.5ml) was injected into the intra-articular space of the DRUJ. Treatment effects were assessed by using the VNS, DASH, MMWS and passive ROM of the DRUJ (supination,pronation from neutral). After US guided and palpation guided IA injection into DRUJ, a radiographic image was taken to determine whether the injected material reached the IA space or infiltrated into the soft tissue. Image analysis and chart review were performed. US guided IA injections showed significantly higher accuracy(98%) than palpation guided IA injections(75%) in DRUJ. The VNS, DASH, - 18 -

MMWS and ROM were improved at 3,6 and 12 months in both groups. There was a significant difference in the VNS,MMWS between the US guided and palpation guided groups at 6,12 month and DASH, ROM at 12 month of follow up. The proportion of patients achieved significant pain relief greater than 50% and more than 15 point of MMWS were significant different between the groups at 6 and 12 months.us guided IA injection showed significantly higher accuracy than palpation guided IA injection in the DRUJ. US guided IA steroid injections were effective in improving the pain of patients with DRUJ disorder during 12 months follow-up. Key Words: Distal radiular joint, Ultrasound, Steroid, Injection - 19 -