Letter to the Editor 13 Gonza ´ lez-Escalada JR, Camba A, Muriel C, et al. randomised double blind crossover study. Pain Validacion del ı´ndice de Lattinen para la evaluacion 2005;118:170–5. del paciente con dolor cronico. Rev Soc Esp Dolor 15 Al-Al-Shaikh M, Michel F, Parratte B, et al. An MRI 2012;19:181–8. evaluation of changes in piriformis muscle morphol- 14 Graboski CL, Gray DS, Burnham RS. Botulinum ogy induced by botulinum toxin injections in the toxin A versus bupivacaine trigger point injections treatment of piriformis syndrome. Diagn Interv for the treatment of myofascial pain syndrome: A Imaging 2015;96:37–43. LETTER TO THE EDITOR Pain Medicine 2018; 19: 411 doi: 10.1093/pm/pnx117 Dear Editor, A 58-year-old man was seen for pain in his right hand for the last few months. He denied any trauma, and the medical history was unremarkable for rheu- matic, orthopedic, and metabolic disorders. Physical examination was normal, except for a painful region on the ulnar side of his right 5th metacarpal bone. Ultrasound (US) imaging was performed as the exten- sion of physical examination. While “sono-palpation” was being used to better/precisely localize the pa- thology; interestingly, the patient asked whether we allowed him to take the probe and place it on the most painful area. Eventually, a small hypoechoic avascular lesion—consistent with a ganglion—was vi- sualized next to the digital artery exactly at the place where the patient indicated (Figure 1). It was decided that the patient would be followed conservatively Figure 1 Longitudinal B-mode (A) and power Doppler (with simple analgesics when necessary), and he was (B) images show the small anechoic/cystic lesion (ar- called for a control visit after three months. rowheads) immediately next to the palmar digital artery Indisputably, US imaging has already taken its place (flow signal in the power Doppler image) and close to in the clinical practice of musculoskeletal physicians the 5th metacarpal bone. Photograph demonstrates the . One of its several advantages would be the possi- patient’s “self-palpation” using the ultrasound probe (C). bility of interactive scanning with the patient, that is, “sono-palpation” or “sono-auscultation.” Especially LEVENT OZC¸ AKAR, MD,* AYSE MERVE ATA, MD,* BAYRAM while trying to localize the exact place of pathology, † KAYMAK, MD,* SCOTT EVANS, AND MURAT KARA, MD* one can easily move the probe over/nearby the pain- *Department of Physical and Rehabilitation Medicine, ful region and ask the patient to show the most pain- Hacettepe University Medical School, Ankara, Turkey; ful area. Likewise, it is quite straightforward that the Department of Foreign Languages, Social Sciences diagnosis cannot/can never be more precise if US University of Ankara, Ankara, Turkey uncovers a pertinent lesion over the place where the patient indicates. References In our patient, we have encountered a more interesting 1Ozc¸ akar L, De Muynck M, eds. Musculoskeletal scenario, whereby he suggested placing the probe him- Ultrasonography in Physical and Rehabilitation self on the painful area . Since we were able to easily Medicine. Milan: Edi.Ermes; 2014. visualize the small ganglion thereafter, we deemed this issue noteworthy and named it as “self-palpation.” For 2 Chang KV, Hung CY, Ozc¸ akar L. Medial sesamoid sure, we do not intend to say that patients can do “self- bone avulsion but not plantar fasciitis: Ultrasonographic sonography,” but instead that, on certain occasions, diagnosis using sonopalpation. Pain Physician 2015;18: physicians might ask their patients to indicate the place while holding the probe. E87–8. Downloaded from https://academic.oup.com/painmedicine/article-abstract/19/2/411/3832860 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Pain Medicine – Oxford University Press
Published: Feb 1, 2018
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