Bülent Alyanak

Purpose: Lateral epicondylitis (LE) is often associated with myofascial trigger points (MTrPs) in the forearm extensor muscles. Although dry needling (DN) is commonly performed using palpation-guided techniques without real-time imaging, its anatomical accuracy remains unclear. This study evaluated the accuracy of palpation-guided DN targeting the extensor digitorum communis (EDC), extensor carpi radialis brevis (ECRB), extensor carpi radialis longus (ECRL), and brachioradialis (BR) using ultrasound verification. Methods: Thirty-nine patients with MRI-confirmed LE and active MTrPs underwent palpation-guided DN targeting the most symptomatic muscle identified by algometry. Ultrasound verified algometer position during target selection but did not guide needle insertion. An independent sonographer blinded to the intended target verified needle-tip location. Accuracy was compared using Fisher's exact test with Bonferroni correction. Results: Accuracy was BR 10/10 (100%; 95% CI 69.2–100.0%), EDC 10/10 (100%; 69.2–100.0%), ECRB 7/9 (77.8%; 40.0–97.2%), and ECRL 1/10 (10%; 0.3–44.5%). After Bonferroni correction for six pairwise comparisons, ECRL accuracy was significantly lower than BR (adjusted p < 0.001), EDC (adjusted p < 0.001), and ECRB (adjusted p = 0.033). Most ECRL misplacements entered ECRB (7/9) or EDC (2/9). No identifiable neurovascular structure was penetrated during immediate ultrasound verification; procedural safety was not established. Conclusion: Anatomical accuracy varied by target muscle in this small, single-operator study. ECRL showed particularly low observed accuracy. Ultrasound guidance may improve anatomical precision when targeting ECRL, but larger multi-operator studies are needed to confirm these findings and determine their clinical relevance.

Hip osteoarthritis (OA) is a major cause of pain and disability in Western societies. Although it is particularly common in older age groups, most cases are reported to occur before retirement [1]....

Objectives: To determine whether the thickness of swallowing‐related muscles measured by ultrasonography (US) differs according to dysphagia status in children with cerebral palsy (CP) and to identify muscle‐specific associations between US measurements and swallowing symptoms. Methods: In this cross‐sectional study, 66 children with CP aged 2–18 years were evaluated at a tertiary outpatient rehabilitation clinic. B‐mode US was used to measure the thickness of swallowing‐related muscles. Symptom‐defined dysphagia was defined as a Pediatric Eating Assessment Tool‐10 (Pedi‐EAT‐10) score of ≥ 4. Muscle thicknesses were compared between children with and without dysphagia. Associations between individual Pedi‐EAT‐10 items and muscle thickness measurements were explored using Spearman correlation and univariate linear regression analyses. Results: Of the 66 children, 27 (40.9%) met the criteria for dysphagia. US‐measured muscle thickness did not differ significantly between children with and without dysphagia for the masseter (0.66 ± 0.12 vs. 0.68 ± 0.10 cm; p = 0.520), genioglossus (0.69 ± 0.15 vs. 0.64 ± 0.13 cm; p = 0.166), geniohyoid (0.60 ± 0.14 vs. 0.64 ± 0.13 cm; p = 0.208), anterior digastric (0.50 ± 0.12 vs. 0.50 ± 0.12 cm; p = 0.887), or mylohyoid muscles (0.15 ± 0.03 vs. 0.15 ± 0.05 cm; p = 0.959). Symptom‐level analyses demonstrated inverse associations between selected swallowing complaints and specific muscle measurements, with the strongest association observed between “coughs while eating” and genioglossus thickness. Conclusions: Although swallowing‐related muscle thickness did not differ between children with CP with and without dysphagia, US measurements were associated with specific caregiver‐reported swallowing complaints. These findings suggest that US may provide complementary, symptom‐oriented information in the clinical assessment of swallowing difficulties in children with CP.

This case describes posterior interosseous nerve (PIN) palsy that developed 15 months after bariatric surgery and the resulting finger drop. Electrophysiological studies confirmed an acute axonal lesion of the PIN. No underlying metabolic pathology was identified. In a patient who showed no improvement despite conventional physiotherapy including electrical stimulation and exercises, mechanical entrapment at the level of the arcade of Frohse was first identified on ultrasound, and subsequently three sessions of ultrasound‐guided hydrodissection with 5% dextrose were performed, resulting in complete functional recovery. To the best of our knowledge, this case represents the first reported example of isolated PIN palsy following bariatric surgery. These findings once again highlight the important role of ultrasound in both diagnosis and treatment.

Injection granulomas (IGs) are recognized as a consequence of the injection of injectates into adipose tissue after routine drug or vaccine injections without reaching the muscular tissue. A series of reactions of the injectates in adipose tissue results in necrotic tissue and deposition of calcium crystals. IGs are usually asymptomatic but may rarely be symptomatic. In the past, symptomatic cases were mostly managed conservatively or surgically. However, to the best of our knowledge, no procedure other than surgical or conservative treatment has been reported. A 57-year-old patient with a history of multiple intramuscular diclofenac injections presented with localized right buttock pain for 8 months. The patient, who did not respond to conservative treatment, underwent an ultrasound-guided barbotage procedure commonly used in the diagnosis of calcific periarthritis. The patient's pain complaint was evaluated according to the visual analog scale (VAS). The patient reported VAS:7 before the barbotage procedure and VAS:2 at the sixth week follow-up after the barbotage procedure. This case report, provided that it is supported by future studies, suggests that the ultrasound-guided barbotage procedure, which is commonly used in patients with calcific periarthritis, may be a promising treatment method in IG cases unresponsive to conservative treatment.

Sonographic identification of the tendinous septum of the semispinalis capitis muscle

Background: Plantar fasciitis is a leading cause of heel pain, affecting approximately 10% of the population. Despite its prevalence, treatments may result in symptom recurrence and chronicity, which can significantly increase patient dissatisfaction. Google Trends provides insights into public interest through search volume analysis. This study examines global and USA trends in plantar fasciitis, focusing on temporal, seasonal, and income-based variations. Methods: Google Trends data for “Plantar Fasciitis” (2004–2024) were analyzed for both global and USA search trends. Monthly and seasonal search volumes were grouped by time and location. Regression and post hoc tests were conducted to identify significant patterns. Comparisons were made between high- and low-income states in the USA. Results: Public interest in plantar fasciitis increased significantly over time, both globally (R² = 0.871, p < 0.001) and in the USA (R² = 0.854, p < 0.001). Interest peaked in summer and declined in winter, with seasonal differences significant worldwide (p < 0.05). Monthly variations were significant only in the USA. No significant difference was found between high- and low-income states (p > 0.05). Conclusions: Interest in plantar fasciitis has grown steadily, reflecting its prevalence and impact. The findings emphasize the need for accessible, high-quality information to address public demand. These insights can guide healthcare professionals and policymakers in developing targeted resources.