Hacettepe University Medical School is a medical school located at Hacettepe University Medical Center in Ankara, Turkey.
Langerhans cell histiocytosis (LCH) is a myeloid neoplastic disorder in which bone is the commonly affected organ system. While treatment for its symptomatic bone lesions varies, modern minimally invasive techniques show significant advantages over traditional approaches. Conventional therapies present notable limitations. Curettage, while frequently used, is associated with local recurrence. The efficacy of intralesional corticosteroid injections remains uncertain, especially for lesions in the extremities or pelvis. Although effective, low-dose radiation therapy carries long-term risks and is reserved for specific cases. Systemic chemotherapy, the standard for multifocal disease, is associated with toxicity and high relapse rates. Radiofrequency ablation (RFA) has emerged as a superior alternative that fills this therapeutic gap. RFA is a minimally invasive procedure that uses targeted heat (60–100°C) to destroy tumor cells with curative intent. Validating prior case reports, our recent study of ten patients confirmed that RFA provides complete pain relief with no residual disease or recurrence on follow-up MRI. Importantly, no significant complications were observed in our cohort or have been reported in the literature for LCH patients treated with RFA. In conclusion, RFA offers a safe, rapid, and durable solution for painful LCH lesions. It should be considered a primary curative treatment for symptomatic LCH of the bone, avoiding the risks of more invasive procedures and systemic therapies.
Intra-articular corticosteroid injection is a standard treatment for adhesive capsulitis and is commonly performed via the rotator interval or posterior glenohumeral approaches, with prior evidence favoring the former. Injectate distribution varies by technique. Additionally, a dual-target approach combining rotator interval and subdeltoid bursal injections has been proposed for subacromial impingement. This study compared dye distribution among rotator interval, dual-target, and posterior glenohumeral injection techniques. This cadaveric study evaluated dye spread in 18 shoulders from nine embalmed cadavers. Three ultrasound-guided techniques were assessed: rotator interval injection (15 mL), dual-target injection (10 mL rotator interval + 5 mL subdeltoid bursa), and posterior glenohumeral injection (15 mL). Following the injection, systematic dissection was performed. Staining of the subdeltoid bursa, long head of the biceps tendon sheath, anterior glenohumeral capsule, and posterior glenohumeral capsule was graded as absent, partial, or extensive. Extensive staining of the biceps tendon sheath and anterior glenohumeral capsule was observed in all shoulders receiving rotator interval or dual-target injections, whereas posterior glenohumeral injections showed inconsistent coverage of these structures. Reliable subdeltoid bursal infiltration occurred only in the dual-target group (5/6 shoulders). The posterior glenohumeral capsule was most consistently and extensively stained following posterior glenohumeral injection (6/6), with moderate coverage in the rotator interval and dual-target groups. Infraspinatus infiltration was uncommon and observed only after posterior glenohumeral injection. The injection technique markedly influences shoulder injectate distribution. Rotator interval and dual-target approaches preferentially address anterior structures, the dual-target technique ensures subdeltoid bursal coverage, and the posterior approach most consistently infiltrates the posterior glenohumeral capsule. Technique selection should be guided by the predominant pathological target in adhesive capsulitis and related disorders. Dual-target and rotator interval approaches reliably infiltrate the anterior capsule, making them suitable for adhesive capsulitis with biceps long head pathology, whereas the posterior glenohumeral approach primarily covers the posterior capsule and is less suitable for concomitant anterior shoulder disorders.
The growth of musculoskeletal ultrasound (US) has led to an increasing trend of US-guided interventions also/sometimes being performed by allied health professionals who lack formal comprehensive medical training. This international expert opinion - developed through structured consultation among 20 Physical and Rehabilitation Medicine (PRM) physicians from 14 countries across five continents - addresses the patient safety, ethical, and medicolegal concerns arising from non-physicians performing such interventions. A narrative literature synthesis was conducted and iteratively reviewed by all contributing authors whereas formal consensus methodology was not employed. Having reviewed the international regulatory landscape, including regulations from the United States, Europe (Germany, France, Italy, Spain, Scandinavian countries, and the United Kingdom), and the Asia-Pacific region; we highlight inconsistencies that may compromise patient welfare. We call upon PRM associations to develop unified position statements establishing minimum competency standards. Policy recommendations would include establishing international complication registries, implementing enforceable supervision protocols, strengthening informed consent requirements, and ensuring transparent provider identification. Through these measures, professional organizations, regulators, and healthcare institutions can promote patient safety, transparency, and consistent standards worldwide.
