Yuji Okuno, M.D. Ph.D
@YujiOkuno_OC
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Interventional Radiologist Chief Director OKUNO CLINIC Chronic pain relief management **Sorry for not being able to respond to comments.
Joined April 2023
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Plantar fasciitis case: This patient experienced left heel pain for about six months, unable to walk. We observed tenderness at the attachment point of the plantar fascia and administered two intra-arterial injection treatments, which we refer to as 'Dochu' treatment.
#heelpain
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A case of rheumatoid arthritis: Despite taking methotrexate, the patient could not effectively alleviate the pain. Steroid therapy was attempted, but the pain in the middle finger persisted, leading to discontinuation.
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A professional soccer player visited our clinic with jumper's knee pain. His patellar tendon was tender when pressed, but after treatment, the tenderness almost disappeared. 2 days later, he resumed light training. One advantage of scalpel-free surgery is a quicker return to work
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I am very honored to receive this wonderful Award. We will continue to make concerted efforts to further contribute to the field of pain treatment.
＃Embolization
#IRad
#IR
#Interventionalradiology
#CIRSE2023
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In cases of lower back pain where the cause is unclear despite MRI examinations, a mild bulging of the lumbar spine was observed, and it was determined that disc herniation was not the cause.
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After undergoing artificial knee joint surgery, a patient presented with severe pain. While the pre-operative pain had subsided, post-surgery, a different type of pain had emerged, accompanied by a sensation of heat in the knee.
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A patient had been suffering from right shoulder pain due to calcific tendinitis for 9 yrs. Upon performing angiography of the artery located in the front of the shoulder, abnormal blood vessels were found. Particle embolic agent was delivered, and the treatment was finished.
#IR
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Treating persistent pain after knee joint replacement surgery. Prosthesis often obstruct the catheter tip. Using Judkins Right shape 3Fr catheter and Asahi intec Veloute 1.7Fr microcatheter.
#Embolization
#InterventionalRadiology
#IRad
#IR
#TAME
#kneepain
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Shin splint case. MRI showed increased vascularity in the anterior aspect of the right tibia, slightly distal to the center, consistent with the site of pain. Transarterial embolization was performed as shown in the attached image. 3 months later, the patient had fully recovered.
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I will be giving several lectures at GEST MSK. Many professionals in the field of MSK embolization will be participating. If you have time, please come to join us.
#GESTMSK2024
#MSKEmbolization
#MSK
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A case of a teenager with knee pain due to subpatellar lipodystrophy. The patient was suffering from pain along with a sensory abnormality known as allodynia. After confirming the disappearance of the moyamoya vessels with TAME, the symptoms showed significant improvement.
#TAME
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Case of a woman in her 50s who has been experiencing stiffness and numbness in her left shoulder without any apparent cause for the past 20 years. There was tenderness and apparent swelling at the superior angle of the scapula, the upper part of the shoulder blade.
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66 yo male Hemodialysis patient with 3 years history of rest pain and nighttime pain on his right shoulder diagnosed with Dialysis Related Amyloid arthropathy. His pain improved by two times transarterial embolization using imipenem.
#InterventionalRadiology
#IRad
#IR
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Happy new year to everyone. I will continue to present cases of transcatheter arterial embolization treatment at our clinic this year as well.
#TAME
#paintreatment
#OkunoClinic
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The patient had experienced stiff shoulder and neck pain for over 5 years. A transcatheter procedure was carried out on the transverse carotid artery, supplies blood to the affected area. He experienced immediate improvement, and after one month, the pain had almost disappeared.
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A patient, an internal medicine doctor, experienced persistent left shoulder pain for over 10 months despite trying rehabilitation, compresses, and injections. When he came to our clinic, we discovered moya moya blood vessel in the front upper part of the shoulder, armpit, and
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I am very honored and pleased to share that I have been selected for the 2023 Award of Excellence and Innovation in IR.
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Polymyalgia rheumatica (PMR) in a woman in her 70s with pain in both shoulders. Compared to typical shoulder joint inflammation, there was an increased occurrence of abnormal blood vessels in multiple areas.
#Embolization
#Irad
#shouldercase
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A male patient experienced lower back pain during golfing, which was particularly exacerbated on cold mornings. No lumbar deformity was observed. After diagnosing the presence of a moyamoya vessel in the painful area, the patient underwent TAME procedure.
＃Embolization
#IR
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Golf elbow case. Abnormal blood flow was observed in the epicondyle of the humerus during an ultrasound examination. To avoid the risk of weakening the tendon with local injection, we opted for trans catheter treatment.
#TAME
#irad
#Embolization
#golfelbow
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Catheterization for periarthritis: 1. Catheter near hip joint to confirm moya moya vessels with contrast medium. 2. Observed on right femur exterior. 3. Post-treatment confirmation of disappearance of moya moya vessels.
#periarthritis
#hippain
#TAME
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An 18-year-old male, diagnosed with accessory navicular syndrome underwent excision surgery. Despite the surgery, persistent pain in his right leg led him to visit one of our clinics. Vascular imaging revealed abnormal blood vessels in the affected area, so we performed a TAME.
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A patient who was unable to turn his head and suffered from neck pain due to a traffic accident. Doppler signals were detected in the left cervical region during the examination, and Moyamoya, abnormal blood vessels were observed in the vascular imaging.
#neckpain
#embolization
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Selecting genicular artery, not all arteries but descending GA, median GA, ILGA, IMGA and SLGA.
#InterventionalRadiology
#IRad
#IR
#Embolization
#TAME
#Paintreatment
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A 21-year-old university student complaining of wrist pain, TFCC injury. He was a baseball player but was unable to grip the bat due to pain. The catheter treatment, lasting approx 30 minutes under local anesthesia, confirmed the disappearance of abnormal blood vessels.
#IR
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A marathon runner came to us with hamstring tendon pain. MRI scan showed significant edema, and catheter contrast identified problematic vessels supplying the hamstring tendon. Embolization procedure performed and she has been able to resume training.
#Embolization
#IR
#IRad
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Hallux valgus case. Protrusions and deformities at the base of both big toes were observed. The skin in that area appeared reddish, and tenderness was present upon pressing. We performed a Dochu, simplified catheter treatment which takes only approx. 10mins.
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This is a case of a 60-year-old male suffering from chronic lower back pain for 30 years, with no clear diagnosis despite visiting various hospitals. He experienced severe nighttime pain and couldn't drive due to the pain.
#TAME
#lowerbackpain
#backpain
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A professional billiard player had pain in the right elbow. After enduring prolonged discomfort and trying various treatments like painkillers, acupuncture, moxibustion, he eventually opted steroid injections, which initially provided relief. But after 2 months, the pain returned
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This patient is a male hurdler in his twenties. He experienced pain on the inner side of his knee after striking it forcefully during training. Pes anserinus tendinitis is an inflammation of the bursa located beneath the inner side of the knee. This patient had point tenderness
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TAE for 68 yo female with persistent knee pain after joint replacement surgery. Spontaneous nighttime pain improved soon after TAE and did not show recurrent for 4 years after the procedure.
#Embolization
#InterventionalRadiology
#IRad
#IR
#TAME
#TAE
#kneepain
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It is a great honor and thanks to Dr. Ziv Haskal for the interview.
MSK research shows ‘higher safety profile and broader indication’ with m... via
@YouTube
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This case illustrates the resolution of vascular-origin lower back pain, potentially overlooked by conventional MRI, through a novel approach.
#TAME
#embolization
#lowerbackpain
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Upon our evaluation, it was determined that he had lateral epicondylitis of the humerus, medial epicondylitis, and posterior periostitis, all of which were addressed through catheterization. The patient made a full recovery after 1 month and was able to resume billiards.
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Patient with Jones fracture, swelling and tenderness on the outer side of the right foot. The fracture did not heal properly and condition known as pseudoarthrosis. Catheterization was performed and it lead to the disappearance of problematic vessels and pain.
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A woman diagnosed with severe thoracic outlet syndrome. This is characterized by symptoms of pain and numbness in the shoulders and hands, often caused by compression of certain nerves and blood vessels leading to the arms. But accurate diagnosis can be challenging in many cases.
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Achilles tendonitis case in a professional middle-distance runner. The patient visited us approx. 7-mo after first experiencing pain. He had previously tried various treatments with limited success and were becoming increasingly anxious
#IR
#Achillestendonitis
#TAME
#Embolization
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A patient fell downstairs, experiencing shoulder blade pain, which briefly improved but later returned along with stiffness. We identified pbv in the suprascapular artery and did catheterization. Initially, there was no immediate relief, but after a month, the pain subsided.
#IR
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This patient was a climber and experienced left groin discomfort for a decade. Covering the area while walking led to pain throughout his left leg, forcing him to quit climbing. Despite seeking help from orthopedic clinics, acupuncture, and physical therapy, no relief was found.
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Problem blood vessels in the facet joint, identified during the examination as the source of pain, leading to catheter treatment. Following the treatment, the patient experienced a remarkable reduction in pain, and night pain disappeared within three days.
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We conducted one session of catheter treatment and one session of arterial injection, called simplified TAME. After one month of arterial injection therapy, the patient reported being able to handle dental instruments without pain.
#rheumatoidarthritis
#fingerpain
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Angiography of lateral epicondylitis. Note that the findings of early venous filling that indicates the presence of micro arterio-venous shunt.
#InterventionalRadiology
#IRad
#IR
#Embolization
#Paintreatment
#epicondylitis
#TAME
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In our clinic, problem blood vessels were found near the left femoral head, likely causing the pain. We performed a transcatheter embolization, and a month after the procedure, the patient wonderfully improved and could walk 20,000 steps a day.
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An ultrasound examination of the painful area revealed an increased blood flow signal and indicated an increase in abnormal blood vessels. Therefore, catheter treatment (TAME) was performed to embolize the affected blood vessels.
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Problematic blood vessels were identified around the artificial joint, and a catheter procedure was performed. The following day, the pain was reduced to less than half. About a month later, the days with almost no pain increased.
#Embolization
#artificialjoint
#kneepain
#IR
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There was a case in which TAME was effective for neck pain occurred as a result of a traffic accident. Athough an MRI showed only a minor cervical herniation, with no apparent narrowing of the nerve pathways, we noticed abnormal vascularities on the right side of the neck.
#TAME
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As the patient was a dentist, the condition started to interfere with work, prompting a visit to our clinic. Using ultrasound, we confirmed a significant enhancement of blood flow signals in the metacarpophalangeal (MP) joint.
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A woman in her 50s had been experiencing both knee pains since her 40s. In her early 50s, she underwent bilateral knee prostheses surgery. But the pain worsened and when she visited our clinic, she couldn't even touch her knees due to strong pain.
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Immediately after the procedure, the patient was surprised to find that his shoulder felt lighter. The previously restricted range of motion also improved, and he was able to resume playing golf. It has been over 3 years since the treatment, and there have been no recurrences.
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It involved accessing the iliac and lumbar arteries branching from the left internal iliac artery.
Approximately one month after the surgery, the patient reported a significant reduction in daily life pain, and they were able to resume playing golf.
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The second image was taken during the treatment. Black lines are blood vessels. We confirmed that embolic agent was spread to the affected area. The pain while walking did not disappear immediately but this patient improved day by day. She is now spending time without any pain.
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Ultrasound revealed abnormal blood flow, leading to a diagnosis of post-surgery inflammation in the fat pad beneath the kneecap. After our transcatheter procedure, she gradually improved and was able to resume her golf hobby after several visits to our clinic.
#Embolization
#IRad
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Our latest paper "Transarterial Embolization for Refractory Overuse Sports Injury: Pictorial Case Reports" has been published online in CardioVascular and Interventional Radiology. Please check below link.
#Embolization
#IR
#Overusesportsinjury
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upper arm. After catheterization, his night time pain vanished, and within a month, his pain became manageable for his daily life.
#Embolization
#shoulderpain
#TAME
#Irad
#moyamoya
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Our first case of Embolization for Stage II Hemorrhoids (Emborrhoid) was performed in 2020 and the outcome has been good.
#IR
#IRad
#InterventionalRaiology
#Embolization
#Hemorrhoids
#TAME
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Abnormal blood vessels were observed both on US and angio, leading to the decision to perform embolization. The treatment itself took about 40 mins. Several years have passed since the treatment, but he has been able to engage in competitive sports without a recurrence.
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Following a vaccination, some individuals may experience prolonged and severe pain and swelling in their shoulder. This condition is known as Shoulder Injury Related to Vaccine Administration (SIRVA). A male felt pain in his shoulder about a month after receiving the vaccine,
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on that area, and swelling were observed with both ultrasound and MRI scans. Thus we performed an embolization procedure. Approx. 2 weeks later, the sensation in the knee noticeably changed, and by one month, he reported no pain even when jumping hurdles.
#tendinitis
#kneepain
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There was tenderness and noticeable swelling at the upper part of the scapula, and due to the presence of moya moya vessel, catheter procedure was performed. No immediate change reported, but the patient noted a reduction in shoulder heaviness and numbness four days later.
#TAME
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Each injection took about 10 minutes. A week after the treatment, the severe pain subsided, and within one month, it had halved from its initial intensity. To further enhance the outcome, a second injection treatment was performed, and the patient reported a reduction in pain.
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My previous account was hacked and frozen. I will be posting to this account.
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While surgical intervention for thoracic outlet syndrome requiring hospitalization was also considered, the patient was very pleased with the symptom improvement achieved through catheter treatment.
#neckpain
#shoulderpain
#handpain
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Abnormal blood vessels were found in the right fourth lumbar artery, matching the painful area. TAME treatment was administered, and the patient reported pain relief within two days, enabling him to sleep through the night without interruption
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The patient underwent catheter treatment on the intercostal artery. About a week later, the pain gradually diminished. One year post-treatment, the patient has been living without a recurrence of pain, enjoying her daily life.
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We proceeded with a catheter treatment, which was completed in about 30 minutes. After 2 months post-treatment, the extent of pain had decreased, and we had an injection therapy for the remaining facet joint pain. Currently, the patient can move their neck freely without any pain
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Although it was not zero pain level, the symptom had been significantly improved with our catheter treatment.
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Angiographic findings from left inferior lateral genicular artery in patients with Rheumatoid Arthritis. Embolization was performed by using imipenem/cilastatin particles. We have performed Emboliziation for RA so far,
#InterventionalRadiology
#Embolization
#Problemvessels
#IR
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Angiography from radial artery in normal hand and in 37 yo female patients with juvenile idiopathic arthritis. The problem neovessels evident abundantly at her wrist and 2nd metacarpophalangeal joint that is much with the area of her pain symptoms.
#IR
#Embolization
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The pathological examination of the infrapatellar fat pad showed only inflammation. So diagnosed with infrapatellar fat pad inflammation. Angiography and embolization procedure was performed and his knee pain improved much better.
#InterventionalRadiology
#Problemvessels
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Superficial layer was captured by red color, middle layer by green, and deep layer was captured by blue color. In the inflammatory conditions, capillary increased disorderly and dilated and proliferated.
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and this pain gradually became more intense. Right after the catheterization, the pain decreased to approximately 20% of its initial intensity. On the same night of the procedure, he was finally able to sleep for the first time in a while, and the pain hasn't worsened since then
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In this patient's case, as she did not experience pain when compressing the brachial plexus below the clavicle and complained of intense pain at the base of her neck, a diagnosis other than thoracic outlet syndrome was considered.
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