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Öhberg, Lars
Publications (10 of 16) Show all publications
Arnerlöv, C., Söderström, M. & Öhberg, L. (2016). Mobile kidney pain provocation ultrasonography before surgery for symptomatic mobile kidney: A prospective study of 43 consecutive patients. Scandinavian journal of urology, 50(1), 61-64
Open this publication in new window or tab >>Mobile kidney pain provocation ultrasonography before surgery for symptomatic mobile kidney: A prospective study of 43 consecutive patients
2016 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, no 1, p. 61-64Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to evaluate whether mobile kidney pain provocation ultrasonography together with intravenous pyelography in supine and standing positions and a full medical history can confirm the diagnosis of the clinical condition of symptomatic mobile kidney and aid the selection of patients for surgical treatment.

MATERIALS AND METHODS: In a consecutive study, 43 patients with the clinical picture of symptomatic mobile kidney, a positive mobile kidney pain provocation ultrasonography and a renal descent of at least 2 lumbar vertebral heights on intravenous pyelography in the standing position, were operated on with nephropexy. Patients' pain relief after nephropexy was evaluated by clinical follow-up, a questionnaire and visual analogue scale (VAS) scoring.

RESULTS: Reduction of pain after nephropexy was associated with a significant decrease in VAS scoring from a median of 8 (range 4-10) preoperatively to a median of 0 (range 0-7) postoperatively (p < 0.001). Thirty-four patients (79%) were cured of their pain and seven patients (16%) experienced substantial relief from their pain symptoms. In two patients (5%) the symptoms were unchanged.

CONCLUSION: The results indicate that mobile kidney pain provocation ultrasonography and intravenous pyelography in supine and standing positions can verify the diagnosis of symptomatic mobile kidney and aid the selection of patients who will benefit from nephropexy.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-121031 (URN)10.3109/21681805.2015.1085087 (DOI)000367832000011 ()26400470 (PubMedID)
Available from: 2016-05-25 Created: 2016-05-25 Last updated: 2018-06-07Bibliographically approved
Kalawy, H., Stålnacke, B.-M., Fahlström, M., Öhberg, L., Linetsky, F. & Alfredson, H. (2013). New objective findings after whiplash injuries: High blood flow in painful cervical soft tissue: An ultrasound pilot study. Scandinavian Journal of Pain, 4(4), 173-179
Open this publication in new window or tab >>New objective findings after whiplash injuries: High blood flow in painful cervical soft tissue: An ultrasound pilot study
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2013 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 4, no 4, p. 173-179Article in journal (Refereed) Published
Abstract [en]

Background

The presence of high blood flow in the structurally abnormal and painful regions of tendinosis, but not in the normal pain-free tendons, was recently confirmed by colour Doppler (CD) ultrasound (US). Biopsies from the regions with high blood flow demonstrated the presence of sympathetic and sensitive nerve fibres juxtapositioned to neovessels. Grey-scale US and CD are reliable methods used to evaluate structural homogeneity, thickness, and blood flow in the peripheral tendons. The aim of this study was to utilize CD to qualitatively evaluate for the presence of abnormal high blood flow in paravertebral tissues after whiplash injuries in patients with chronic neck pain.

Methods

Twenty patients with chronic neck pain after whiplash-associated disorder (WAD) and 20 pain-free control subjects were included in the study. The same experienced radiologist performed all grey-scale US and CD examinations.

Results

More regions with high blood flow were observed in the patient group than in the control group. At all levels, the high blood flow pattern was detected at the enthesis of the spinous processes and bilaterally juxtapositioned to the facet joints.

Conclusion

All regions identified by the patients as painful and tender corresponded to the positive high blood flow found during the CD examination.

Implications

These findings document increased blood-flow/neovascularisation at insertions of neck muscles which may indicate that there are pathological neovascularisation with accomanying pain- and sympathetic nerves, similar to what has been found in Achilles-tendinosis. These findings promise that similar treatments that now is successful with Achilles tendinosis, may be effective in the WAD-painful muscle insertions of the neck.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Whiplash injury, Neck pain, Color Doppler, Ultrasound, High blood flow, Enthesopathy
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-87847 (URN)10.1016/j.sjpain.2013.06.006 (DOI)
Available from: 2014-04-13 Created: 2014-04-13 Last updated: 2018-06-08Bibliographically approved
Sherif, A. M., Eriksson, E., Thorn, M., Vasko, J., Öhberg, L., Riklund, K. & Ljungberg, B. (2012). Sentinel node detection in renal cell carcinoma. A feasibility study. European urology. Supplement, 11(1), E927-U948
Open this publication in new window or tab >>Sentinel node detection in renal cell carcinoma. A feasibility study
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2012 (English)In: European urology. Supplement, ISSN 1569-9056, E-ISSN 1878-1500, Vol. 11, no 1, p. E927-U948Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2012
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-55538 (URN)000303001301466 ()
Available from: 2012-05-25 Created: 2012-05-21 Last updated: 2018-06-08Bibliographically approved
Sherif, A. M., Eriksson, E., Thörn, M., Vasko, J., Riklund, K., Öhberg, L. & Ljungberg, B. J. (2012). Sentinel node detection in renal cell carcinoma. A feasibility study for detection of tumour-draining lymph nodes.. BJU International, 109(8), 1134-1139
Open this publication in new window or tab >>Sentinel node detection in renal cell carcinoma. A feasibility study for detection of tumour-draining lymph nodes.
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2012 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 109, no 8, p. 1134-1139Article in journal (Refereed) Published
Abstract [en]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? This is the first presented results and second publication on detection of tumour-draining lymph nodes in human renal cell carcinoma. Techniques are displayed and tumour-draining patterns are presented. OBJECTIVE: •  To evaluate the feasibility of performing sentinel node detection in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: •  An open series of 13 arbitrarily selected patients with T1b-T3b RCC scheduled for radical nephrectomy at a single Tertiary Academic Centre were examined with different modalities of sentinel node detection. •  Preoperative ultrasonography-guided injection of radioactive isotope, lymphoscintigram and single photon emission computed tomography/computed tomography, followed by intraoperative gamma-probe detection and Patent Blue detection, as well as postoperative scintigram of the main specimen were the planned interventions. •  These investigations were performed in conjunction with intended open radical nephrectomy. RESULTS: •  In 10 of the 13 patients sentinel node detection was achieved with 32 sentinel nodes displayed. •  Radio-guided surgery using an intraoperative gamma-probe resulted in the highest realtive detection rate with detection of sentinel nodes in nine patients. •  In total, nine metastatic sentinel nodes were detected in three patients. •  One patient, preoperatively staged as N+, was restaged after sentinel node detection and histopathology as pN0. CONCLUSIONS: •  Sentinel node detection in renal tumours is feasible although evaluation of different modes of detection needs further refinement and standardization. •  All nodes preoperatively detected by routine computed tomography as suspicious metastatic lesions were confirmed as sentinel nodes, including two nodes considered as metastatic by preoperative routine imaging but ultimately staged as non-metastatic sentinel nodes.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
renal cell carcinoma, lymph node staging, sentinel node, radio-guided surgery, single photon emission computed tomography
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-51992 (URN)10.1111/j.1464-410X.2011.10444.x (DOI)21883833 (PubMedID)
Available from: 2012-02-07 Created: 2012-02-07 Last updated: 2018-06-08Bibliographically approved
Alfredson, H., Masci, L. & Öhberg, L. (2011). Partial midportion Achilles tendon ruptures: new sonographic findings helpful for diagnosis.. British Journal of Sports Medicine, 45(5), 429-432
Open this publication in new window or tab >>Partial midportion Achilles tendon ruptures: new sonographic findings helpful for diagnosis.
2011 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 429-432Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Partial Achilles tendon ruptures are not always easy to diagnose. A history including a sudden onset of pain, and/or relative weakness in plantar flexion force, are indicators. The most loaded side of the Achilles tendon is the dorsal side (skin side). OBJECTIVE: To evaluate the ultrasound (US) and Doppler (CD) findings in patients with a suspected partial rupture in the Achilles tendon. Material and METHODS: Seventeen patients (16 men and 1 woman) with a mean age of 36 years (range 23-71) were examined clinically and by US+CD because of midportion Achilles tendon pain. There was an acute onset in 14/17 patients, and all had painful weakness during tendon loading activity. RESULTS: In all patients the US examination showed a partial Achilles tendon rupture, presented as a disrupted dorsal (skin side) tendon line and an irregular tendon structure mainly located in the dorsal and mid-tendon. The size of the rupture varied from 1/3 to 2/3 of the tendon thickness. In the dorsal part of the tendon, corresponding to the region with disrupted tendon line and irregular structure, CD examination showed high blood flow-most often of a longitudinal character. Six of the patients were surgically treated, and macroscopical examination verified the ultrasound findings, showing disruption on the dorsal side, and a partial rupture in the dorsal and mid- tendon. CONCLUSIONS: Ultrasound and Doppler examination can be helpful tools to diagnose partial midportion Achilles tendon ruptures. The characteristic findings of a disrupted dorsal tendon line, and high blood flow in the structurally abnormal dorsal tendon, indicate a partial rupture.

National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-32766 (URN)10.1136/bjsm.2009.067298 (DOI)19945976 (PubMedID)
Available from: 2010-03-25 Created: 2010-03-25 Last updated: 2018-06-08Bibliographically approved
Alfredson, H., Willberg, L., Öhberg, L. & Forsgren, S. (2011). Ultrasound and doppler-guided artthroscopic shaving for the treatment of patellar tendinopathy/jumper´s knee: biological background and description of method. In: Sanchis-Alfonso, Vicente (Ed.), Anterior knee pain and patellar instability: (pp. 367-371). London: Springer London
Open this publication in new window or tab >>Ultrasound and doppler-guided artthroscopic shaving for the treatment of patellar tendinopathy/jumper´s knee: biological background and description of method
2011 (English)In: Anterior knee pain and patellar instability / [ed] Sanchis-Alfonso, Vicente, London: Springer London, 2011, p. 367-371Chapter in book (Refereed)
Abstract [en]

Treatment with ultrasound and Doppler-guided arthroscopic shaving of the region with vessels and nerves outside the dorsal tendon has shown promising clinical results in patients with proximal patellar tendinopathy/Jumper´s knee. The results concerning only a limited patient material has been published in a scientific paper. Results on larger materials are under evaluation for later publication. Proper understanding of the ultrasound and Doppler findings, to enable for a precise and minimal arthroscopic shaving procedure on the dorsal side of the tendon, are cornerstones using this new type of treatment.

Place, publisher, year, edition, pages
London: Springer London, 2011
National Category
Basic Medicine
Identifiers
urn:nbn:se:umu:diva-73350 (URN)10.1007/978-0-85729-507-1_27 (DOI)9780857295071 (ISBN)
Available from: 2013-06-20 Created: 2013-06-20 Last updated: 2018-06-08Bibliographically approved
Zeisig, E., Fahlström, M., Öhberg, L. & Alfredson, H. (2010). A 2-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow. British Journal of Sports Medicine, 44(8), 584-587
Open this publication in new window or tab >>A 2-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow
2010 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 44, no 8, p. 584-587Article in journal (Refereed) Published
Abstract [en]

Background Tennis elbow is a tendinopathy affecting the upper extremity. Recent studies have shown high sensitivity for ultrasound (US) examination and high specificity for colour Doppler (CD) examination. There are no mid- or long-term follow-up investigations of the tendon structure and blood flow using these techniques.

Objective To use US and CD to study structure and blood flow in the extensor origin in patients with tennis elbow treated with intratendinous injections.

Design Follow-up study

Setting Sports Medicine Unit, Umeå University.

Patients 25 patients (28 elbows), mean age 46 years (range 27–66), treated with intratendinous injections due to chronic pain from tennis elbow.

Method US and CD examination of the extensor origin was carried out at inclusion and at follow-up two years after intratendinous injection treatment with polidocanol and/or a local anaesthetic.

Main outcome measurements US (structure) and CD (blood flow) findings.

Results All patients had structural tendon changes and high blood flow at inclusion when given the injection treatment. At the two-year follow-up, structural tendon changes were seen in 20/28 elbows and high blood flow was seen in 4/28 elbows. The majority of patients with a good clinical result after treatment had no visible blood flow (17/20), but the structural changes showed no relation to a good result (13/20 remaining changes).

Conclusions Doppler findings, but not structure, might be related to the clinical result after intratendinous injection treatment of tennis elbow.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2010
Keywords
Tennis elbow, injection treatment
National Category
Medical and Health Sciences Sport and Fitness Sciences
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-3483 (URN)10.1136/bjsm.2008.049874 (DOI)000278712200010 ()
Available from: 2008-09-22 Created: 2008-09-22 Last updated: 2018-06-09Bibliographically approved
Hoksrud, A., Öhberg, L., Alfredson, H. & Bahr, R. (2008). Color Doppler ultrasound findings in patellar tendinopathy (jumper's knee).. The American journal of sports medicine, 36(9), 1813-1820
Open this publication in new window or tab >>Color Doppler ultrasound findings in patellar tendinopathy (jumper's knee).
2008 (English)In: The American journal of sports medicine, ISSN 1552-3365, Vol. 36, no 9, p. 1813-1820Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recent studies have revealed structural changes with neovessels in patients with jumper's knee and Achilles tendinopathy, and treatment with sclerosing injections has shown promising clinical results. PURPOSE: To study the prevalence of neovascularization and structural tendon changes on color Doppler ultrasound examination in elite athletes with clinical symptoms of jumper's knee and to examine the ultrasound characteristics of the tendon after sclerosing injection treatment with polidocanol. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors recruited patients among elite athletes with a clinical diagnosis of jumper's knee who participated in a previous randomized clinical trial. The patients recorded knee function using the Victorian Institute of Sport Assessment score. Patients were examined by color Doppler ultrasound at baseline and, for patients with structural changes and neovascularization who received sclerosing treatment, after treatment. RESULTS: Sixty-three patients (11 women and 52 men) with 79 symptomatic tendons were studied. The ultrasound examination revealed that neovascularization was present in 48 of the 79 tendons (60%). Of 33 patients (43 tendons) who received sclerosing injections, 29 patients (37 tendons, 86%) were examined 37 (19 to 53) weeks after their final sclerosing injections. Of these, 7 tendons (18.9%) had no change in neovascularization after treatment, 21 tendons (56.8%) had less neovascularization, and 9 tendons (24.3%) had more visible neovascularization. There were no significant differences in the change in Victorian Institute of Sport Assessment score between patients who had less, more, or unchanged neovascularization after treatment (analysis of variance, P = .9). CONCLUSION: About two thirds of patients with jumper's knee can be expected to have structural tendon changes with neovascularization. There was no relationship between changes in ultrasound characteristic and knee function after sclerosing treatment.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-22761 (URN)10.1177/0363546508319897 (DOI)18753682 (PubMedID)
Available from: 2009-05-18 Created: 2009-05-18 Last updated: 2018-06-08
Zeisig, E., Fahlström, M., Öhberg, L. & Alfredson, H. (2008). Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study. British Journal of Sports Medicine, 42(4), 267-271
Open this publication in new window or tab >>Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study
2008 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 42, no 4, p. 267-271Article in journal (Refereed) Published
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-3482 (URN)10.1136/bjsm.2007.042762 (DOI)
Available from: 2008-09-22 Created: 2008-09-22 Last updated: 2018-06-09Bibliographically approved
Willberg, L., Sunding, K., Öhberg, L., Forssblad, M., Fahlström, M. & Alfredson, H. (2008). Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol.. Knee Surgery, Sports Traumatology, Arthroscopy, 16(9), 859-864
Open this publication in new window or tab >>Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol.
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2008 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 16, no 9, p. 859-864Article in journal (Refereed) Published
Abstract [en]

Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.

Place, publisher, year, edition, pages
Springer, 2008
Keywords
Achilles tendon, chronic pain, injections, polidocanol, randomized, controlled trial
National Category
Orthopaedics Sport and Fitness Sciences Surgery
Identifiers
urn:nbn:se:umu:diva-22760 (URN)10.1007/s00167-008-0579-x (DOI)18633599 (PubMedID)
Funder
Swedish Research Council
Available from: 2009-05-18 Created: 2009-05-18 Last updated: 2018-06-08Bibliographically approved
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