Jonathan T Finnoff

University of Washington Seattle, Seattle, WA, United States

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Publications (49)71.19 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The first purpose of this investigation was to describe and validate an ultrasound-guided ischial bursa injection technique in an unembalmed cadaveric model. The second purpose was to compare the distance between the ischial tuberosity and the sciatic nerve in a hip neutral versus 90 degree flexed hip position in asymptomatic volunteers. The first part was a single blind, prospective study. The second part was a prospective cohort study. Academic institution procedural skills laboratory and outpatient clinic. The first part of the study involved one cadaveric specimen. The second part of the study involved 20 asymptomatic subjects. The mean age of the subjects was 28 years, and the mean BMI was 23.2 kg/m(2) +/- 2.8 (minimum 18.3, maximum 29.5). In the first part of the study, a single operator completed bilateral ultrasound-guided ischial bursa injections in an unembalmed cadaveric specimen using diluted colored latex. In the second part of the study, ultrasound was used in 20 asymptomatic volunteer subjects (10 males and 10 females) to measure the distance from the lateral edge of the ischial tuberosity to the sciatic nerve. The injections were graded for accuracy as follows: accurate (all injectate contained within the ischial bursa), accurate with overflow (injectate within the ischial bursa, but also located in adjacent structures other than the needle track), or inaccurate (injectate not within the ischial bursa). The second part of the study measured the distance from the ischial tuberosity to the sciatic nerve with subjects in two different positions (prone, and side-lying with the tested hip flexed to 90 degrees). Results: Post-injection cadaveric dissections revealed that both ultrasound-guided injections accurately placed liquid latex within the ischial bursae. There was no evidence of injury to surrounding neurovascular structures. Among asymptomatic volunteers, the average distance between the ischial tuberosity and the sciatic nerve increased from 28.4 mm (range 20.5-38.9 mm) in the neutral position to 41.9 mm (range 30.9-66.0 mm) with the hip flexed to 90 degrees (average change 13.5 mm away from the ischial tuberosity, p = .0001). Ultrasound-guided ischial bursa injections are technically feasible. Flexing the hip to 90 degrees increases the distance between the ischial tuberosity and the sciatic nerve in asymptomatic volunteers, thus potentially resulting in a safer needle trajectory when ischial bursa injections are clinically indicated. Further investigation in clinical settings is warranted to validate these findings.
    PM&R 08/2013; · 1.37 Impact Factor
  • Elena J Jelsing, Eugene Maida, Jonathan T Finnoff, Jay Smith
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    ABSTRACT: Objective To determine whether there is a consistent extension of the lateral synovial recess under the iliotibial band (ITB) in an unembalmed cadaveric model. Design A prospective laboratory investigation. Setting A procedural skills laboratory of a tertiary medical center. Subjects Twelve unembalmed cadaveric knee specimens. Methods The suprapatellar recess, ITB, and region deep to the ITB were examined sonographically to document the absence of fluid in each knee. Thereafter, 60 mL of normal saline solution was injected into each knee to distend the joint recesses. Postinjection sonographic examination of the ITB at the level of the lateral femoral epicondyle was repeated at 0°, 25°, and 45° of knee flexion to detect and characterize any fluid visualized in the region of the ITB. The location of fluid in relation to the ITB was recorded as anterior, deep, posterior, or a combination of these positions. Results Fluid was observed anterior and deep to the ITB in 100% of 12 specimens. In 2 specimens, fluid also was noted posterior to the ITB. The presence and location of the fluid did not appear to change as a function of knee position. Using dynamic sonographic evaluation, we could track the fluid deep to the ITB back to the knee joint. Conclusions The lateral synovial recess appears to regularly extend beneath the anterior ITB. Fluid deep to the ITB should precipitate further evaluation of the knee joint when clinically indicated. Although distention of the lateral synovial recess is not always symptomatic, synovial irritation may be a pathoetiologic factor in the production of lateral knee pain syndromes, including ITB syndrome.
    PM&R 08/2013; · 1.37 Impact Factor
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    ABSTRACT: Objectives- The purpose of this study was to determine whether the iliotibial band (ITB) moves relative to the lateral femoral epicondyle (LFE) as a function of knee flexion in both non-weight-bearing and weight-bearing positions in asymptomatic recreational runners. Methods- Five male and 15 female asymptomatic recreational runners (10-30 miles/wk) aged 18 to 40 years were examined with sonography to assess the distance between the anterior fibers of the ITB and the LFE in full extension, 30° of knee flexion, and 45° of knee flexion. Measurements were obtained on both knees in the supine (non-weight-bearing) and standing (weight-bearing) positions. Results- The distance between the anterior fibers of the ITB and the LFE decreased significantly from full extension to 45° of knee flexion in both supine (0.38-cm average decrease; P < .001) and standing (0.71-cm average decrease; P < .001) positions. These changes reflect posterior translation of the ITB during the 0° to 45° flexion arc of motion in both the supine and standing positions. Conclusions- Sonographic evaluation of the ITB in our study population clearly revealed anteroposterior motion of the ITB relative to the LFE during knee flexion-extension. Our results indicate that the ITB does in fact move relative to the femur during the functional ranges of knee motion. Future investigations examining ITB motion in symptomatic populations may provide further insight into the pathophysiologic mechanisms of ITB syndrome and facilitate the development of more effective treatment strategies.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2013; 32(7):1199-1206. · 1.40 Impact Factor
  • Elena Jelsing, Jonathan Finnoff, Bruce Levy, Jay Smith
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    ABSTRACT: OBJECTIVE: To evaluate the prevalence and distribution of fluid associated with the iliotibial band (ITB) in asymptomatic recreational runners. DESIGN: Prospective cohort study. SETTING: Sports medicine center at a tertiary medical center. PATIENTS: Five male and fifteen female asymptomatic recreational runners (10-30 miles per week) ages 18-40 years. METHODS: Participants were examined using ultrasonography to assess for the presence of fluid at the level of the lateral femoral epicondyle and determine its relationship to the ITB at 0 and 30 degrees of knee flexion in both supine (non-weightbearing) and standing (weightbearing) positions. RESULTS: Fluid was associated with the ITB in 100% of asymptomatic recreational runners, and was bilateral in 90%. When examined in full extension, fluid was seen in 67.5% of knees (n= 40) when supine, compared to 95% of the knees when standing. When examined in 30 degrees of flexion, the presence of fluid decreased to 30% when supine and 22.5% when standing. With the knee in full extension in a supine/standing position, fluid was located anterior and deep 70/74% of the time and anterior only 11/0% of the time. With the knee flexed to 30 degrees in a supine/standing position, fluid was located anterior and deep 50/33% of the time and anterior only 33/67% of the time. CONCLUSION: The prevalence of fluid associated with the ITB varied with body and knee position, was most common in the standing position with the knee extended, and was generally located anterior or anterior and deep to the ITB. The clinical significance of our findings are twofold: (1) body position should be considered when searching for fluid in the vicinity of the ITB, and (2) clinicians and imagers should exercise caution when interpreting the clinical significance of fluid associated with the ITB during ultrasonographic evaluation of runners with lateral knee pain.
    PM&R 02/2013; · 1.37 Impact Factor
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    ABSTRACT: OBJECTIVE: To validate the diagnostic performance of an in-scanner exercise-based magnetic resonance imaging (MRI) examination used to screen for chronic exertional compartment syndrome (CECS). Final clinical impression and intracompartmental needle manometry (INM) served as the reference standards. MATERIALS AND METHODS: Consecutive patients, referred by a sports medicine physician or orthopedic surgeon, underwent the MRI examination for lower extremity pain over the past 4 years and 9 months. Utilizing a diagnostic T2-weighted intensity ratio threshold of 1.54, established by a prior cohort of patients, sensitivity, specificity, predictive value, and diagnostic odds ratio were calculated for the anterior compartments. The means of the T2-weighted intensity ratios were compared using the Wilcoxon rank sum test. RESULTS: A total of 79 patients were identified, and 76 met the inclusion criteria and were evaluated. Of these, 23 met clinical diagnostic criteria. Sensitivity and specificity were 96% (95% CI: 79-99%) and 87% (95% CI: 75-94%) using the established threshold of 1.54. T2-weighted intensity ratio provided excellent discrimination with a concordance statistic of 0.96 (95% CI: 0.91-1.00). In the subset of 36 patients with INM results, 23 patients met criteria for CECS, although only 19 patients met both INM and clinical criteria. The sensitivity and specificity of the MRI examination relative to INM results were 87% (95%: 70-96%) and 62% (95% CI: 36-82%) respectively. CONCLUSION: In-scanner exercise-based MRI demonstrated reliability and reproducibility as a non-invasive screening test for CECS, thus reducing the need for invasive INM.
    Skeletal Radiology 07/2012; · 1.74 Impact Factor
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    ABSTRACT: PURPOSE To introduce axial balanced steady state free precession (bSSFP) MR imaging with provocative maneuvers as an adjunct test for popliteal artery entrapment syndrome (PAES). METHOD AND MATERIALS All scans were performed on a 1.5 T scanner. An axial 2D bSSFP, non-fat saturated imaging technique was performed through both knees simultaneously with the following parameters: TR 3.2-8.2 ms, minimum TE (1.3-1.8 ms), flip angle 45º, field of view to include both knees (30-40 cm), 5 mm slice thickness with 0 skip, 224 pixel × 256 pixel matrix, and number of excitations 1. An 8 channel torso phased array coil was used in association with a Plexiglas footplate. bSSFP was performed in the neutral position and then in resisted plantar and dorsiflexion (Figure). All scans were performed and analyzed by a single fellowship trained musculoskeletal radiologist. A retrospective chart review was performed to identify patients who underwent additional diagnostic evaluation with provocative ultrasound (US) and/or conventional angiography. RESULTS One hundred and twenty legs were evaluated in 60 patients. A total of 22 extremities (11 patients) underwent conventional diagnostic angiography and/or subsequent surgical intervention. The positive predictive value (PPV) of provocative bSSFP was 100% with 14 true positives and no false positives. The negative predictive value (NPV) of bSSFP was 50% with 4 true negatives and 4 false negatives. Arterial US exams with provocative measures were evaluated independently with a PPV of 64% (7 true positives and 4 false positives.) There were no true negatives and 7 false negatives for arterial US. Eighteen extremities underwent both provocative bSSFP and arterial US prior to conventional provocative diagnostic angiography. The PPV of provocative bSSFP and US were 100% and 64%, respectively. The NPV of bSSFP was 67% in this subset of patients. There were 7 false negatives and no true negatives with US. CONCLUSION The bSSFP PPV in our study group was 100% compared with 64% for provocative arterial US. The bSSFP NPV was only 50%, but this was superior to provocative arterial US in our study group. CLINICAL RELEVANCE/APPLICATION bSSFP may simplify the evaluation of patients with chronic exertional leg pain by identifying patients who may benefit from conventional diagnostic angiography to exclude PAES.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
  • Jay Smith, Marco Rizzo, Yusef A Sayeed, Jonathan T Finnoff
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    ABSTRACT: Distal radioulnar joint (DRUJ) disorders are uncommon but important causes of ulnar-sided wrist pain and disability. Fluoroscopically guided injections may be performed to diagnose or treat DRUJ-related pain or as part of a diagnostic arthrogram. Sonographic guidance may provide a favorable alternative to fluoroscopic guidance for distal DRUJ injections. This report describes and validates a sonographically guided technique for DRUJ injections in an unembalmed cadaveric model. An experienced clinician used sonographic guidance to inject diluted colored latex into the DRUJs of 10 unembalmed cadaveric specimens. Subsequent dissection by a fellowship-trained hand surgeon confirmed accurate injections in all 10 specimens. Two cases of ulnocarpal flow, indicative of triangular fibrocartilage injury, were noted during injection and subsequently confirmed during dissection. Clinicians should consider using sonographic guidance to perform DRUJ injections when clinically indicated. Further research should explore the efficacy of sonographically guided DRUJ injections to treat patients with painful DRUJ syndromes or to evaluate the triangular fibrocartilage complex in patients with ulnar wrist pain syndromes.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 11/2011; 30(11):1587-92. · 1.40 Impact Factor
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    ABSTRACT: The purpose of this study was to determine and compare the accuracies of sonographically guided and palpation guided scaphotrapeziotrapezoid (STT) joint injections in a cadaveric model. A clinician with 6 years of experience performing sonographically guided procedures injected 1.0 mL of a diluted latex solution into the STT joints of 20 unembalmed cadaveric wrist specimens using a palmar approach. At a minimum of 24 hours after injection, an experienced clinician specializing in hand care completed palpation guided injections in the same specimens using a dorsal approach and 1 mL of a different-colored latex. A fellowship-trained hand surgeon blinded to the injection technique then dissected each specimen to assess injection accuracy. Injections were graded as accurate if the colored latex was found in the STT joint, whereas inaccurate injections resulted in no latex being found in the joint. All sonographically guided injections were accurate (100%; 95% confidence interval, 81%-100%), whereas only 80% of palpation guided injections were accurate (95% confidence interval, 61%-99%). Sonographically guided injections were significantly more accurate than palpation guided injections, as determined by the ability to deliver latex into the joint (P < .05). Sonographic guidance can be used to inject the STT joint with a high degree of accuracy and is more accurate than palpation guidance within the limits of this study design. Clinicians should consider using sonographic guidance to perform STT joint injections when precise intra-articular placement is desired. Further clinical investigation examining the role of sonographically guided STT joint injections in the treatment of patients with radial wrist pain syndromes is warranted.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 11/2011; 30(11):1509-15. · 1.40 Impact Factor
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    Jonathan T Finnoff, Elena J Jelsing, Jay Smith
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    ABSTRACT: It is estimated that between 1.6 and 3.8 million concussions occur annually in the United States. Although frequently regarded as benign, concussions can lead to multiple different adverse outcomes, including prolonged postconcussive symptoms, chronic traumatic encephalopathy, cognitive impairment, early onset dementia, movement disorders, psychiatric disorders, motor neuron disease, and even death. Therefore it is important to identify individuals with concussion to provide appropriate medical care and minimize adverse outcomes. Furthermore, it is important to identify individuals who are predisposed to sustaining a concussion or to having an adverse outcome after concussion. This article will discuss the current research on serum biomarkers for concussion, genetic influence on concussion, risk factors associated with concussion predisposition and poor outcome, and practical suggestions for the application of this information in clinical practice.
    PM&R 10/2011; 3(10 Suppl 2):S452-9. · 1.37 Impact Factor
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    ABSTRACT: The purpose of this study was to determine whether sonography can identify the distal posterior interosseous nerve at the wrist. On the basis of previous anatomic descriptions, high-resolution musculoskeletal sonography was used in an attempt to identify the distal posterior interosseous nerve in the wrists of 20 unembalmed cadaveric specimens (11 male and 9 female; ages 54-98 years). High-frequency scanning (17-5 MHz) of the fourth dorsal extensor compartment revealed a small (1-3 mm) hypoechoic structure located on the compartment floor, presumed to represent the posterior interosseous nerve. Electronic calipers measured the distance between Lister's tubercle and this structure, as well as the structure's radial-ulnar width and volar-dorsal height. The presumed posterior interosseous nerves of 10 specimens were then injected with diluted colored latex using sonographic guidance. Subsequent dissection definitively identified the sonographically visualized and injected structure. Dissection revealed latex within the posterior interosseous nerve in all 10 injected specimens, thus confirming that the sonographically visualized structure represented the distal posterior interosseous nerve. The nerve was identified sonographically in all 20 examined specimens, was located an average of 4.88 mm (range, 2.10-10.0 mm) ulnar to Lister's tubercle, and had an average width and height of 2.35 mm (range, 1.20-3.50 mm) and 1.01 mm (range, 0.80-1.40 mm), respectively. High-resolution sonography can reliably identify the distal posterior interosseous nerve within the fourth dorsal extensor compartment. Clinicians should consider formal evaluation of the posterior interosseous nerve in patients presenting with dorsal wrist pain syndromes. Future investigations should explore the potential role of sonographically guided percutaneous procedures directed at the posterior interosseous nerve.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 09/2011; 30(9):1233-9. · 1.40 Impact Factor
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    ABSTRACT: To determine whether ultrasound (US)-guided percutaneous needle tenotomy followed by a platelet-rich plasma (PRP) injection would result in pain reduction, functional improvement, or structural alterations in patients with chronic, recalcitrant tendinopathy. Part A was a retrospective observational study. Part B was a prospective observational study. Outpatient academic sports medicine center. Patients were required to have chronic (>3 months), recalcitrant tendinopathy treated with US-guided percutaneous tenotomy and PRP injection between January 2007 and October 2009. Fifty-one subjects met the inclusion criteria. Forty-one (80%) participated in part A of the study, whereas 34 subjects (67%) participated in part B. In part A, subjects completed a survey obtaining anthropomorphic, demographic, pain, and functional data. Subjects' platelet, hemoglobin, and white blood cell concentrations from their whole-blood and PRP samples were also obtained. In part B, subjects returned to the clinic after US-guided percutaneous needle tenotomy and PRP injection for a diagnostic US, which was compared with their preprocedure diagnostic US. The main outcome measures included changes in pain, function, and tendon characteristics. The tendinopathy location was in the upper extremity in 10 subjects (24.4%), was in the lower extremity in 31 subjects (75.6%), and had been present for a mean of 40 months. The mean postprocedure follow-up was 14 months, and the maximum benefits occurred 4 months postprocedure. There were mean functional and worst-pain improvements of 68% and 58%, respectively. Eighty-three percent of subjects were satisfied with their outcomes and would recommend the procedure to a friend. Although no tendons demonstrated a normal sonographic appearance after the procedure, 84% of subjects had an improvement in echotexture, 64% had a resolution of intratendinous calcifications, and 82% had a decrease in intratendinous neovascularity. None of the variables analyzed in this study demonstrated a significant correlation with pain or functional outcome measures. In this case series, we found US-guided percutaneous needle tenotomy followed by PRP injection to be a safe and effective treatment for chronic, recalcitrant tendinopathy, and this treatment was associated with sonographically apparent improvements in tendon morphology. However, because of the intrinsic limitations of the study design and the heterogeneity of treated tendons, further research is required to corroborate our findings.
    PM&R 08/2011; 3(10):900-11. · 1.37 Impact Factor
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    ABSTRACT: To determine whether pre-injury hip muscle weakness is associated with the development of patellofemoral pain (PFP) in high school running athletes. Prospective cohort study. Academic institution sports medicine center. High school running athletes. Baseline hip strength of high school running athletes was assessed at the beginning of the running season. Strength testing was repeated in athletes who developed PFP. Peak hip muscle strengths and strength ratios were compared between the injured and non-injured groups. Six injuries occurred in 5 of the 98 subjects who completed the study. The baseline hip external-to-internal strength ratio was lower in injured than in uninjured subjects (P = .008). In the injured group, hip abduction and external rotation strengths decreased from pre-injury to post-injury (P = .002 and P = .01, respectively). Logistic regression analysis demonstrated that a greater baseline hip abduction strength (odds ratio = 5.35, 95% confidence interval [CI] 1.46-19.53; P < .01) and abduction-to-adduction strength ratio increased the risk of injury (odds ratio = 14.14, 95% CI 0.90-221.06; P = .05), and a greater pre-injury hip external-to-internal rotation strength ratio decreased the risk of injury (odds ratio < 0.01, 95% CI ≤ .01, 0.44; P = .02). The findings of the current study suggest that stronger pre-injury hip abductors (particularly in relation to their hip adductors) and weaker pre-injury hip external rotators (particularly in relation to their hip internal rotators) are associated with the development of PFP. In addition, persons in whom PFP develops appear to lose hip abduction and external rotation strength when compared with their pre-injury strength. Finally, a higher hip external-to-internal rotation strength ratio may protect against the development of PFP.
    PM&R 08/2011; 3(9):792-801. · 1.37 Impact Factor
  • Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2011; 30(8):1162-6. · 1.40 Impact Factor
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    ABSTRACT: The objective of this proceeding is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence,severity, and consequences of concussion in ice hockey. methods: A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review two months prior to the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit and break out sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey. Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were: metrics and databases; recognizing,managing, and return to play; hockey equipment and ice arenas;prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System (ARS). The strategic planning process was conducted to assess: Where are we at?; Where must we get to?; and What strategies are necessary to make progress on the prioritized action items? Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceeding.
    Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 07/2011; 21(4):281-7. · 1.50 Impact Factor
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    ABSTRACT: The aim of this study was to describe and to validate an ultrasound-guided peroneal tendon sheath (PTS) injection technique and to compare the accuracy of ultrasound-guided vs. palpation-guided PTS injections in a cadaveric model. Twenty cadaveric lower limbs were injected with and without ultrasound guidance, using a different color of liquid latex for each injection technique. The injections were performed by a single investigator in a randomized order. Cadaveric specimens were dissected 1 wk later by a blinded investigator who graded injection accuracy on a 3-point scale (1, accurate; 2, partially accurate; 3, inaccurate). Ultrasound-guided injections were 100% (20 of 20) accurate whereas palpation-guided injections were 60% (12 of 20) accurate (P = 0.008). Six palpation-guided injections were partially accurate, and two were inaccurate. Two of the partially accurate and both of the inaccurate injections were intratendinous. In a cadaveric model, ultrasound-guided PTS injections are significantly more accurate than palpation-guided injections. When performing PTS injections, clinicians should consider ultrasound guidance to improve injection accuracy and minimize potential complications such as intratendinous injection.
    American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 07/2011; 90(7):564-71. · 1.56 Impact Factor
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    ABSTRACT: The objective of this proceedings is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence, severity, and consequences of concussion in ice hockey. A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review two months prior to the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit and breakout sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence-based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey. Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were: metrics and databases; recognizing, managing and return to play; hockey equipment and ice arenas; prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System (ARS). The strategic planning process was conducted to assess: Where are we at?; Where must we get to?; and What strategies are necessary to make progress on the prioritized action items? Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceedings.
    The Clinical Neuropsychologist 07/2011; 25(5):689-701. · 1.68 Impact Factor
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    ABSTRACT: To determine the accuracy of palpating the long head of the biceps tendon (LHBT) within the intertubercular groove with the use of ultrasonographic localization as a gold standard. Prospective, single-blinded pilot study. Sports medicine clinic at a tertiary care academic institution. Twenty-five male and female asymptomatic volunteers ages 24-41 years (mean, 30.9 ± 4.3 years) with body mass indices of 19.3 to 36.3 kg/m(2) (23.84 ± 4.8 kg/m(2)). Three examiners of differing experience (a sports medicine board-certified staff physician, a sports medicine fellow, and a physical medicine and rehabilitation resident) identified the LHBT location in the intertubercular groove via palpation on a subject in the supine position and marked its location by taping an 18-gauge Tuohy needle to the skin overlying the groove. The examiner order was randomized. A fourth examiner who was blinded to the palpation order assessed the previous examiner's palpation accuracy by comparing the needle position to the sonographically determined tendon position. Needle placement in relation to the intertubercular groove was graded as being within the groove, medial to the groove, or lateral to the groove. In the latter 2 cases, the distance from the needle to the closest groove edge was recorded. Overall accuracy rate was 5.3% (4/75), ranging from 0% (0/25) for the resident to 12% (3/25) for the fellow (P ≤ .007 for interexaminer differences). All missed palpations were localized medial to the intertubercular groove by an average of 1.4 ± 0.5 cm (range, 0.3 for the fellow to 3.5 cm for the resident). Based on the current methodology, clinicians have a tendency to localize the intertubercular groove medial to its actual location. Consequently, clinicians should exercise caution when relying on clinical palpation to either diagnose a biceps tendon disorder or perform a bicipital tendon sheath injection. When clinically indicated, sonographic guidance can be used to accurately identify the LBHT within the intertubercular groove.
    PM&R 06/2011; 3(11):1035-40. · 1.37 Impact Factor
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    ABSTRACT: To evaluate the accuracy of ultrasound (US)-guided and palpation-guided knee injections by an experienced and a less-experienced clinician with use of a superolateral approach. Single-blinded, prospective study. Academic institution procedural skills laboratory. Twenty cadaveric knee specimens without trauma, surgery, or major deformity. US-guided and palpation-guided knee injections of colored liquid latex were performed in each specimen by an experienced and a less-experienced clinician with use of a superolateral approach. The order of injections was randomized. The specimens were subsequently dissected by a blinded investigator and assessed for accuracy. Accuracy was divided into 3 categories: (1) accurate (all of the injectate was within the joint), (2) partially accurate (some of the injectate was within the joint and some was within the periarticular tissues), and (3) inaccurate (none of the injectate was within the joint). The accuracy rates were calculated for each clinician and guidance method. US-guided knee injections that used a superolateral approach were 100% accurate for both clinicians. Palpation-guided knee injections that used a superolateral approach were significantly influenced by experience, with the less-experienced investigator demonstrating an accuracy rate of 55% (95% confidence interval = 34%-74%) and the more experienced investigator demonstrating an accuracy rate of 100% (95% confidence interval = 81%-100%). US-guided knee injections that use a superolateral approach are very accurate in a cadaveric model, whereas the accuracy of palpation-guided knee injections that use the same approach is variable and appears to be significantly influenced by clinician experience. These findings suggest that US guidance should be considered when one performs knee injections with a superolateral approach that require a high degree of accuracy.
    PM&R 06/2011; 3(6):507-15. · 1.37 Impact Factor
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    ABSTRACT: Invasive leg compartment testing may be performed to diagnose chronic exertional compartment syndrome. No prior study has assessed the accuracy of leg compartment needle tip access. This study was undertaken to describe and determine the accuracy of palpation-guided and ultrasound-guided techniques for needle tip placement into the deep and superficial posterior leg compartments by a less experienced clinician and a more experienced clinician using a cadaveric model. Controlled laboratory study. Twenty unembalmed adult lower limb cadaveric specimens were used for the study. Two investigators, a sports medicine fellow with 10 months of musculoskeletal ultrasound experience and a staff physiatrist with 3 years of musculoskeletal ultrasound experience, each performed 1 palpation-guided and 1 ultrasound-guided colored latex dye injection into the deep and superficial posterior leg compartments of each cadaveric specimen. A blinded investigator dissected the specimens and graded them for accuracy. The accuracy rates of palpation-guided (accuracy rate, 90%; 95% confidence interval [CI], 76%-97%) and ultrasound-guided (accuracy rate, 88%; 95% CI, 73%-95%) deep posterior compartment injections were statistically equivalent (P = 1.000). All 80 injections performed into the superficial posterior compartment were accurate (accuracy rate, 100%; 95% CI, 89%-100%). The accuracy of the less experienced investigator (total injection accuracy rate, 88%; 95% CI, 73%-95%) and the more experienced investigator (total injection accuracy rate, 90%; 95% CI, 76%-97%) were not significantly different (P = 1.000). Needle tip placement into the deep and superficial posterior leg compartments is relatively accurate with palpation guidance regardless of level of experience, and does not improve with the use of ultrasound guidance. Ultrasound guidance does not appear to be indicated for routine deep or superficial posterior leg compartment pressure testing. However, this does not preclude the need for ultrasound guidance in selected clinical scenarios.
    The American journal of sports medicine 05/2011; 39(9):1968-74. · 3.61 Impact Factor
  • Yusef Sayeed, Jonathan T Finnoff, Wojciech Pawlina, Jay Smith
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2011; 30(5):710-3. · 1.40 Impact Factor

Publication Stats

201 Citations
71.19 Total Impact Points

Institutions

  • 2013
    • University of Washington Seattle
      • Department of Rehabilitation Medicine
      Seattle, WA, United States
  • 2010–2013
    • Mayo Clinic - Rochester
      • Department of Physical Medicine & Rehabilitation
      Rochester, Minnesota, United States
  • 2003–2013
    • Mayo Foundation for Medical Education and Research
      • Department of Physical Medicine and Rehabilitation
      Rochester, MI, United States
  • 2009
    • University of Utah
      • Division of Physical Medicine and Rehabilitation
      Salt Lake City, UT, United States