Jonathan T Finnoff

University of California, Davis, Davis, California, United States

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Publications (71)133.29 Total impact

  • Sathish Rajasekaran · Jonathan T. Finnoff
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    ABSTRACT: Exertional leg pain is a common condition seen in runners and the general population. Given the broad differential diagnosis of this complaint, this article focuses on the incidence, anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and management of common causes that include medial tibial stress syndrome, tibial bone stress injury, chronic exertional compartment syndrome, arterial endofibrosis, popliteal artery entrapment syndrome, and entrapment of the common peroneal, superficial peroneal, and saphenous nerves. Successful diagnosis of these conditions hinges on performing a thorough history and physical examination followed by proper diagnostic testing and appropriate management.
    No preview · Article · Feb 2016 · Physical Medicine and Rehabilitation Clinics of North America
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    ABSTRACT: The fabella is a sesamoid bone situated in the posterolateral knee, which may contribute to posterolateral knee pain by impinging on the adjacent common peroneal nerve (CPN). Although anatomic studies have established an relationship between the fabella and CPN, we present 4 cases of posterolateral knee pain radiating into the anterolateral leg in which sonography was able to determine the source of the pain as CPN compression by an adjacent fabella. In 2 of these cases, resolution of symptoms was achieved with ultrasound-guided CPN blocks, whereas 1 case was surgically treated, and another was managed with oral analgesics. These cases illustrate the utility of diagnostic and interventional sonography in the evaluation and treatment of posterolateral knee pain secondary to fabellar impingement of the CPN.
    No preview · Article · Jan 2016 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
  • Sathish Rajasekaran · Jonathan T. Finnoff
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    ABSTRACT: Out-of-plane (OOP) ultrasound guided injections are often cited as more difficult than in-plane (IP) ultrasound guided injections, particularly for the novice ultrasonographer. In certain circumstances, the OOP approach is required due to the constraints of adjacent anatomical structures. To date, only the “walkdown” approach has been detailed in the literature as a means to improve accuracy with the OOP approach. However, this approach uses a set needle entry angle (angle of incidence) and distance for the injection. This article uses the trigonometric function, arctan=opposite/adjacent (arcTOA), to allow readers to easily estimate the needle angle of incidence (arcTOA technique), allowing more flexibility when planning and performing OOP injections.
    No preview · Article · Jan 2016 · PM&R
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    Mederic M Hall · Jonathan T Finnoff · Yusef A Sayeed · Jay Smith
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    ABSTRACT: Objectives: The primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain. Methods: Thirty-nine asymptomatic runners without a history of plantar heel pain were recruited. The following sonographic measures were recorded: power Doppler sonography in the plantar heel pad and plantar fascia, echo texture of the plantar heel pad, uncompressed heel pad thickness, compressed heel pad thickness, heel pad compressibility index, plantar fascia thickness, and plantar fascia echo texture. Results: Doppler flow was shown in the plantar heel pads of 88% (68 of 77) of heels and 92% (36 of 39) of runners. Heel pad echo texture abnormalities were found in 86% (66 of 77) of heels and 97% (38 of 39) of runners. Mean values for right and left uncompressed heel pad thickness were 13.8 and 13.7 mm, respectively. The mean heel pad compressibility indices were 0.51 for the right heel and 0.53 for the left heel. Eight percent (6 of 77) of fat pads in 10% (4 of 39) of runners had abnormal compressibility indices. Doppler flow was present in the plantar fascia in 31% (24 of 77) of heels and 44% (17 of 39) of runners. The mean plantar fascia thicknesses were 3.78 mm for the right and 3.87 mm for the left. Forty-eight percent (37 of 77) of heels had an abnormal plantar fascia echo texture. Conclusions: At least 1 potentially abnormal sonographic finding was present in each heel of all asymptomatic runners in this study. Consequently, sonographic abnormalities in the plantar heel should be interpreted within the clinical context when evaluating runners.
    Full-text · Article · Sep 2015 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
  • Jonathan T Finnoff · Sathish Rajasekaran
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    ABSTRACT: Chronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest. The most common site for CECS in the lower extremity is the anterior leg compartment. We report a case of a collegiate athlete with bilateral anterior and lateral leg compartment CECS who was successfully treated with an ultrasound-guided, percutaneous needle fascial fenestration of the affected compartments in both legs and was able to return to full, unrestricted activity within 1 week of the procedure. This case highlights the potential application of this procedure for the treatment of anterior and lateral leg CECS.
    No preview · Article · Sep 2015 · PM&R
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    ABSTRACT: INTRODUCTION. The fabella is a sesamoid bone in the posterolateral knee which may present itself as an etiologic cause of pain. In close proximity to the common fibular (peroneal) nerve (CFN), the fabella may impinge upon the nerve to cause fibular nerve palsies. While anatomical studies have established a relationship between the fabella and CFN, we present cases where sonography was able to determine the source of the pain secondary to CFN compression by an adjacent fabella in posterolateral knee pain that radiates into the anterolateral leg pain. METHODS. Four patients presented with complaints of posterolateral knee pain radiating into the anterolateral leg pain. All patients underwent diagnostic and interventional ultrasound (US) in the evaluation of posterolateral knee pain. SUMMARY. Two female and two male patients presented with complaints of posterolateral knee pain radiating into the anterolateral leg pain. Diagnostic and interventional ultrasound was able to determine the source of the pain was secondary to CFN compression by an adjacent fabella. In three cases, pain symptoms were resolved with US-guided CFN block. One patient had temporarily relief with CFN block and required surgical treatment with fabellectomy for complete resolution of symptoms. CONCLUSIONS. Dynamic sonography plays a role in providing convincing in vivo evidence to establish a causal relationship between fabella and fibular neuropathy in posterolateral knee pain.
    Full-text · Conference Paper · Jun 2015
  • Jonathan T Finnoff · John G Costouros · David J Kennedy

    No preview · Article · Apr 2015 · PM&R
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    ABSTRACT: The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based on the evidence, the official AMSSM position relevant to each subject is made.
    No preview · Article · Jan 2015 · Clinical Journal of Sport Medicine
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    Rajasekaran Sathish · Jonathan T Finnoff
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    ABSTRACT: Heel pain is the most common type of foot pain. The differential diagnosis for pain in this region is vast, but plantar fasciopathy is thought to be the most common cause for pain in this region. This article will review the anatomy, biomechanics, pathophysiology, his-tory, physical examination, diagnostic imaging, and treat-ment options available for plantar fasciopathy.
    Full-text · Article · Dec 2014
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    ABSTRACT: The American Medical Society for Sports Medicine (AMSSM) developed a musculoskeletal ultrasound curriculum for sports medicine fellowships in 2010. As the use of diagnostic and interventional ultrasound in sports medicine has evolved, it became clear that the curriculum needed to be updated. Furthermore, the name 'musculoskeletal ultrasound' was changed to 'sports ultrasound' (SPORTS US) to reflect the broad range of diagnostic and interventional applications of ultrasound in sports medicine. This document was created to outline the core competencies of SPORTS US and to provide sports medicine fellowship directors and others interested in SPORTS US education with a guide to create a SPORTS US curriculum. By completing this SPORTS US curriculum, sports medicine fellows and physicians can attain proficiency in the core competencies of SPORTS US required for the practice of sports medicine.
    Full-text · Article · Oct 2014 · British Journal of Sports Medicine
  • Source
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    ABSTRACT: The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based upon the evidence, the official AMSSM position relevant to each subject is made. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Oct 2014 · British Journal of Sports Medicine
  • James R Meadows · Jonathan T Finnoff
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    ABSTRACT: Nerve entrapments are a potential cause of lower extremity pain in athletes. Signs and symptoms suggestive of nerve entrapment include anesthesia, dysesthesias, paresthesias, or weakness in the distribution of a peripheral nerve. The physical examination may reveal an abnormal neurologic examination finding in the distribution of a peripheral nerve, positive nerve provocative testing, and positive Tinel sign over the area of entrapment. Electrodiagnostic studies, radiographs, magnetic resonance imaging studies, and sonographic evaluation may assist with the diagnosis of these disorders. Initial treatment usually involves conservative measures, but surgical intervention may be required if conservative treatment fails. This article discusses the diagnosis and treatment of common lower extremity nerve entrapments in athletes. A high index of suspicion for nerve entrapments enables the clinician to identify these conditions in a timely manner and institute an appropriate management program, thus improving patient outcomes.
    No preview · Article · Sep 2014 · Current Sports Medicine Reports
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    Sathish Rajasekaran · Rodney Li Pi Shan · Jonathan T Finnoff
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    ABSTRACT: To estimate the prevalence of perceived and International Committee of Medical Journal Editors (ICMJE) defined honorary authorship, and identify factors affecting each rate in the physical medicine and rehabilitation literature. Internet-based survey. First authors of papers published in three major physical medicine and rehabilitation journals between January 2009 and December 2011 were surveyed in June and July of 2012. The reported prevalence of perceived and ICMJE defined honorary authorship were the primary outcome measures, and multiple factors were analyzed to determine if they were associated with these measures.Results: The response rate was 27.3% (248/908). The prevalence of perceived and ICMJE defined honorary authorship were 18.0% (44/244) and 55.2% (137/248), respectively. Factors associated with perceived honorary authorship in the multivariate analysis included the suggestion that an honorary author should be included (P<.0001), being a medical resident or fellow (P=.0019), listing "reviewed manuscript" as one of the non-authorship tasks (P=.0013), and the most senior author deciding the authorship order (P=.0469). Living outside of North America was independently associated with ICMJE defined honorary authorship (P=.0079) in the multivariate analysis. In the univariate analysis, indicating that the most senior author decided authorship order was significantly associated with ICMJE defined honorary authorship (P=.0003). Our results suggest honorary authorship does occur in a significant proportion of the physical medicine and rehabilitation literature. Additionally, we found several factors associated with perceived and ICMJE defined honorary authorship and a discrepancy between the two rates. Further studies with larger response rates are recommended to further explore this topic.
    Full-text · Article · Nov 2013 · Archives of physical medicine and rehabilitation
  • Sathish Rajasekaran · Rodney Li Pi Shan · Jonathan Finnoff

    No preview · Conference Paper · Nov 2013
  • Steve J Wisniewski · Mark Hurdle · Jason M Erickson · Jonathan T Finnoff · Jay Smith
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    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.
    No preview · Article · Aug 2013 · PM&R
  • 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.
    No preview · Article · Aug 2013 · PM&R
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    Sathish Rajasekaran · Jonathan T Finnoff
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    ABSTRACT: Many ultrasound educational products and ultrasound researchers present diagnostic and interventional ultrasound information using picture-in-picture videos, which simultaneously show the ultrasound image and transducer and patient positions. Traditional techniques for creating picture-in-picture videos are expensive, nonportable, or time-consuming. This article describes an inexpensive, simple, and portable way of creating picture-in-picture ultrasound videos. This technique uses a laptop computer with a video capture device to acquire the ultrasound feed. Simultaneously, a webcam captures a live video feed of the transducer and patient position and live audio. Both sources are streamed onto the computer screen and recorded by screen capture software. This technique makes the process of recording picture-in-picture ultrasound videos more accessible for ultrasound educators and researchers for use in their presentations or publications.
    Full-text · Article · Aug 2013 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
  • Jonathan T Finnoff

    No preview · Article · Jul 2013 · PM&R
  • Source
    Elena J Jelsing · Jonathan T Finnoff · Andrea L Cheville · Bruce A Levy · Jay Smith
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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.
    Preview · Article · Jul 2013 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
  • Elena J. 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.
    No preview · Article · Feb 2013 · PM&R

Publication Stats

616 Citations
133.29 Total Impact Points

Institutions

  • 2013-2016
    • University of California, Davis
      Davis, California, United States
  • 2011
    • Mayo Foundation for Medical Education and Research
      Рочестер, Michigan, United States
  • 2003-2011
    • Mayo Clinic - Rochester
      • Department of Physical Medicine & Rehabilitation
      Рочестер, Minnesota, United States
  • 2009
    • University of Washington Seattle
      • Department of Orthopaedics and Sports Medicine
      Seattle, Washington, United States
    • University of Hawaiʻi at Mānoa
      Honolulu, Hawaii, United States