Publications (77)134.38 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: There have been many recently published articles reporting improved accuracy of corticosteroid injection with the use of ultrasound-guidance compared to the conventional method of palpation-guided injections. It has been postulated that this improved accuracy would result in improved clinical outcomes. However, studies have been mixed in regards to whether ultrasound-guidance improves efficacy of corticosteroid injections. There is a significant need for high-quality research to be performed to adequately answer this question. This review summarizes the currently published studies comparing the efficacy of ultrasound- and palpation-guided corticosteroid injections.
- [Show abstract] [Hide abstract] ABSTRACT: Diagnostic and interventional ultrasound is a rapidly evolving field in sports medicine. The use of ultrasound has increased exponentially during the past decades. This imaging modality is appealing to sports medicine physicians because of its broad diagnostic and interventional capabilities. In sports medicine, the indications for diagnostic ultrasound extend well beyond the musculoskeletal realm to include other conditions such as ocular trauma, thoracoabdominal trauma, and cardiac morphology. Thus, the term “sports ultrasound” has been adopted as a more accurate representation of the broad and unique applications of ultrasound in this specialty. Ultrasound-guided procedures also have evolved from the commonly performed joint and tendon sheath injections to include ultrasound-guided surgical procedures. This article will discuss the evolution of diagnostic and interventional ultrasound in sports medicine using a case-based approach to highlight its many new applications.
Article: Exertional Leg Pain[Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [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.
Mayo Clinic - Rochester
Рочестер, Minnesota, United States
- Department of Physical Medicine & Rehabilitation
University of Washington Seattle
Seattle, Washington, United States
- Department of Orthopaedics and Sports Medicine
University of Hawaiʻi at MānoaHonolulu, Hawaii, United States