Ultrasound-guided fascial plane blocks for post-breast surgery pain syndrome.

INTRODUCTION: Persistent pain following breast surgery is common and may be challenging to treat. In patients refractory to conservative treatments, ultrasound-guided fascial plane blocks of thoracic nerves can be a useful option. RESULTS: This type of neuro blockade technique provides advantages in terms of safety and efficacy that are convenient for physicians managing refractory and complex cases of post-breast surgery syndrome. CONCLUSION: This technical review aims to present an up-to-date summary of the most common ultrasound-guided fascial plane blocks for chronic pain in post-breast surgery patients, provide a detailed technical description of each intervention, and propose preferred injections based on the anatomical location of the pain.

Telemedicine Evaluation of Hip Ailments.

Background During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has provided new means of patient care while still allowing for physical examination and history to be obtained. Hip ailments are a common musculoskeletal problem leading to limited function. Today, we lack a standardized telemedicine hip evaluation protocol. Aim The aim of this manuscript is to provide an efficient means of extracting relevant information while performing telemedicine examinations of the hip. Methods The authors have created a step-by-step evaluation guide for physicians to evaluate hip complaints, including inspection, palpation, range of motion, strength testing, functional assessment, gait analysis, and special testing, with images of each maneuver. Results  We have developed a table of evaluation questions and instructions and a glossary of images of each maneuver to facilitate hip examination via telemedicine. Conclusions This manuscript provides a structured template for performing a telehealth examination of hip ailments.

Physiatrists' Attitudes and Knowledge About Cancer Rehabilitation.

Objective We aim to assess the awareness and evaluation pattern among physiatrists regarding cancer rehabilitation and associated barriers to access. Design The present study is a cross-sectional study in the Physical Medicine and Rehabilitation (PMR) Association Annual Meeting in Puerto Rico that used a 10-item questionnaire to summarize physiatrists' clinical patterns with their persons diagnosed with cancer (PDWCs). Results Thirty-eight (66.7%) participants answered they received minimal to no education about cancer rehabilitation benefits. Cancer patients represented 10% or less of the weekly patient load for 47 (82.5%) physiatrists surveyed. The most common type of cancer encountered was breast cancer for the management of adverse effects. Twenty-nine (50.9%) physiatrists answered that a multifactorial barrier was the cause for limited services within this population group. All participants agreed that rehabilitation is at least sometimes beneficial for cancer patients, and 54 (94.7%) believed these services are needed. Conclusion Although rehabilitation specialists learn about the benefits of rehabilitation for PDWCs, there continues to be a limited number of PDWCs evaluated, mainly due to poor access, lack of information about cancer rehabilitation, and economic difficulties. Further efforts should be made to emphasize the importance of integrating rehabilitation techniques in the care of PDWCs.

Gender Diversity in Primary Care Sports Medicine Leadership.

ABSTRACT: Diversity, equity, and inclusion have been recognized as important drivers of excellence and innovation in the physician workforce. Given the historical underrepresentation of women in medicine, gender diversity is of interest. In this cross-sectional study, we sought to quantify leadership representation of female physicians in primary care sports medicine settings, including primary care sports medicine fellowship programs, select sports medicine societies, and select sports medicine-related scientific journals. Data were collected by querying the corresponding web site for each fellowship program, society, and journal and analyzed in a descriptive manner. Results showed that fewer female physicians hold primary care sports medicine leadership roles than men do. This work establishes a baseline for female representation in primary care sports medicine leadership; efforts should continue to increase the presence of women in leadership positions.

Comprehensive Evaluation of Primary Care Sports Medicine Fellowship Websites.

OBJECTIVE: To evaluate the comprehensiveness of primary care sports medicine fellowship websites and identify potential areas of improvement. DESIGN: Cross-sectional analysis of fellowship program websites using quantitative and descriptive statistics. SETTING: Internet. PARTICIPANTS: A total of 192 primary care sports medicine fellowship websites listed on the Electronic Residency Application Service (ERAS) website. INDEPENDENT VARIABLES: Program Specialty and Program Region. MAIN OUTCOME MEASURES: The presence or absence of 19 predetermined criteria on primary care sports medicine fellowship websites. RESULTS: The average number of criteria that was included on each website was 9.8 (SD 3.5) (51.6%) of the possible 19. Programs had as few as 2 of the 19 (10.5%) criteria included on their website, and others had as many as 17 of the 19 (89.4%) criteria. Of the 192 primary care sports medicine fellowships, only 5 (2.6%) addressed at least 80% of the 19 different criteria. No primary care sports medicine fellowship website included all 19 criteria. CONCLUSIONS: Most primary care sports medicine fellowship websites do not offer comprehensive information about their programs for prospective applicants.

Counting ribs and thoracic levels under ultrasound: a systematized technical protocol for both posterior and anterior approaches.

Over the last two decades, the clinical applications of diagnostic and interventional ultrasound have expanded rapidly. When analyzing the chest wall and thoracic region, ultrasound has previously been shown to reliably identify chest wall pathologies like rib fracture and slipping rib syndrome, as well as having fundamentally changed perioperative management and patient outcomes after the emergence of point-of-care ultrasound. In addition, ultrasound guidance has recently become more popular for multiple blocks in the field of regional anesthesia and pain medicine. In this technical report, we systematize an ultrasound-guided protocol for counting ribs and thoracic levels for both posterior and anterior approaches, which does not require level confirmation by fluoroscopy. With this protocol, we hope to create an effective educational resource to support physicians from any specialty background as they engage in point-of-care ultrasound applications in the thoracic region.

Oncologists' Attitude and Knowledge about Cancer Rehabilitation.

INTRODUCTION: Cancer survivors may experience multiple comorbidities related to the disease itself and adverse effects from treatment. Rehabilitation specialists could provide treatment options; however, oncologic rehabilitation services are underutilized. OBJECTIVE: To assess oncologists' awareness of the benefits of rehabilitation for cancer care patients and to identify barriers to rehabilitation referrals in adult cancer patients in Puerto Rico. DESIGN: Cross-sectional study. SETTING: Regional Annual Meeting of the Association of Medical Hematology and Oncology of Puerto Rico, 4-7 September 2015. PARTICIPANTS: Forty-two oncologists. INTERVENTIONS: Participants completed a 10-item questionnaire focused on demographics, knowledge, and clinical practices over the previous 12 months related to rehabilitation in cancer patients. MAIN OUTCOME MEASURES: Frequency, reasons, and timing for oncologist referral of cancer patients to rehabilitation. Perceived risks and benefits of rehabilitation in cancer patients and their correlation to patient referrals, prognosis, type of cancer, and type of symptoms. RESULTS: Thirty-seven oncologists (88.1%) received minimal or no education about cancer rehabilitation, its benefits, and indications. This resulted in 31 oncologists (73.8%) referring less than 15% of their patients for rehabilitation, with almost a third of participants referring less than 5%. However, 39 (92.9%) agreed that rehabilitation is always or frequently beneficial for their patients. Fifteen (35.7%) said they did not refer patients if prognosis was less than 6 months, and 16 (38.0%) avoided referring patients with life expectancy of less than 3 months. CONCLUSIONS: Although medical oncologists have some knowledge that rehabilitation is beneficial for their patients, there is a low referral rate. This could be due to lack of information about cancer rehabilitation and limited access to cancer rehabilitation specialists. Further efforts should be made to improve access to rehabilitation care for cancer patients and survivors.

Delayed diagnosis of traumatic gunshot wound Brown-Sequard-plus syndrome due to associated brachial plexopathy.

INTRODUCTION: Brown-Séquard Syndrome (BSS) is one of the rarest incomplete spinal cord syndromes. The combination of injuries to peripheral nerves and the central nervous system result in an array of symptoms that can result in overlapping clinical presentations and delayed diagnosis. Early detection of spinal cord injury in patients with peripheral nerve injury has been observed to have a positive effect on outcomes. CASE PRESENTATION: This report discusses the case of a 29-year-old male patient with Brown-Sequard-Plus Syndrome (BSPS) and Brachial Plexopathy (BP) secondary to gunshot wound in the left inferior neck. The patient was found initially with left hemibody weakness. A chest CT Scan demonstrated a fracture of the left T2 transverse process. Imaging studies of the spinal cord were not performed in the acute setting. Evaluation in an outpatient setting 3 weeks later showed significant left upper extremity weakness with improvement of left lower extremity strength. Also present were loss of pain and temperature sensation on the right side below the T2 dermatome level. A cervico-thoracic MRI was requested and revealed a T2 level spinal cord contusion. Electrodiagnostic studies confirmed a lower trunk left BP. DISCUSSION: The patient was diagnosed with BSPS and associated left lower trunk BP. To our knowledge, this is the first reported case of a concomitant BSPS and BP secondary to a gunshot wound. Delayed diagnosis of BSPS may occur in a trauma setting underlying the importance of a detailed history and physical examination for favorable outcomes.