An Evaluation of Musculoskeletal Interventional Ultrasound Training in Canadian Physical Medicine and Rehabilitation Residency Programs.

BACKGROUND: Ultrasound is a rapidly evolving field of medicine with strong utility in musculoskeletal practices. In Canadian physical medicine and rehabilitation (PM&R) residency programs there are no national standards for objectives of training in this area. This possible disconnection between demand and availability could lead to gaps in education. OBJECTIVE: (1) To determine the current state of interventional musculoskeletal ultrasound (MSUS) training in Canadian PM&R residency programs, as perceived by both residents and program directors; (2) to evaluate the perspectives of experts in the field on current and future MSUS curriculum inclusion. DESIGN: This study was a cross-sectional cohort study using an explanatory sequential mixed methods design. SETTING: This project included anonymous online surveys and targeted telephone/in-person semistructured interviews. PARTICIPANTS: Participants were Canadian PM&R residents or clinicians. Survey responses included 71 residents and nine program directors. Interviews were conducted with nine MSUS experts. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measures included residents' level of interest, amount of exposure, and barriers to training. Themes regarding resident exposure and future directions for MSUS training were obtained based on expert interviews. RESULTS: The vast majority (97%) of current PM&R residents are interested in using ultrasound clinically, with 73% reporting having had "none" to "limited exposure" in MSUS. Expert interviews revealed four major themes: (1) appropriate training is dependent on access, (2) MSUS represents an emerging standard of care, (3) a minimal baseline level of competence should be expected, and (4) various strategies may be used to integrate basic MSUS into existing residency curriculums. CONCLUSIONS: The use of ultrasound as a clinical tool is rapidly increasing. Current PM&R residents have a desire to incorporate this skill into their future practices. Although barriers exist to implementing this training on a national level, the future looks promising with multiple strategies outlined to assist the process.

A Controlled Trial Evaluating the Safety and Effectiveness of Ultrasound-Guided Looped Thread Carpal Tunnel Release.

Background: Open carpal tunnel release typically requires several weeks of recovery. A less invasive, ultrasound-guided percutaneous technique of releasing the transverse carpal ligament using a thread (thread carpal tunnel release [TCTR]) has been described. To date, its clinical effectiveness and safety have been evaluated exclusively by the group that developed the technique, using a single outcome measure without a control comparison. The objective of this study was to independently evaluate the safety and effectiveness of TCTR using multiple outcome measures and a control comparison. Methods: A convenience sample of 20 participants with refractory moderate or severe carpal tunnel syndrome underwent TCTR of their most symptomatic hand. Outcome measures included pre-TCTR and 1-, 3-, and 6-month post-TCTR Boston questionnaire; pre-, 3-, and 6-month post-TCTR monofilament sensibility, strength, ultrasound, and electrodiagnostic testing; weekly post-TCTR phone interviews for 1 month; and satisfaction surveys at 3 and 6 months post-TCTR. Results: No complications were reported. During the month post-TCTR, significant prompt improvements in hand pain and dysfunction occurred. The following significant improvements were demonstrated in the treated versus control hand: Boston Questionnaire scores, median nerve distal motor latency, transcarpal tunnel motor and sensory conduction velocities and sensory nerve action potential amplitudes. No significant differences in sensibility, pinch or grip strength, median nerve cross-sectional area (CSA) at the carpal tunnel inlet, or wrist: forearm median nerve CSA ratio were documented between TCTR and control sides. Satisfaction with the TCTR procedure was high (85%-90%). Conclusions: This study supports previous reports that the TCTR procedure is safe and effective.

The effect of repeated zygapophysial joint radiofrequency neurotomy on pain, disability, and improvement duration.

OBJECTIVE: To assess the effectiveness of repeated radiofrequency neurotomy (RFN) on pain, disability, and treatment effect duration. PATIENTS: One hundred-four patients who underwent repeat RFN for chronic neck or back pain were prospectively followed using a Pain Disability Questionnaire-Spine (PDQ-S). Complete data sets were available for 73, 73, and 36 patients for the 1st, 2nd, and 3rd RFN, respectively. RESULTS: Pain intensity, pain frequency, and patient-specific disability measures were significantly improved post-initial, second, and third RFN. Moreover, there was no statistically significant difference among the PDQ-S scores post-RFN 1, 2, and 3. There was no statistical significance between the duration of pain relief post-RFN 1 and pain relief post-RFD 2. CONCLUSION: Repeated cervical and lumbar RFN reduces pain and disability with equal effectiveness for approximately 10 months in patients with facetogenic chronic neck and back pain.