A musculoskeletal ultrasound course for physical medicine and rehabilitation residents.

Musculoskeletal ultrasound is an imaging modality that can be used to evaluate nerve, tendon, muscle, ligament, and joint disorders and to guide therapeutic procedures. A growing proportion of physiatrists are interested in musculoskeletal ultrasound as demonstrated by the increasing number of musculoskeletal ultrasound articles published in physical medicine and rehabilitation journals and quantity of musculoskeletal ultrasound courses and workshops at physical medicine and rehabilitation conferences. The Mayo Clinic (Rochester, MN) Physical Medicine and Rehabilitation residency program developed a musculoskeletal ultrasound course for their physical medicine and rehabilitation residents, which was implemented in 2008. A detailed description of the course is provided in this article. In addition, results from a premusculoskeletal ultrasound course and postmusculoskeletal ultrasound course practical and written test are presented, and the results of a postmusculoskeletal ultrasound course resident survey are discussed. This information can be used by other physical medicine and rehabilitation residency programs to assist in the creation of their own musculoskeletal ultrasound course.

Femoroacetabular impingement: an overlooked cause of hip pain.

Femoroacetabular impingement is a cause of hip pain arising from abnormal contact between the proximal femur and the acetabulum during terminal hip motion. This is caused by a structural abnormality at the femoral head/neck junction or the acetabulum. The problem usually presents in young adults and can often go undiagnosed for years. Failure to identify and properly restore the biomechanics has been hypothesized to lead to the early onset of hip osteoarthritis; thus, early recognition is important. In this case study, we report on a 31-yr-old patient with many years of bilateral hip pain who underwent successful treatment of bilateral femoroacetabular impingement.

Procedure-based nonsurgical management of lumbar zygapophyseal joint cyst-induced radicular pain.

OBJECTIVE: To evaluate the success of fluoroscopically guided, contrast-enhanced lumbar zygapophyseal joint (Z-joint) aspiration and steroid injection combined with transforaminal epidural steroid injections (TFESIs) for the treatment of lumbar Z-joint cyst-induced radicular pain. DESIGN: Retrospective case series with independent follow-up. SETTING: Institutional, referral center. PARTICIPANTS: Twenty-three patients referred to a single provider for procedure-based management of radicular pain believed secondary to lumbar Z-joint cyst. Inclusion criteria consisted of lumbar radicular pain that was consistent with the level and side of the Z-joint cyst as a causative lesion. INTERVENTIONS: Eighteen patients were treated with a fluoroscopically guided, contrast-enhanced Z-joint aspiration and steroid injection at the level of the causative cyst coupled with a fluoroscopically guided, contrast-enhanced TFESI over the level of the presumably irritated spinal nerve. MAIN OUTCOME MEASURES: Patient satisfaction, and whether or not surgery was performed. RESULTS: Fifty percent of patients treated with the procedure had significant long-term benefit and avoided surgical intervention at an average follow-up of 9.9 months. CONCLUSIONS: Fluoroscopically guided, contrast-enhanced spinal procedures as part of an aggressive nonsurgical treatment program are a safe and effective alternative to surgical intervention for lumbar Z-joint cyst-induced radicular pain.