American Medical Society for Sports Medicine sports ultrasound curriculum for sports medicine fellowships
Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions and mentored clinical experience. To assist with prioritisation of learning, we have organised relevant pathology and procedures as essential, desirable and optional The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones and a sample objective structured clinical examination to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.
American Medical Society for Sports Medicine Sports Ultrasound Curriculum for Sports Medicine Fellowships
ABSTRACT/UNASSIGNED:Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions, and mentored clinical experience. To assist with prioritization of learning, we have organized relevant pathology and procedures as essential, desirable, and optional. The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones, and a sample objective structured clinical examination (OSCE) to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.
Suggested Curricular Guidelines for Musculoskeletal and Sports Medicine in Physical Medicine and Rehabilitation Residency Training
ABSTRACT/UNASSIGNED:A sports medicine physician manages musculoskeletal (MSK) injuries and sport-related medical and MSK conditions of patients of all ages and abilities. Physical medicine and rehabilitation physicians (physiatrists) must be adequately trained to provide this care for all patients including, but not limited to, athletes participating in organized sports, the weekend warrior as well as athletes with disabilities. Accreditation Council of Graduate Medical Education core requirements and basic guidelines help physiatry residency training programs develop and implement residency curriculums. The goal of this article is to provide suggested curricular guidelines to optimize physiatrist training in MSK and sports medicine.
Rehabilitation of the Dancer
Rehabilitation of dance injury should be a team-based approach lead by a medical practitioner with experience in both musculoskeletal medicine and dance specific demands. The rehabilitation protocol begins with a dance specific initial assessment, followed by injury management, progression of the rehabilitation program including dance specific movement, advancing to full independence.
Rehabilitation of the patellofemoral joint
Nonsurgical care by a specialist in physical medicine and rehabilitation is typically a multifaceted approach, which can include modalities, bracing, medication, injection, proprioceptive techniques, restoration of normal movement patterns, and overall conditioning. There is evidence that physical therapy interventions have significant beneficial effect on pain and function compared with no treatment.
Minimally invasive lumbar spinal decompression in the elderly: outcomes of 50 patients aged 75 years and older
OBJECTIVE:Lumbar spinal stenosis and spondylosis are major causes of morbidity among the elderly. Surgical decompression is an effective treatment, but many elderly patients are not considered as candidates for surgery based on age or comorbidities. Minimally invasive surgical techniques have recently been developed and used successfully for the treatment of lumbar spinal disease. Our objective was to examine the safety and efficacy of minimally invasive lumbar spinal surgery for elderly patients. METHODS:We reviewed demographic information, pre- and postoperative Visual Analog Scale pain scores, Oswestry Disability Index scores, and Short-Form 36 scores of prospectively accrued patients who underwent minimally invasive decompression of lumbar degenerative disease at two institutions between January 2002 and December 2005. Data from patients who were at least 75 years old were selected. Statistical analysis methods included paired t test, multiple linear regression, and linear mixed effects modeling. RESULTS:Fifty-seven patients with a mean age of 81 years met the study criteria (median follow-up period, 7 mo; mean follow-up period, 10 mo). No major complications or deaths occurred. Fifty patients had sufficient outcomes data for analysis. Visual Analog Scale pain scores decreased from 5.7 to 2.2 for back pain and from 5.7 to 2.3 for symptomatic leg pain (P < 0.05). Oswestry Disability Index scores decreased from 48 to 27; Short-Form 36 Body Pain and Physical Function scores also showed statistically significant improvements after surgery (P < 0.05). The longitudinal analysis demonstrated durability of the symptom relief. CONCLUSION/CONCLUSIONS:Minimally invasive lumbar spine decompression is a safe and efficacious treatment for elderly patients with spinal stenosis and spondylosis. Elderly patients should be considered good candidates for lumbar surgical decompression using minimally invasive techniques.
Minimally invasive resection of intradural-extramedullary spinal neoplasms
OBJECTIVE:Spinal intradural-extramedullary neoplasms are uncommon lesions that usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes open laminectomy with intradural resection. We describe an alternative minimally invasive surgical technique in a consecutive series of patients undergoing treatment for symptomatic lesions. METHODS:Six patients (four men, two women) presented with symptoms including pain (five out of six) and/or neurological deficit (two out of six) with radiographic evidence of intradural pathology. All patients underwent surgical resection using a minimally invasive, unilateral approach. Pain relief was analyzed using the visual analog scale and magnetic resonance imaging to evaluate the extent of resection. Traditional laminectomy for tumor resection disrupts the muscular, ligamentous, and bony structures of the spine, which may contribute to pain and instability. Minimally invasive resection of intradural tumors offers the option of reducing approach morbidity when resecting these lesions. Using a tubular retractor system (X-Tube, Medtronic Sofamor-Danek, Memphis, TN) and microscopic surgical techniques, we were able to resect different intradural lesions successfully. RESULTS:All patients underwent successful, complete resection of their intradural-extramedullary tumors. The average patient age was 47 years (range, 41-60 yr) with one cervical, one thoracic, and four lumbar lesions. The mean operative time was 247 minutes (range, 180-320 min), the estimated blood loss was 56 mLs (range, 40-75 mLs), and the hospital stay was 57 hours (range, 48-80 h). Histologically, five tumors were determined to be schwannomas and one was identified as a myxopapillary ependymoma. There were no complications associated with this surgical technique. Postoperative magnetic resonance imaging demonstrated complete resection in all cases. CONCLUSION/CONCLUSIONS:Intradural-extramedullary neoplasms can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization and disruption to local tissues suggest that, in the hands of an experienced surgeon, this technique may present an alternative to traditional open tumor resection.
Thoracic microendoscopic discectomy: a human cadaver study
STUDY DESIGN/METHODS:Feasibility analysis of percutaneous posterolateral thoracic microendoscopic discectomy in a human cadaver model. OBJECTIVE:To describe a new, minimally invasive, posterolateral approach to the thoracic spine for the treatment of disc herniations. SUMMARY OF BACKGROUND/BACKGROUND:Thoracoscopic discectomy offers surgeons direct ventral access to thoracic disc herniations but requires entry into the chest. Many surgeons favor a posterolateral approach to the thoracic spine, thereby avoiding morbidity associated with entry into the thoracic cavity. By adapting minimal access surgical techniques to the thoracic spine, effective treatment of thoracic disc herniations should be possible and may help expedite recovery. METHODS:Two cadaveric human torsos were used. Using simple adaptations of our standard lumbar microendoscopic discectomy technique, endoscopic discectomies were performed throughout the mid and lower thoracic spine. Operative time was recorded. The extent of the discectomy as well as the extent of bony removal was evaluated using computed tomography myelography. RESULTS:Nine discectomies were performed in two cadaveric specimens, from T5-T6-T9-T10. Operative times ranged from 46 to 77 minutes (mean 60 minutes). The procedure required removing 3.4 mm (+/-1.9 mm) of the ipsilateral facet, which amounted to 35.4% (+/-17.5%) of the facet complex. Canal decompression averaged 73.5% (+/-7.9%). CONCLUSIONS:Thoracic microendoscopic discectomy allows for a posterolateral approach to thoracic disc herniation without entry into the chest cavity that consistently gives access to the majority of the canal while requiring only a minimal amount of bone removal. This technique provides an approach angle similar to that obtained with other posterolateral discectomy techniques while limiting the morbidity associated with exposure.