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Özgül B, Starbuck C, Polat MG, Abdeen R, Nester C. Inter and intra-examiner reliability of musculoskeletal ultrasound scanning of Anterior Talofibular Ligament and ankle muscles. J Ultrasound 2023; 26:137-146. [PMID: 36048331 PMCID: PMC10063751 DOI: 10.1007/s40477-022-00699-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/13/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE Although the function of subjects with chronic ankle instability (CAI) has been examined, structural analysis by ultrasound scanning of the structures surrounding the ankle is limited. Before such structural comparisons between injured and uninjured people can be made it is important to investigate a reliable measurement protocol of structures possibly related to CAI. The aim of this study was to investigate the inter-intra examiner reliability of ultrasonic characteristics of selected structures in healthy subjects. METHODS Eleven healthy participants were assessed by an experienced sonographer and inexperienced certificated examiner. Ultrasound images were collected of the ATFL length and ankle muscles of gastrocnemius medialis (GM), tibialis anterior (TA) and peroneals. Thickness was measured for the muscles, whilst cross-sectional area (CSA) was measured for the peroneals. Inexperienced examiner repeated the measurements a week later. RESULTS Inter-examiner reliability was excellent for all structures (ICC3,1 = 0.91-0.98). Intra-examiner reliability shows excellent agreement for all structures (ICC3,1 = 0.92-0.98) except GM (good agreement) (ICC3,1 = 0.82). LoA, relative to structure size, ranged from 1.38 to 6.88% for inter-reliability and from 0.07 to 5.79% for intra-reliability. CONCLUSION This study shows a high level of inter-intra examiner reliability in measuring the structures possibly related to CAI. Future research has been planned to investigate the structural analysis in CAI by using applied MSUS protocol.
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Affiliation(s)
- Bahar Özgül
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey.
| | - Chelsea Starbuck
- Applied Sports, Technology, Exercise, and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Mine Gülden Polat
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Rawan Abdeen
- Faculty of Applied Medical Sciences, Diagnostic Radiology Technology Department, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Christopher Nester
- School of Health Sciences and Society, University of Salford, Manchester, UK
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Fredericksen K, Kiel J. Bedside ultrasound-guided aspiration and corticosteroid injection of a baker's cyst in a patient with osteoarthritis and recurrent knee pain. J Am Coll Emerg Physicians Open 2021; 2:e12424. [PMID: 33969342 PMCID: PMC8082707 DOI: 10.1002/emp2.12424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Baker's cyst accompanying knee osteoarthritis represents a common cause of knee pain presenting to the emergency department. In this case report, a 56-year-old male presented with atraumatic left knee pain and swelling. Radiographically, he had tricompartmental osteoarthritis and was found to have a baker's cyst on duplex ultrasound. Using point-of-care ultrasound, the cyst was aspirated and corticosteroids were injected. The patient tolerated the procedure well and was discharged with a compression wrap and orthopedic follow-up. Baker's cyst aspiration with corticosteroid injection represents a safe alternative treatment option for patients. In some cases, this treatment may be definitive. Orthopedists currently use this procedure to reduce pain and improve function for patients with chronic knee ailments related to baker's cysts. As demonstrated in this case report, implementing this bedside procedure in the emergency department with orthopedic follow-up expands non-surgical, non-narcotic treatment options for patients with chronic knee pain secondary to Baker's cysts with osteoarthritis.
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Affiliation(s)
- Kim Fredericksen
- Department of Emergency MedicineUniversity of Florida‐Jacksonville College of MedicineJacksonvilleFloridaUSA
| | - John Kiel
- Department of Emergency MedicineUniversity of Florida‐Jacksonville College of MedicineJacksonvilleFloridaUSA
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Abdelomnem SM, Egila SE, Fawzy RM, Mohamed MA, Abdelkader NA. Assessment of tendon involvement in chronic hemodialysis patients: an ultrasonographic study. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/err.err_60_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ghosh N, Kruse D, Subeh M, Lahham S, Fox JC. Comparing Point-of-care-ultrasound (POCUS) to MRI for the Diagnosis of Medial Compartment Knee Injuries. J Med Ultrasound 2017; 25:167-172. [PMID: 30065483 PMCID: PMC6029305 DOI: 10.1016/j.jmu.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/20/2017] [Indexed: 11/05/2022] Open
Abstract
Background: Ultrasound has become an increasingly utilized tool for the imaging of the musculoskeletal system, especially for imaging the components of the knee. Even though MRI is touted as being the golden standard for identifying knee pathologies, the use of ultrasound has gained popularity in this field given its ability for rapid diagnosis. This study aims to investigate the efficacy of point-of-care ultrasound (POCUS) to diagnose injuries to the medial knee compartment when compared to magnetic resonance imaging (MRI). Methods: This was a prospective, observational study conducted at an orthopedic outpatient clinic. Prospective patients with medial knee pain scheduled for an MRI of the knee were evaluated by POCUS prior to the MRI. Sonographic findings were then compared to MRI results to assess correlation. Results: Nine patients were enrolled in the study. Median age was 53 years and eight were male (89%). POCUS demonstrated 100% sensitivity and 50% specificity for medial meniscus tear and 67% sensitivity and 83% specificity for medial collateral ligament (MCL) tear. Conclusion: Ultrasound may have a role as the initial rapid imaging modality in patients with suspected medial meniscus or MCL tears as it is highly sensitive, and it may serve as an effective screening tool for patients with both acute and chronic knee pain.
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Affiliation(s)
- N Ghosh
- Northwestern University, Dept of Internal Medicine, USA
| | - D Kruse
- University of California-Irvine, Dept of Primary Care Sports Medicine, USA
| | - M Subeh
- University of California-Irvine, Dept of Emergency Medicine, USA
| | - S Lahham
- University of California-Irvine, Dept of Emergency Medicine, USA
| | - J C Fox
- University of California-Irvine, Dept of Emergency Medicine, USA
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Kim GW, Kang C, Oh YB, Ko MH, Seo JH, Lee D. Ultrasonographic Imaging and Anti-inflammatory Therapy of Muscle and Tendon Injuries Using Polymer Nanoparticles. Theranostics 2017; 7:2463-2476. [PMID: 28744328 PMCID: PMC5525750 DOI: 10.7150/thno.18922] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/17/2017] [Indexed: 12/23/2022] Open
Abstract
Ultrasonography is a reliable diagnostic modality for muscle and tendon injuries, but it has been challenging to find right diagnosis of minor musculoskeletal injuries by conventional ultrasonographic imaging. A large amount of hydrogen peroxide (H2O2) are known to be generated during tissue damages such as mechanical injury and therefore H2O2 holds great potential as a diagnostic and therapeutic marker for mechanical injuries in the musculoskeletal system. We previously developed poly(vanillyl alcohol-co-oxalate) (PVAX), which rapidly scavenges H2O2 and exerts antioxidant and anti-inflammatory activity in H2O2-associated diseases. Based on the notion that PVAX nanoparticles generate CO2 bubbles through H2O2-triggered hydrolysis, we postulated that PVAX nanoparticles could serve as ultrasonographic contrast agents and therapeutic agents for musculoskeletal injuries associated with overproduction of H2O2. In the agarose gel phantom study, PVAX nanoparticles continuously generated CO2 bubbles to enhance ultrasonographic echogenicity significantly. Contusion injury significantly elevated the level of H2O2 in skeletal muscles and Achilles tendons. Upon intramuscular injection, PVAX nanoparticles significantly elevated the ultrasound contrast and suppressed inflammation and apoptosis in the contusion injury of musculoskeletal systems. We anticipate that PVAX nanoparticles hold great translational potential as theranostic agents for musculoskeletal injuries.
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Affiliation(s)
- Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Changsun Kang
- Department of BIN Convergence Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
| | - Young-Bin Oh
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Dongwon Lee
- Department of BIN Convergence Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
- Department of Polymer•Nano Science and Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
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Wang W, Xu GH. Allograft tendon reconstruction of the anterior talofibular ligament and calcaneofibular Ligament in the treatment of chronic ankle instability. BMC Musculoskelet Disord 2017; 18:150. [PMID: 28388886 PMCID: PMC5385052 DOI: 10.1186/s12891-017-1492-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 03/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background The purpose was retrospectively to investigate functional and clinical outcomes after anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) reconstruction using a single allograft. Methods Patients with severe chronic lateral instability of the ankle underwent surgery after conservative treatment failed. Ultrasounds of the ankle were performed, and if the AFTL and CFL were completely torn without enough soft tissue for repair, the ligaments were reconstructed using allograft tendon. Outcomes were assessed by clinical examination, stress radiography, ultrasound, the American Orthopaedic Foot and Ankle Society score (AOFAS), and Karlsson Ankle Functional score (KAFS) before surgery and at final follow-up. Results Nineteen patients, ten men and nine women with mean age of 27.9 years (range, 19–41 years), underwent reconstruction. Mean follow-up was 30 months (range, 24–40 months). At final follow-up, all patients had returned to activity without instability, pain, or limited range of motion. On stress radiography, mean talar tilt angle decreased from 17.32° ± 3.58° before surgery to 4.16° ± 1.12° at follow-up (p < 0.001). Mean anterior drawer test (ADT) distance decreased from 9.79 ± 1.01 mm before surgery to 3.97 ± 0.99 mm at follow-up (p < 0.05). Mean AOFAS improved from 64.00 ± 18.43 to 90.32 ± 5.17 points (p < 0.001), and mean KAFS improved from 50.84 ± 16.73 to 90.89 ± 5.08 points (p < 0.001). Ultrasound showed the reconstructed ligaments maintained good continuity and excellent tension. No case of infection and immunological rejection was reported. Conclusion This novel reconstruction technique takes into account the anatomical specialty of AFTL and CFL. This case series showed increased stability of the ankle in clinical and functional outcomes. Trial registration The trial registration number (TRN) and date of registration: ChiCTR-ORC-17010796, Mar 6th 2017. Retrospectively registered.
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Affiliation(s)
- Weikai Wang
- Department of Joint and Sports Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, No 60, Wuning Xi Road, Dongyang, Zhejiang, People's Republic of China
| | - Guo Hong Xu
- Department of Joint and Sports Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, No 60, Wuning Xi Road, Dongyang, Zhejiang, People's Republic of China.
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Fernández-Lao C, Galiano-Castillo N, Cantarero-Villanueva I, Martín-Martín L, Prados-Olleta N, Arroyo-Morales M. Analysis of Pressure Pain Hypersensitivity, Ultrasound Image, and Quality of Life in Patients with Chronic Plantar Pain: A Preliminary Study. PAIN MEDICINE 2016; 17:1530-41. [PMID: 26814301 DOI: 10.1093/pm/pnv022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/07/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate widespread pressure pain in patients with chronic plantar heel pain compared with that in healthy controls and to investigate the differences in ultrasound imaging and quality of life between these two groups. METHODS A total of 22 patients (11 female) with chronic plantar heel pain and the same number of healthy patients, matched according to age and gender, were included in this pilot study. Pressure pain thresholds (PPTs) were bilaterally assessed over the calcaneus bone, the plantar fascia, the first and fifth metatarsals, the soleus muscle, the second metacarpal, and the zygapophyseal joint of C5-C6. Plantar fascia thickness was measured via ultrasound imaging. In addition, quality of life and physical function were assessed using the Short-Form 36 (SF-36) questionnaire and the Foot and Ankle Ability Measure (FAAM) questionnaire, respectively. RESULTS Analysis of covariance (ANCOVA) results showed significant differences in the PPTs at all points between the groups (P < 0.001), but not between sides. The PPTs were significantly lower in the patients than in the controls at all sites (P < 0.05). The results showed significant increases in fascia thickness at the calcaneus insertion (group: F = 74.172, P ≤ 0.001; side: F = 8.920, P ≤ 0.001) and the middle fascia point (group: F = 133.685, P = <0.001; side: F = 11.414, P = <0.001) on ultrasound in the patient group compared with the matched control group. The analysis also revealed that the patient group had a significantly lower score on every subscale of the SF-36 and FAAM questionnaires (all P < 0.001), except for the mental component, compared with the matched control group. DISCUSSION Patients suffering from chronic plantar heel pain showed widespread and bilateral hypersensitivity, increased thickness of the plantar fascia in the affected foot, and deterioration in quality of life and physical functioning compared with matched controls.
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Affiliation(s)
- Carolina Fernández-Lao
- *Physical Therapy Department, Instituto Biosanitario Granada (IBS.Granada) and Instituto Mixto Universitario Deporte y Salud (IMUDS), University of Granada, Spain
| | | | - Irene Cantarero-Villanueva
- *Physical Therapy Department, Instituto Biosanitario Granada (IBS.Granada) and Instituto Mixto Universitario Deporte y Salud (IMUDS), University of Granada, Spain
| | | | - Nicolás Prados-Olleta
- Surgery Department, University of Granada, University Hospital Virgen de Las Nieves, Orthopaedic Surgery and Traumatology Service, Granada, Spain
| | - Manuel Arroyo-Morales
- *Physical Therapy Department, Instituto Biosanitario Granada (IBS.Granada) and Instituto Mixto Universitario Deporte y Salud (IMUDS), University of Granada, Spain;
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Hussein DA, El-Azizi NO, Abdel Meged AH, Al-Hoseiny SA, Hamada AM, Sabry MH. Ultrasonographic tendon alteration in relation to parathyroid dysfunction in chronic hemodialysis patients. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2015; 8:9-14. [PMID: 25674023 PMCID: PMC4315125 DOI: 10.4137/cmamd.s20887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To find the nature of tendon involvement in chronic kidney disease (CKD) patients on regular hemodialysis (RD), and its relationship to parathyroid hormone (PTH) level using ultrasonography (US). METHOD A total of 50 CKD patients on RD subjected to musculoskeletal examination of knee and ankle, laboratory evaluation, and US of quadriceps tendon and Achilles tendon were involved. RESULTS Ankle joint tenderness was the most frequent sign on examination. US of the Achilles tendons showed tenderness during probing in 44% patients, calcific deposition in 24% patients, abnormal peritendon tissue in 20% patients, and abnormal anteroposterior (A-P) middle and distal one-third thicknesses of the Achilles tendon in 20% and 18% patients, respectively. PTH positively correlated with the duration of dialysis, serum phosphorus level, presence of calcific deposit, and increased thickness of the Achilles tendon. CONCLUSION The most common ultrasonographic finding in CKD patients on RD was Achilles tendon tenderness during probing. PTH level positively correlated with the duration of dialysis, presence of calcific deposit, and increased thickness of Achilles tendon.
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Affiliation(s)
- Dahlia A Hussein
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Noran O El-Azizi
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Ali H Abdel Meged
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Sameh A Al-Hoseiny
- Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Abdelhady M Hamada
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Moshira H Sabry
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
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Liu K, Gustavsen G, Royer T, Wikstrom EA, Glutting J, Kaminski TW. Increased ligament thickness in previously sprained ankles as measured by musculoskeletal ultrasound. J Athl Train 2015; 50:193-8. [PMID: 25384002 PMCID: PMC4495430 DOI: 10.4085/1062-6050-49.3.77] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Lateral ankle sprains are among the most common injuries in sport, with the anterior talofibular ligament (ATFL) most susceptible to damage. Although we understand that after a sprain, scar tissue forms within the ligament, little is known about the morphologic changes in a ligament after injury. OBJECTIVE To examine whether morphologic differences exist in the thickness of the ATFL in healthy, coper, and unstable-ankle groups. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 80 National Collegiate Athletic Association Division I collegiate athletes (43 women, 37 men, age = 18.2 ± 1.1 years, height = 175.8 ± 11.1 cm, body mass = 75.0 ± 16.9 kg) participated in this study. They were categorized into the healthy, coper, or unstable group by history of ankle sprains and score on the Cumberland Ankle Instability Tool. MAIN OUTCOME MEASURE(S) A musculoskeletal sonographic image of the ATFL was obtained from each ankle. Thickness of the ATFL was measured at the midpoint of the ligament between the attachments on the lateral malleolus and talus. RESULTS A group-by-limb interaction was evident (P = .038). The ATFLs of the injured limb for the coper group (2.20 ± 0.47 mm) and the injured limb for the unstable group (2.28 ± 0.53 mm) were thicker than the ATFL of the "injured" limb of the healthy group (1.95 ± 0.29 mm) at P = .015 and P = .015, respectively. No differences were seen in the uninjured limbs among groups. CONCLUSIONS Because ATFL thicknesses of the healthy group's uninjured ankles were similar, we contend that lasting morphologic changes occurred in those with a previous injury to the ankle. Similar differences were seen between the injured limbs of the coper and unstable groups, so there must be another explanation for the sensations of instability and the reinjuries in the unstable group.
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Affiliation(s)
- Kathy Liu
- School of Public Health, University of Evansville, IN
| | - Geoff Gustavsen
- Department of Kinesiology and Applied Physiology and Biomechanics and Movement Sciences Program, University of Delaware, Newark
| | - Todd Royer
- Department of Kinesiology and Applied Physiology and Biomechanics and Movement Sciences Program, University of Delaware, Newark
| | - Erik A. Wikstrom
- Department of Kinesiology, University of North Carolina at Charlotte
| | | | - Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology and Biomechanics and Movement Sciences Program, University of Delaware, Newark
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Ultrasound-Guided Aspiration and Corticosteroid Injection of Baker's Cysts in Knee Osteoarthritis. Am J Phys Med Rehabil 2010; 89:970-5. [DOI: 10.1097/phm.0b013e3181fc7da2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A musculoskeletal ultrasound course for physical medicine and rehabilitation residents. Am J Phys Med Rehabil 2010; 89:56-69. [PMID: 19884807 DOI: 10.1097/phm.0b013e3181c1ee69] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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