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Cushman DM, Petrin Z, Eby S, Clements ND, Haight P, Snitily B, Teramoto M. Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners. PHYSICIAN SPORTSMED 2021; 49:410-419. [PMID: 33153352 PMCID: PMC8648045 DOI: 10.1080/00913847.2020.1847004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001).Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.
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Affiliation(s)
- Daniel M Cushman
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Ziva Petrin
- Rutgers New Jersey Medical School, Department of Physical Medicine & Rehabilitation
| | - Sarah Eby
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Nathan D. Clements
- University of Texas, San Antonio, Department of Physical Medicine & Rehabilitation
| | | | | | - Masaru Teramoto
- University of Utah Division of Physical Medicine & Rehabilitation
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Schuster NM, Clements ND, Suri P, Stojanovic MP. Is This Spine Pain Facetogenic? Addressing Diagnostic Myths. Pain Med 2021; 22:S31-S35. [PMID: 34308958 DOI: 10.1093/pm/pnab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nathaniel M Schuster
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego, Health System, La Jolla, California, USA
| | - Nathan D Clements
- Department of Rehabilitation Medicine, University of Texas San Antonio Long, School of Medicine, San Antonio, Texas, USA
| | - Pradeep Suri
- VA Puget Sound, Rehabilitation Care Services, Seattle, Washington, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Washington, USA
| | - Milan P Stojanovic
- Department of Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Cushman DM, Teramoto M, Asay A, Clements ND, McCormick ZL. Corticosteroid and Local Anesthetic Use Trends for Large Joint and Bursa Injections: Results of a Survey of Sports Medicine Physicians. PM R 2020; 13:962-968. [PMID: 32969178 DOI: 10.1002/pmrj.12499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Physician decision-making surrounding choices for large joint and bursa injections is poorly defined, yet influences patient safety and treatment effectiveness. OBJECTIVE To identify practice patterns and rationale related to injectate choices for large joint and bursal injections performed by physician members of the American Medical Society for Sports Medicine (AMSSM). DESIGN An electronic survey was sent to 3400 members of the AMSSM. Demographic variables were collected: primary specialty (residency), training location, practice location, years of clinical experience, current practice type, and rationale for choosing an injectate. PARTICIPANTS A total of 674 physicians responded (minimum response rate of 20%). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Outcomes of interest included corticosteroid type and dose, local anesthetic type, and total injectate volume for each large joint or bursa (hip, knee, and shoulder). RESULTS Most respondents used triamcinolone (50% to 56% of physicians, depending on injection location) or methylprednisolone (25% to 29% of physicians), 21 to 40 mg (53% to 60% of physicians), diluted with lidocaine (79% to 87%) for all large joint or bursa injections. It was noted that 36.2% (244/674) of respondents reported using >40 mg for at least one injection type. Most (90.5%, 610/674) reported using an anesthetic other than ropivacaine for at least one type of joint or bursa injection. Physicians who reported lidocaine use were less likely to report that their injectate choice was based on the literature that they reviewed (odds ratio [OR] 0.41 [0.27-0.62], P < .001). Respondents predominantly used 5 to 7 mL of total injectate for all large joints or bursae (45% to 54% of respondents), except for the pes anserine bursa, where 3-4 mL was more common (51% of physicians). CONCLUSIONS It appears that triamcinolone and methylprednisolone are the most commonly used corticosteroids for sports medicine physicians; most physicians use 21 to 40 mg of corticosteroid for all injections, and lidocaine is the most-often used local anesthetic; very few use ropivacaine. Over one-third of respondents used high-dose (>40 mg triamcinolone or methylprednisolone) for at least one joint or bursa.
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Affiliation(s)
- Daniel M Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
| | - Alexandra Asay
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
| | - Nathan D Clements
- Department of Physical Medicine & Rehabilitation, University of Texas Health Science Center, San Antonio, TX
| | - Zachary L McCormick
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
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Dicks MA, Clements ND, Gibbons CR, Verduzco-Gutierrez M, Trbovich M. Atypical presentation of Covid-19 in persons with spinal cord injury. Spinal Cord Ser Cases 2020; 6:38. [PMID: 32404880 PMCID: PMC7220614 DOI: 10.1038/s41394-020-0289-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Madeline A Dicks
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Nathan D Clements
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - C R Gibbons
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Cushman DM, Christiansen J, Kirk M, Clements ND, Cunningham S, Teramoto M, McCormick ZL. Image guidance used for large joint and bursa injections; a survey study. PHYSICIAN SPORTSMED 2020; 48:208-214. [PMID: 31560251 DOI: 10.1080/00913847.2019.1674122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To determine the current rates of use of available image guidance modalities for large joint and bursal injections, in addition to their relationships to physician demographics.Methods: An electronic survey was sent to 3,400 members of the American Medical Society for Sports Medicine (AMSSM), examining types of guidance used for each large joint and bursal injection.Results: A total of 674 sports medicine physicians responded to the survey. Intra-articular hip and glenohumeral joint injections were more commonly performed with ultrasound guidance, while palpation-guidance was more common with all other injections. Physicians who specialized in Physical Medicine & Rehabilitation (PM&R) were more likely to use ultrasound for trochanteric bursa (p = 0.007, OR = 4.16 [1.46-11.8]), while internal medicine-, pediatrics-, and family medicine-trained physicians were more likely to use palpation guidance for at least one joint (p < 0.05). Physicians with fewer years of experience were more likely to use ultrasound for glenohumeral joint injections (p ≤ 0.002 for all age groups with less than 20 years of experience, ORs ranging from 6.3 to 9.2).Conclusion: Palpation-guidance is the most common technique used for large joint and bursal injections, other than for glenohumeral and hip joint injections. PM&R-trained physicians and those with less experience tend to use ultrasound more frequently.
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Affiliation(s)
- Daniel M Cushman
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Jacob Christiansen
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Melissa Kirk
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Nathan D Clements
- Department of Physical Medicine & Rehabilitation, University of Texas Health Science Center, San Antonio, TX, USA
| | - Shellie Cunningham
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Masaru Teramoto
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
| | - Zachary L McCormick
- University of Utah Division of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA
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Clements ND, McCormick ZL, Vydra D, Nagpal A, Akuthota V, Kennedy DJ, Cushman DM. Serious Complications Associated with Interventional Spine Procedures-Results of a Spine Intervention Society Survey. Pain Med 2020; 21:651-653. [PMID: 31188448 DOI: 10.1093/pm/pnz135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nathan D Clements
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah Medical Center, Salt Lake City, Utah
| | - Darrell Vydra
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ameet Nagpal
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Venu Akuthota
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado
| | - David J Kennedy
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel M Cushman
- Division of Physical Medicine and Rehabilitation, University of Utah Medical Center, Salt Lake City, Utah
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Cushman DM, Mattie R, Clements ND, McCormick ZL. The Effect of Body Mass Index on Fluoroscopic Time and Radiation Dose During Intra‐articular Hip Injections. PM R 2016; 8:876-82. [DOI: 10.1016/j.pmrj.2016.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/04/2016] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Affiliation(s)
| | - Ryan Mattie
- Department of Orthopaedic Surgery, PM&R, Stanford University, Redwood City, CA; Stanford University Health Care, Stanford Outpatient Medical Center, 450 Broadway St, Pavilion C, MC 6342, Redwood City, CA 94063
| | | | - Zachary L. McCormick
- Department of PM&R/Department of Anesthesiology, Northwestern University, Chicago, IL
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Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am 1980; 62:1232-51. [PMID: 7440603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A new concept, continuous passive motion of a synovial joint in vivo, was investigated to determine its biological effect on the healing of full-thickness articular cartilage defects that penetrate the subchondral bone of knee joints of adolescent and adult rabbits. The effect of continuous passive motion was compared with the effects of immobilization and of intermittent active motion. This investigation included assessment of 480 defects in the knees of 120 adolescent rabbits and assessment of 108 defects in the knees of twenty-seven adult rabbits. The continuous passive motion was well tolerated by these animals, whose general well-being was undisturbed. The healing of the defects at weekly intervals up to four weeks was assessed by gross examination and by an analysis of two indices of healing determined by light microscopy: (1) the nature of the reparative tissue, and (2) the degree of metachromasia of the matrix as demonstrated by toluidine-blue staining. At three weeks this assessment revealed that in the adolescent rabbits, healing of the defects by hyaline articular cartilage was present in 8 per cent of forty defects in ten animals whose knees were immobilized, in 9 per cent of forty defects in ten animals whose knees were permitted intermittent active motion, and in 52 per cent of forty defects in ten animals whose knees were managed immediately after operation by continuous passive motion. At three weeks, in the adult animals, healing of the defects by hyaline articular cartilage was present in 3 per cent of thirty-six defects in nine animals whose knees were immobilized, in 5 per cent of thirty-six defects in nine animals whose knees were permitted intermittent active motion, and in 44 per cent of thirty-six defects in nine animals whose knees were managed immediately after operation by continuous passive motion. Thus, the metaplasia of the healing tissue within the defects from undifferentiated mesenchymal tissue to hyaline articular cartilage was not only much more rapid but also much more complete with continuous passive motion than with either immobilization or intermittent active motion.
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Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am 1980. [DOI: 10.2106/00004623-198062080-00002] [Citation(s) in RCA: 689] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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