Joel S Sellers, DO, FAOASM CAQSM, RMSK

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1 Joel S Sellers, DO, FAOASM CAQSM, RMSK This is a sports slide of an Olympic wrestler Chris Taylor 1

2 This is a Sports Illustrated slide of jockey Johnny Sellers This is a slide of Coach Jim Sellers 2

3 This is a slide of Coach Jim Sellers Trends in Sports Medicine are changing the role of identifying, diagnosing and developing new treatment strategies for sports and orthopedic injuries. -History and physical -Xray, MSK US, MRI -Surgery, non-surgery -Physical therapy, exercise modification -Age, disease, activity affect outcomes -Acute vs chronic nature of the injury 3

4 CHALLENGES 1.Competitive athlete 2.Recreational athlete 3.Aging population 4.Obesity 5.Concurrent diseases Why MSK Ultrasound? PHYSICS Gray scale Tissue Characteristics -Tendon, bone, ligament, muscle, joint, cyst Hyperechoic Hypoechoic Anechoic Doppler 4

5 Why MSK Ultrasound? Accuracy Precision Efficacy Cost Effective Accuracy US% PALP% FLUORO Shoulder AC GH Joint SA/SD Biceps Knee Pes Hip JT Piriformis

6 ACUTE VS CHRONIC INFLAMMATION Acute inflammation: Cell types Tissue reaction Healing modifiers Chronic inflammation: Cell types Tissue reaction Healing modifiers Diseased and dead tissue factors may be the main pain generators We are moving away from the itis term and instead using the the opathy term. ie Tendinopathy COMMON OVERUSE INJURIES 1. Rotator cuff Tendinopathy 2. Subacromial bursitis 3. Calcific Tendinopathy 4. Paralabral Cysts 5. Spinoglenoid Cysts 6. Glenohumeral degenerative and inflammatory arthritis 7. Adhesive capsulitis 6

7 COMMON OVERUSE INJURIES 8. Medial/Lateral Epicondylitis 9. Plantar Fasciitis 10. Wrist Tendinopathy 11. Patellofemoral Syndrome 12. Knee Osteoarthritis/Degenerative Meniscus 13. Hip Tendinopathy/Osteoarthritis ROTATOR CUFF TENDINOPATHY Shoulder MSK US Shoulder Tendinopathy 7

8 SUBACROMIAL BURSITIS Bursitis INJECTION SUBACRIOMAL BURSA Picture Video 8

9 CALCIFIC TENDINOPATHY Calcific tendinopathy INJECTION/TENOTOMY 9

10 PARALABRAL CYST Cyst INJECTION/ASPIRATION OF PARALABRIAL CYST 10

11 SPINOGLENOID CYST Cyst ASPIRATION OF SPINOGLENOID CYST 11

12 GLENOHUMERAL ARTHRITIS Arthritis INTRA-ARTICULAR SHOULDER INJECTION 12

13 ADHESIVE CAPSULITIS Capsulitis INTRA-ARTICULAR SHOULDER INJECTION 13

14 LATERAL EPICONDYLITIS Abnormal COMMON EXTENSOR TENDON INJECTION 14

15 MEDIAL EPICONDYLITIS Calcific Tendonopathy COMMON FLEXOR TENDON INJECTION 15

16 PLANTAR FASCIITIS Abnormal PLANTAR FASCIAL INJECTION 16

17 WRIST TENDINOPATHY DeQuervain s tenosynovitis DeQUERVAIN S 1 st DORSAL COMPARTMENT 17

18 PATELLO FEMORAL SYNDROME Abnormal knee PES BURSITIS Abnormal 18

19 PES BURSAL INJECTION KNEE OSTEOARTHRITIS Abnormal 19

20 KNEE INTRA-ARTICULAR INJECTION HIP GLUTEAL TENDINOPATHY Abnormal 20

21 LATERAL GLUTEAL INJECTION HIP OSTEOARTHRITIS Abnormal 21

22 HIP INTRA-ARTICULAR INJECTION ILIOPSOAS TENDINOPATHY/BURSITIS Abnormal 22

23 ILIOPSOAS BURSAL INJECTION ATHLETIC PUBALGIA Abnormal 23

24 INJECTIONS 1. Steroids 2. Visco-supplements 3. Platelet Rich Plasma 4. Stem Cell 5. Tenex PRESENT/FUTURE MEDICARE 2017 GUIDELINES 1. Diagnostic Ultrasound must be site certified by the AIUM 2. Future requirement for MSK US prior to MRI COST EFFECTIVENESS 1. MSK US is cheaper than MRI 2. MSK US procedures may avoid or delay more expensive surgical procedures REGENERATIVE MEDICINE 1. Less recovery-faster 2. May postpone or avoid major surgery 24

25 As physicians, we should be attempting to help people become more functionally active and improve their quality of life. 25

ORTHOPAEDIC INJECTION AND ASPIRATION TECHNIQUES

ORTHOPAEDIC INJECTION AND ASPIRATION TECHNIQUES OAAPN October 20, 2016 David H. Sohn, JD MD Chief, Shoulder and Sports Medicine University of Toledo Medical Center When to aspirate? To rule out infection