Isolated Nerve Palsy of the Flexor Pollicis Longus After a Radial Shaft Fracture: A Case Report.

We present the case of a patient who developed an isolated palsy of the flexor pollicis longus (FPL) branch of the anterior interosseous nerve (AIN) following a fracture of the right radial shaft. The diagnosis of AIN palsy in this setting is rare, especially involving partial neuropathies of only the FPL branch. Clinical presentation in this scenario can be mistaken for other musculoskeletal pathology, and electrodiagnostic studies can be helpful in confirming the diagnosis.

Persistent knee pain after uncomplicated total knee arthroplasty secondary to undiagnosed spondylotic myelopathy: a case report.

Introduction: Knee osteoarthritis and cervical spondylotic myelopathy are both frequent disorders in the aging patient. Total knee arthroplasty is an increasingly common surgical procedure, with approximately 20% of patients describing persistent knee pain after the procedure, for which it is often difficult to find a cause. We review known reasons for pain after total knee arthroplasty and present a new clinically challenging case of persistent knee pain due to previously undiagnosed cervical spondylotic myelopathy.

The PROMIS Upper Extremity Computer Adaptive Test Correlates With Previously Validated Metrics in Patients With Carpal Tunnel Syndrome.

The Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) computer adaptive test was developed to improve precision and reduce question burden. We hypothesized that in patients with carpal tunnel syndrome (CTS): (1) PROMIS UE would correlate with established patient-reported outcome measures (PROs); (2) the time and number of questions required would be lower than current metrics; (3) there would be no floor or ceiling effects; and (4) PROMIS UE would not correlate with disease severity. Patients undergoing electrodiagnostic evaluation found to have a primary diagnosis of unilateral CTS prospectively completed PROMIS UE, Quick Disabilities of the Arm, Shoulder and Hand (qDASH), and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ).

Predicting outcomes of total joint arthroplasty using the distress and risk assessment method.

Background: Psychological distress is presumed to be an important factor that can adversely impact the outcome of orthopaedic procedures. The Distress and Risk Assessment Method (DRAM) is an evaluation tool which assesses psychological distress in patients with low back pain. The purpose of this prospective study was to assess the influence of preoperative psychological distress, as determined by the DRAM score, on the functional outcomes of total joint arthroplasty (TJA).

Neer Award 2018: the effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial.

Background: Opioids are commonly administered for the treatment of acute and chronic pain symptoms. The current health care system is struggling to deal with increasing medication abuse and rising mortality rates from overdose. Preoperative patient-targeted education on opioid use is an avenue yet to be explored.

Patient-Reported Disability Measures Do Not Correlate with Electrodiagnostic Severity in Carpal Tunnel Syndrome.

Background: Electrophysiologic studies including electromyography and nerve conduction studies play a role in the evaluation of carpal tunnel syndrome (CTS), despite evidence that these studies do not correlate with CTS-specific symptom scores. There is a lack of evidence comparing electrophysiologic data with general measures of function.

Methods: Fifty patients presenting for CTS treatment over an 8-month period were analyzed retrospectively.

Comparative Effectiveness of Treatments for Chronic Low Back Pain: A Multiple Treatment Comparison Analysis.

Study Design: A systematic review and network meta-analysis.

Objective: To determine current treatment options of chronic low back pain (LBP) as defined by randomized controlled trials (RCTs) and to compare effectiveness of those treatments using a mixed-treatment comparison (MTC).

Summary Of Background Data: It is important to provide an evidence-based assessment of the treatment options that exist for LBP.

Complex regional pain syndrome: diagnosis and treatment.

This article discusses the diagnostic criteria, clinical course, and complications of complex regional pain syndrome. Multidisciplinary treatment including physical and occupational therapy, psychological evaluation and treatment, pharmacologic management, and more aggressive options including sympathetic blocks, sympathectomy, and spinal cord stimulation are also reviewed.

Fingolimod therapy and macular hemorrhage.

A 54-year-old woman with relapsing-remitting multiple sclerosis (MS) developed visual loss in her left eye due to a macular hemorrhage 11 months after starting fingolimod. Visual acuity was 20/80 in the left eye, with a dense retinal hemorrhage involving the fovea with adjacent hard exudate and macular thickening confirmed by spectral domain optical coherence tomography. Three months after stopping fingolimod, vision in the left eye improved to 20/30 with resolution of the macular hemorrhage and exudates.

Does opioid pain medication use affect the outcome of patients with lumbar disc herniation?

Study Design: Subgroup analysis of prospective, randomized cohort.

Objective: To review the results of patients who received opioid pain medications during treatment compared with that of patients who did not receive opioid medications.

Summary Of Background Data: The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of surgical treatment versus nonoperative treatment for lumbar intervertebral disc herniation.

Update on the role of z-joint injection and radiofrequency neurotomy for cervicogenic headache.

Cervicogenic headache is a common secondary headache that typically is referred from the upper cervical spine, that is, segments C3-C4 and rostral. Diagnostic injections to one or more of these segmental joints (including the atlanto-occipital joint, atlanto-axial joint, and C2-C3 and C3-C4 zygapophysial joints [z-joints]) frequently are used to establish the pain generator in the cervical spine that is responsible for the radiation of pain into the head. Therapeutic interventions used to alleviate pain include corticosteroid injections into the z-joint (ie, C2-C3 and C3-C4) or bony articulations (ie, C0-C1 and C2-C2), and percutaneous radiofrequency (RF) neurotomy at the C2-C3 and C3-C4 z-joints.

Electrodiagnostic evaluation of compressive nerve injuries of the upper extremities.

Electrodiagnostic testing includes electromyography and nerve conduction studies that are physiologic tests used in the diagnosis of peripheral nerve injuries. It is a supplement rather than a replacement for a physical examination. This article reviews the terminology as well as the findings seen and used in electrodiagnostic studies.

The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial.

Study Design: A secondary analysis comparing diabetic patients with nondiabetic patients enrolled in the Spine Patient Outcomes Research Trial (SPORT).

Objective: To compare surgical outcomes and complications between diabetic and nondiabetic spine patients.

Summary Of Background Data: Patients with diabetes are predisposed to comorbidities that may confound the diagnosis and treatment of patients with spinal disorders.

Dose response to interferon therapy in multiple sclerosis: an evaluation of the evidence.

Background: Interferon beta (IFNbeta) is a disease-modifying therapy for multiple sclerosis (MS). Although clinical benefits have been demonstrated in several large, randomized, double-blind studies, the optimal dosing of IFNbeta is controversial.

Methods: A search was conducted using the key words IFNbeta, multiple sclerosis, Avonex, Rebif, Betaseron/Betaferon, efficacy, MRI, and dose-response relationship in MEDLINE, EMBASE, and other databases to locate relevant pivotal clinical trials, other prospective studies, and systematic reviews evaluating the efficacy and tolerability of IFNbeta published between 1985 and 2007.

A prospective baseline versus on-treatment study assessing patient perceptions of using a smaller needle when injecting intramuscular interferon beta-1 a (Avonex).

This study assessed patient perceptions of using a smaller needle (1-inch, 25-gauge) to administer weekly intramuscular (IM) interferon beta-1 a (IFNbeta-1 a [Avonex]) injections. Patients received 1 IM IFNbeta-1 a injection at baseline using the standard needle (1.25-inch, 23-gauge), followed by 4 weekly injections using the smaller needle.

Biological treatment for degenerative disc disease: implications for the field of physical medicine and rehabilitation.

Spine care is a fast-growing sector of the outpatient practice for physiatrists. Current nonsurgical treatment modalities and surgical options for severe symptomatic intervertebral disc degeneration have limited and inconsistent clinical results. Thus, the development of novel approaches, such as biological treatments that offer the potential to halt or even reverse disc degeneration and restore physiologic disc function, are very attractive.

Interventions in chronic pain management. 6. Interventional approaches to chronic pain management.

Unlabelled: This self-directed learning module highlights strategies for interventional treatments for chronic pain disorders. It is part of the chapter on chronic pain in the Self-Directed Physiatric Education Program for practitioners in physical medicine and rehabilitation. Specifically, the first module reviews an interventional protocol for recalcitrant buttock and hip pain.

Interventions in chronic pain management. 5. Approaches to medication and lifestyle in chronic pain syndromes.

Unlabelled: This self-directed learning module first reviews the importance of weight management and smoking cessation in the treatment of axial low back pain and then describes the use of medication in complex regional pain syndrome and trigeminal neuralgia. It is part of the chapter on chronic pain in the Self-Directed Physiatric Education Program for practitioners in physical medicine and rehabilitation. The first objective explores the correlation of tobacco usage and obesity with lower back pain.

Interventions in chronic pain management. 4. Monitoring progress and compliance in chronic pain management.

Unlabelled: This self-directed learning module highlights the monitoring of progress and compliance in chronic pain management. It is part of the chapter on chronic pain in the Self-Directed Physiatric Education Program for practitioners in physical medicine and rehabilitation. Specifically, the first module focuses on the use of pain rating scales to monitor progress, and the second and third learning objectives focus on evaluating abuse potential and interpreting drug screens.

Interventions in chronic pain management. 3. Evaluation and management of lumbar pain syndromes.

Unlabelled: This self-directed learning module highlights approaches to the investigation of selected lumbar spine conditions. It is part of the chapter on chronic pain management in the Self-Directed Physiatric Education Program for practitioners in physical medicine and rehabilitation. The first objective explores the diagnostic evaluation for groin and buttock pain in a 66-year-old man with pain during ambulation.

Interventions in chronic pain management. 2. Diagnosis of cervical and thoracic pain syndromes.

Unlabelled: This self-directed learning module highlights approaches to the investigation of common cervical and thoracic conditions. It is part of the chapter on chronic pain management in the Self-Directed Physiatric Education Program for practitioners in physical medicine and rehabilitation. The differential diagnosis of cervical and thoracic syndromes as well as cervicogenic headache is reviewed.

Interventions in chronic pain management. 1. Update on important definitions in pain management.

Unlabelled: This self-directed learning module highlights definitions used in pain management. It is part of the chapter on chronic pain management in the Self-Directed Physiatric Education Program for practitioners in physical medicine and rehabilitation. Terms that describe pain and narcotic use that are frequently used and misused are reviewed.

Retroperitoneal false aneurysm presenting as anterior thigh pain and weakness: a case report.

This case highlights the importance of considering retroperitoneal pathology in the differential diagnosis of anterior thigh pain and weakness. We describe a woman in her mid seventies with a history of a left total hip arthroplasty and lumbar decompression who presented with left anterior thigh pain and left lower-extremity weakness. A computed tomography scan of the retroperitoneum revealed a mass along the left iliopsoas muscle.

"Whippets"-induced cobalamin deficiency manifesting as cervical myelopathy.

Background: Nitrous oxide (N2O) is inhaled in anesthesia and as a recreational drug from whipped cream dispensers. Its abuse reaches approximately 10% in some age groups. By inactivating cobalamin (Cbl) (vitamin B12), N2O can cause neurologic and hematologic manifestations.