Benjamin Marshall

Long-Term Function, Pain and Medication Use Outcomes of Radiofrequency Ablation for Lumbar Facet Syndrome

Objective Radiofrequency ablation (RFA) of the medial branch nerves for facet-mediated low back pain demonstrates clinical benefit for 6–12 months and possibly up to 2 years. This study investigated function, pain, and medication use outcomes of RFA for lumbar facet syndrome in a cohort with long-term follow-up. Methods Individuals evaluated in a tertiary academic pain practice between January, 2007–December, 2013, 18–60 years of age, with a clinical and radiologic diagnosis of lumbar facet syndrome, who underwent ≥1set of diagnostic medial branch blocks with resultant >75% pain relief and subsequent RFA were included. Outcomes measured were the proportion of individuals who reported ≥50% improvement in function, ≥50% improvement in pain; change in median NRS pain score, daily morphine equivalent consumption (DME), Medication Quantification Scale III (MSQ III) score and procedure complications. Results Sixty-two consecutive individuals with a median age and 25%–75% interquartile range (IQR) of 34 years (35, 52) met inclusion criteria. Seven individuals were lost to follow-up. Duration of pain was <2 years in 42%, 2–5 years in 40%, >5 years in 18% of individuals. Median duration of follow-up was 39 months (16, 60). Function and pain improved by ≥50% in 58% (CI 45%, 71%) and 53% (CI 40%, 66%) of individuals, respectively. The median reduction in MQS III score was 3.4 points (0, 8.8). No complications occurred in this cohort. Conclusions This study demonstrates a durable treatment effect of RFA for lumbar facet syndrome at long-term follow-up, as measured by improvement in function, pain, and analgesic use.

Pain Reduction and Repeat Injections After Transforaminal Epidural Injection With Particulate Versus Nonparticulate Steroid for the Treatment of Chronic Painful Lumbosacral Radiculopathy

The corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature.

Poster 194 Exercise in Non-Vascular Unilateral Amputees and Intact Limb Knee Injury

of the right wrist and forearm were negative for fracture. She was diagnosed with wrist extensor tendonitis and was recommended to stop kettlebell lifting permanently. She presented to the musculoskeletal physiatry clinic for a second opinion as she desired to continue competing. When discussing her lifting technique, the patient indicated that with each kettlebell snatch, the kettlebell fell directly onto her distal forearm; this contact worsened her pain. Physical exam revealed right dorsolateral forearm tenderness with a focal palpable nodule at the distal one-third of the forearm. Right wrist passive range of motion was normal and pain-free. Pain was provoked with resisted wrist extension with radial deviation. Setting: Outpatient musculoskeletal physiatry clinic. Results: Bedside musculoskeletal ultrasound revealed cortical irregularity of the radius over the tender area. There was no evidence of tenosynovitis of the distal wrist extensor tendons. MRI demonstrated bone marrow edema with suspected stress fracture line at the distal one-third radial diaphysis. Discussion: This case illustrates the ability of ultrasound to detect bony cortical changes in a case of a radial stress fracture with normal plain radiographs. The case highlights the necessity of analyzing biomechanics and form in determining the etiology of athletic injuries. Conclusions: Musculoskeletal ultrasound is a useful tool that may help detect stress fractures in the context of negative radiographs. Proper form and technique in weight-lifting can help prevent repetitive stress injuries. Stress fractures should be considered in athletes who come into repetitive, high-velocity contact with their equipment, such as kettlebells. Level of Evidence: Level V

The Motivational Influence of Milestone Times on 10-km Running Performance

To date, little research has been conducted to evaluate the potentially motivating effect of completing a race at a specific “milestone” finishing time. As this is difficult to perform in a laboratory setting, we examined 10-km runners from a large cohort to see if they were more likely to complete a race before rather than after a set milestone time (40:00, 45:00, and 50:00). Frequency distributions for finishers of each sex were created in 30-second time groups, with ideal normal distributions modeled based on this data. The actual time group frequencies were compared to the “expected” values from the modeled normal distributions. We included time groups that contained at least 1,000 finishers, thus were constrained to 36:00 – 52:00 for men and 43:30 to 52:00 for women. A total of 180,731 men and 53,047 women were included in the analysis. Men showed significant positive deviations (more finishers than expected) in the 39:30-40:00, 44:30-45:00, and 48:30-50:00 time groups (3 groups); they showed significant negative deviations only at 40:00-40:30 and 50:00-50:30. Women only showed significant positive time group deviations from 48:30-50:00 (1 group) with no significant negative deviations. In conclusion, despite the relatively arbitrary nature of milestones, they appear to exert a motivational influence on 10-km runners.

Poster 293 Facial Diplegia and Paresthesias as a Rare Guillain-Barré Variant: A Case Report

found between PVR and ALS-FRS with a R, 0.95 and P .025. A linear correlation also was noted between PVR and lower limbs Ashworth Scale. Conclusions: Urinary retention is common in ALS. Urologic evaluation is indicated in patients with ALS and with prominent spasticity. Bladder disorders in subjects with ALS subjects be treated with therapies aimed at improving pelvic floor muscles activity (strength and spasticity). In cases in which retention is documented, self-intermittent catheterization should be considered.