Jacob L. Sellon

Physical Activity, Quality of Life, and Burnout Among Physician Trainees: The Effect of a Team-Based, Incentivized Exercise Program

OBJECTIVE To prospectively study the effects of an incentivized exercise program on physical activity (PA), quality of life (QOL), and burnout among residents and fellows (RFs) in a large academic medical center. PARTICIPANTS AND METHODS In January 2011, all RFs at Mayo Clinic in Rochester, Minnesota (N=1060), were invited to participate in an elective, team-based, 12-week, incentivized exercise program. Both participants and nonparticipants had access to the same institutional exercise facilities. Regardless of participation, all RFs were invited to complete baseline and follow-up (3-month) assessments of PA, QOL, and burnout. RESULTS Of the 628 RFs who completed the baseline survey (59%), only 194 (31%) met the US Department of Health and Human Services recommendations for PA. Median reported QOL was 70 on a scale of 1 to 100, and 182 (29%) reported at least weekly burnout symptoms. A total of 245 individuals (23%) enrolled in the exercise program. No significant differences were found between program participants and nonparticipants with regard to baseline demographic characteristics, medical training level, PA, QOL, or burnout. At study completion, program participants were more likely than nonparticipants to meet the Department of Health and Human Services recommendations for exercise (48% vs 23%; P<.001). Quality of life was higher in program participants than in nonparticipants (median, 75 vs 68; P<.001). Burnout was lower in participants than in nonparticipants, although the difference was not statistically significant (24% vs 29%; P=.17). CONCLUSION A team-based, incentivized exercise program engaged 23% of RFs at our institution. After the program, participants had higher PA and QOL than nonparticipants who had equal exercise facility access. Residents and fellows may be much more sedentary than previously reported.

Intraarticular platelet-rich plasma injection in the treatment of knee osteoarthritis: review and recommendations.

Intraarticular platelet-rich plasma (PRP) injection has emerged as a promising treatment for knee osteoarthritis. Studies to date, including multiple randomized controlled trials, have shown that PRP is a safe and effective treatment option for knee osteoarthritis. Intraarticular PRP is similar in efficacy to hyaluronic acid, and seems to be more effective than hyaluronic acid in younger, active patients with low-grade osteoarthritis. Treatment benefits seem to wane after 6-9 mos. There are numerous PRP treatment variables that may be of importance, and the optimal PRP protocol remains unclear. Future investigations should control and analyze the effects of these variables in PRP treatment. High-quality randomized controlled trials are needed to optimize PRP treatment methods and better define the role of PRP in osteoarthritis management in the knee and, potentially, in other joints.

Variability of the Ischiofemoral Space Relative to Femur Position: An Ultrasound Study

Ischiofemoral impingement is caused by compression of the quadratus femoris muscle between the ischial tuberosity and lesser trochanter. The evaluation of ischiofemoral impingement includes radiologic studies to evaluate the ischiofemoral space dimensions. No prior study has evaluated the effect of femoral position on ischiofemoral space dimensions.

Comparing PRP injections with ESWT for athletes with chronic patellar tendinopathy.

OBJECTIVE To compare the effectiveness of injections of platelet-rich plasma (PRP) compared with focused extracorporeal shock-wave therapy (ESWT) among athletes with chronic patellar tendinopathy (jumpers knee). DESIGN Randomized controlled single-center trial, with 12 months of follow-up. SETTING Tertiary-level care in Rome, Italy. Patients were recruited from January 2009 to May 2011. PARTICIPANTS Patients who received a diagnosis of jumpers knee from a participating physician were recruited into the study (n = 46). Inclusion criteria were chronic (≥6 months), unilateral, proximal patellar tendinopathy in a recreational or elite athlete confirmed by ultrasound (US); prior failed nonoperative management that concluded ≥12 weeks prior to study entry; and ages 18 to 50 years. Exclusion criteria were coexisting knee lesions, systemic disorders, knee surgery or corticosteroid injection in the previous 3 months, and contraindications to PRP treatment. INTERVENTION Patients in the PRP group (n = 23) received 2 US-guided injections separated by 1 week and directed at the affected tendon portion. Each injection consisted of 2 mL of nonactivated, autologous PRP extracted from a single centrifugation of 10-mL blood and administered by a trained physician via a 22-guage needle. Patients in the focused ESWT group (n = 23) received 3 treatments (2400 impulses at 0.17-0.25 mJ/mm per session) separated by 48 to 72 hours. Treatments were guided by inline US and administered by 1 experienced operator. No local anesthesia was used in either group. One week later, both groups began a conventional stretching and strengthening program for 2 weeks. At 4 weeks, patients gradually resumed normal activities and sports, as tolerated. MAIN OUTCOME MEASURES At 2, 6, and 12 months after treatment, patients were assessed by a single investigator, blinded to group assignment. The main measure was the Italian version of the Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire, which evaluates severity of symptoms, function, and ability to participate in sport. A 10-cm visual analog scale (VAS) was used to assess pain while doing 5 single-leg squats. Patients also assessed their response to treatment on the Blazina scale (excellent to poor). No patients were lost to follow-up MAIN RESULTS During the 12-month follow-up period, VISA-P scores for both groups improved significantly from baseline (55.3 for PRP, 56.1 for ESWT), although the PRP group had greater improvement at 6 months (86.7 vs 73.7; P = 0.014) and 12 months (91.3 vs 77.6; P = 0.026). Pain scores during 5 single-leg squats demonstrated similar findings. At 12 months a greater proportion of patients in the PRP group rated their response to treatment as good or excellent (PRP, 91.3% vs ESWT, 60.8%; P = 0.035), although at earlier follow-ups the groups did not differ. Both the injections and ESWT caused transient discomfort. No patient had surgery during follow-up. CONCLUSIONS Athletes with chronic patellar tendinopathy responded positively to both PRP injection and ESWT. However, the PRP-treated patients demonstrated significantly greater improvements in VISA-P and pain scores by 6 months and significantly better functional outcomes and satisfaction based on a modified Blazina scale, at 12 months.

Feasibility of First Metatarsophalangeal Joint Injections for Sesamoid Disorders: A Cadaveric Investigation

To determine whether accurately placed first metatarsophalangeal joint (MTPJ) injections consistently deliver injectate to the metatarsosesamoid articulations.

Sonographically guided obturator internus injections: Techniques and validation

The primary purpose of this investigation was to describe and validate sonographically guided techniques for injecting the obturator internus (OI) muscle or bursa using a cadaveric model.

Sonographically Guided Anterior Cruciate Ligament Injection: Technique and Validation

To describe and validate a practical technique for sonographically guided anterior cruciate ligament (ACL) injections.

Differential Plantaris-Achilles Tendon Motion: A Sonographic and Cadaveric Investigation

Differential motion between the plantaris and Achilles tendons has been hypothesized to contribute to pain in some patients presenting with Achilles tendinopathy. However, objective evidence of differential Achilles‐plantaris motion is currently lacking from the literature.

Botulinum Toxin for Chronic Exertional Compartment Syndrome: A Case Report With 14 Month Follow-Up.

Chronic exertional compartment syndrome (CECS) presents a unique therapeutic challenge. Fasciotomy, currently the most well accepted treatment approach, still has a significant number of treatment failures, demonstrating the need for additional options. Botulinum toxin has been introduced as a potential therapeutic agent, but long-term outcomes are unknown. We present the longest documented follow-up (14 months) of a CECS case treated with botulinum toxin injections. At 14 months follow-up, the patient reported continued pain relief and had resumed her active lifestyle without any adverse effects. Although more research is needed to optimize patient selection and treatment protocol, this case illustrates the potential for botulinum toxin as a long duration, low risk alternative treatment option for CECS.

Ultrasound Evaluation of the Lower Trapezius in Adolescent Baseball Pitchers.

Biomechanical studies have demonstrated that the lower trapezius (LT) facilitates normal shoulder function, and given its potential role in causing and/or perpetuating dysfunction, clinicians have begun to evaluate and rehabilitate the LT in the context of comprehensive shoulder rehabilitation programs. Although some studies have compared side‐to‐side differences in LT thickness among nonthrowers, no studies have been performed to examine the normal ultrasound appearance of the LT in the adolescent throwing population.