John M. Vasudevan

Hemiplegic shoulder pain: an approach to diagnosis and management.

Stroke is a significant source of mortality and long-term disability in the United States. Of persons who survive a stroke, approximately 50% will have hemiplegia, half of whom will live with a nonfunctional arm. Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, reduces participation and worsens outcomes in rehabilitation. Management of HSP is challenging because its causes are multifactorial and there is limited, conflicting, or nonspecific evidence in support of most treatments. This article develops an effective approach for diagnosis and treatment using the best available evidence to aid practitioners in obtaining optimal results.

Evaluation of the athlete with buttock pain.

Buttock (gluteal) pain is commonly experienced by athletes of all ages and activity levels. Evaluation of buttock pain can be challenging because the differential diagnoses are extensive. Symptoms may originate from the pelvis or hip or be referred from the lumbosacral spine or neurovascular structures. Few articles in the literature are dedicated to the primary complaint of buttock pain. The purpose of this article is to provide a clinical algorithm to assist the sports clinician in reaching an accurate diagnosis and initiating the appropriate treatment.

Piriformis Syndrome: A Review of the Evidence and Proposed New Criteria for Diagnosis

Conflicting historical definitions of piriformis syndrome present a challenge to its proper identification and effective clinical approach. The objective of this chapter is to perform a comprehensive review of the pertinent literature to date, from the initial descriptions of the syndrome to the latest methods of management. A synthesis of the results helps to define the optimal criteria for diagnosis and the strength of evidence for both noninterventional and interventional treatment.

Poster 384 Unilateral Femoral Neuropathy after Childbirth in the Context of an Undiagnosed Underlying Peripheral Polyneuropathy: A Case Report

reports that her most recent ankle sprain occurred approximately 3 weeks prior to her initial visit. Musculoskeletal ultrasound was used to evaluate the ATF ligaments bilaterally. The patient returned to clinic two weeks after her initial visit to have platelet rich plasma injected in to the area of interest usingMSKultrasound guidance. Shewas also given a CAM boot for which to wear for ambulation while out of bed and followed up 2 weeks, 4 weeks, and 3 months later. Setting: Outpatient Sports Clinic at Mount Sinai Hospital. Results or Clinical Course: After PRP was injected MSK ultrasound was used to evaluate the ATFL, it was found that the ligament not only regained its fibular texture but also became shorter decreasing anterior translocation during anterior drawer. Discussion: PRP is derived from autologous blood and plays a major role in the natural healing process of the body. In this case the ATFL showed increased laxity which likely contributed to the recurrent nature of the patient’s injury. PRP contains granules that stimulate angiogenesis, cell replication, and a variety of other processes needed to heal soft tissue injuries. This form of treatment appears to aid in the healing of chronic ligamentous injuries as evidenced by the return of the fibular texture of the ligament as well as the decreased length and laxity of the ligament seen on musculoskeletal ultrasound. Conclusion: Platelet rich plasma could play a vital role in the treatment of chronic and recurrent ligament injuries and should be further studied using similar techniques.