Mary Caldwell

Is There a Relationship Between Body Mass Index and Fluoroscopy Time During Sacroiliac Joint Injection? A Multicenter Cohort Study

OBJECTIVE To determine the relationship between BMI and fluoroscopy time during intra-articular sacroiliac joint (SIJ) injections performed for a pain indication. DESIGN Multicenter retrospective cohort study. SETTING Three academic, outpatient pain treatment centers. SUBJECTS Patients who underwent fluoroscopy guided SIJ injection with encounter data regarding fluoroscopy time during the procedure and body mass index (BMI). MAIN OUTCOME MEASURE Median and 25-75% Interquartile Range (IQR) fluoroscopy time. RESULTS 459 SIJ injections (350 patients) were included in this study. Patients had a median age of 57 (IQR 44, 70) years, and 72% were female. The median BMI in the normal weight, overweight, and obese groups were 23 (IQR 21, 24), 27 (IQR 26, 29), and 35 (IQR 32, 40), respectively. There was no significant difference in the median fluoroscopy time recorded between these BMI classes (p = 0.45). First-time SIJ injection (p = 0.53), bilateral injection (p = 0.30), trainee involvement (p = 0.47), and new trainee involvement (trainee participation during the first 2 months of the academic year) (p = 0.85) were not associated with increased fluoroscopy time for any of the three BMI categories. CONCLUSIONS Fluoroscopy time during sacroiliac joint injection is not increased in patients who are overweight or obese, regardless of whether a first-time sacroiliac joint injection was performed, bilateral injections were performed, a trainee was involved, or a new trainee was involved.

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.

(471) The relationship between body mass index and fluoroscopy time during intra-articular hip injections: a multicenter cohort study

and chronic fatigue syndrome (CFS). Up to now chronic fatigue mechanisms are only partially understood and few effective therapies exist. Animal studies have shown that peripheral tissues have metabo-receptors and activation of these metabo-receptors has resulted in fatigue in laboratory animals. We have shown that individuals with chronic fatigue syndrome have sensitized metaboreceptors which become activated by tissue metabolites, thus signaling fatigue during muscle activity or even at rest. Blocking these metabo-receptors with local anesthetics could improve general fatigue of patients with CFS. Patients who fulfilled the CDC Criteria for CFS were randomized into a double blind, placebocontrolled, parallel study of injections into 4 areas of the trapezius and gluteal muscles. Patients were excluded if they had received previous muscle injections with local anesthetics. Patients received either 4 injections with 50mg of 1%lidocaine or saline. Outcome measure were overall fatigue, depression, anxiety, and pain. Patients indicated by forced choice after the injections whether they had received lidocaine or saline. 28 subjects (50.8 years) received lidocaine and 27 subjects (50.3 years) received saline injection. An ANOVA showed a significant main effect for time (p<.001) and significant interaction effects of time*group (p=.03) indicating that lidocaine was more effective for decreasing fatigue than placebo. Forced choices of participants confirmed successful blinding of participants’ drug allocation. Lidocaine injections into muscles effectively reduced overall fatigue of CFS-patients more than placebo suggesting that peripheral pathways play an important role for fatigue signaling. Local anesthetics may represent a novel approach for chronic fatigue.

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

Poster 318 Undiagnosed Stress Fracture and Osteonecrosis of the Tibia in an Active Transtibial Amputee: A Case Report

(47.3%) showing intra-articular flow. Fifteen injections were performed using the posterior approach, and 4 (30.8%) had intra-articular flow. There was no statistically significant difference between the anterior and posterior approaches regardless of physician level of experience. Conclusion: The results of this study suggest that image guidance is an important utility for accurate navigation into the glenohumeral joint space. Although the experienced physician had a significantly higher accuracy rate with blind GHJ injections than those physicians at the fellowship level, the experienced physician still missed the intra-articular space on initial attempt more than 30% of the time. Neither the anterior nor the posterior approach proved to be significantly more accurate for blind GHJ injections regardless of provider experience.