Patrick M. Foye

Osteoarthritis of the acromioclavicular joint: a review of anatomy, biomechanics, diagnosis, and treatment.

Shoulder pain is a frequent presenting complaint to physiatrists. Commonly encountered pathogeneses include rotator cuff pathology, bursitis, biceps tendonitis, and labral tears. Because the majority of shoulder pain originates within the subacromial region and the glenohumeral joint, the acromioclavicular, sternoclavicular, and scapulothoracic articulations may be overlooked. Osteoarthritis of the acromioclavicular joint is a common source of shoulder pain that is often neglected by clinicians and researchers. The proper diagnosis of acromioclavicular joint osteoarthritis requires a thorough physical exam, plain-film radiograph, and a diagnostic local anesthetic injection. Current treatment options are rather limited. Initial therapies are similar to that of osteoarthritis in other joints and include oral analgesics or anti-inflammatories and an emphasis on activity modification. Physical therapy, unfortunately, has little to offer, as therapeutic exercise and range of motion play only a minor role. If a diagnostic local anesthetic injection provides relief, there may be a role for corticosteroid injections. It seems that the administration of local corticosteroids into the acromioclavicular joint may provide short-term pain relief. The judicious administration of such injections remains controversial, and most experts agree that steroid injections do not alter the natural progression of the disease. Surgical options, indicated typically after a minimum of 6 mos of unsuccessful conservative treatment consist of open or arthroscopic distal clavicle resection.

Use of Platelet-Rich Plasma in Intra-Articular Knee Injections for Osteoarthritis: A Systematic Review

To systematically analyze the literature on the use of platelet‐rich plasma (PRP) for intra‐articular injections of the knee and its efficacy in the treatment of knee osteoarthritis (OA).

Functional performance deficits in athletes with previous lower extremity injury.

ObjectiveTo evaluate the influence of previously treated, though clinically resolved, lower extremity injury on performance in a timed 20-meter shuttle run. DesignCase control study. SettingNational Collegiate Athletic Association (NCAA) Division I college during the 2000/2001 preparticipation physicals. ParticipantsNCAA Division I athletes (n = 213) participated in this research study. Athletes were excluded if they presently had an unresolved lower extremity injury or low back pain. Main Outcome MeasuresTime to complete a 20-meter shuttle run was recorded. Previous lower extremity injury and college year were recorded via a short questionnaire. ResultsA significantly slower response time on the 20-meter shuttle run was observed in freshman athletes with a history of a lower extremity injury, as compared with freshmen without a previous injury (p = 0.01). No significant difference was noted in nonfreshman collegiate athletes regardless of injury history (p = 0.98). ConclusionKinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits, which may be missed on a standard physical assessment. The slower shuttle run times observed in freshmen with previous lower extremity injury may be a manifestation of insufficient treatment received at the high school level or the benefit of a mandatory core strengthening program in returning athletes. Further study is necessary to identify and validate the cause-and-effect relationship. Clinical RelevanceThis study may support residual functional deficits in incoming college athletes, which may be related to inadequate care in the high school setting.

A study of thyrotropin-releasing hormone for the treatment of spinal muscular atrophy: a preliminary report.

ObjectiveTo determine whether thyrotropin-releasing hormone (TRH) can increase muscle strength in children with spinal muscular atrophy types 2 and 3. DesignA randomized, double-blinded, controlled, 5-wk drug trial of six subjects and three controls. Subjects and controls ranged from 4 to 8 yr of age and were randomly assigned to treatment and placebo groups in a ratio of 2:1. TRH (protirelin) or placebo was delivered intravenously through percutaneous intravenous catheters at a dose of 0.1 mg/kg (in 50 ml of normal saline) for a total of 29 days. Patients were evaluated using electromyography and handheld dynamometry of the deltoids, biceps, triceps, wrist extensors, hip flexors, quadriceps, hamstrings, and grip strength before and immediately after 5 wk of treatment. A unidirectional t test was used to compare mean values. ResultsDynamometry improved significantly only for the six treated subjects (P < 0.02). Peroneal nerve conduction velocities were significantly faster in the treatment group (paired t test, P = 0.036). The parents of the treated children also provided anecdotal evidence of improvements in function. Improvements lasted 6–12 mo. ConclusionsTRH may be a useful treatment for spinal muscular atrophy. A larger, crossover design group comparison study is warranted.

Pain, dizziness, and central nervous system blood flow in cervical extension: vascular correlations to beauty parlor stroke syndrome and salon sink radiculopathy.

Foye PM, Najar MP, Camme A Jr, Stitik TP, DePrince ML, Nadler SF, Chen B: Prospective study of pain, dizziness, and central nervous system blood flow in cervical extension: Vascular correlations to beauty parlor stroke syndrome and salon sink radiculopathy. Am J Phys Med Rehabil 2002;81:395–399. Objective Professional shampoos have previously been implicated in beauty parlor stroke syndrome and salon sink radiculopathy. The purpose of this study was to record pain, dizziness, and cervical blood flow while subjects were specifically placed into the salon sink position and to determine whether an additional cervical support would alter these symptoms and measurements. Design In 25 volunteers who reported previous dizziness from salon shampoos, we recorded subjective levels of pain and dizziness and objective measurements of blood flow within the vertebral and carotid arteries at baseline and then during cervical extension into a salon sink, with and without additional cervical support. Results When the additional cervical support was not used, there was significantly greater dizziness, neck pain, and carotid blood flow. No statistically significant differences were seen in the vertebral artery blood flow when comparing the three positions. Conclusions Pain and dizziness were commonly reproduced in this previously symptomatic population but significantly less frequently when a supplemental cervical support was used. Individuals with a history of such symptoms should probably exercise caution when deciding whether to receive a salon sink shampoo.

Phlebotomy-related lateral antebrachial cutaneous nerve injury.

Stitik TP, Foye PM, Nadler SF, Brachman GO: Phlebotomy-related lateral antebrachial cutaneous nerve injury. Am J Phys Med Rehabil 2001;80:230–234.Although phlebotomy is a common and widespread procedure, the medical literature provides limited information in terms of the documented complications of venipuncture. Documentation of phlebotomy-related nerve injuries is even more limited. The authors present a case report of a phlebotomy-induced lesion of the lateral antebrachial cutaneous nerve. According to our literature search, this is the first case in which electrodiagnostic studies were used to document venipuncture-related injury of the lateral antebrachial cutaneous nerve. Specific electrodiagnostic testing is used to definitively diagnose this rare injury and to track recovery. Electrodiagnostic testing can be helpful in evaluating cases of sensory disturbance after phlebotomy.

Measuring professionalism in a physiatry residency training program.

DeLisa JA, Foye PM, Jain SS, Kirshblum S, Christodoulou C: Measuring professionalism in a physiatry residency training program. Am J Phys Med Rehabil 2001;80:225–229.A 12-item questionnaire modeled after the one prepared by the American Board of Internal Medicine dealing with professionalism was distributed to 122 physiatry residents representing six training programs, of whom 59% (72) responded. The mean item score on the survey was 7.7 (SD = 1.0) on a scale from 1 to 10, where 10 represents the highest level of professionalism. The internal reliability of the questionnaire was found to be satisfactory (Cronbach’s &agr; = 0.75). A factor analysis of the questionnaire items resulted in three factors explaining 64% of the variance. These factors were: excellence, honor/integrity, and altruism/respect; Eigen values were 3.35, 2.37, and 1.31, respectively. These factors are similar to those obtained in the American Board of Internal Medicine survey. This similarity is a positive feature in ongoing efforts to develop a reliable tool for measuring professionalism in physiatry residency training.

Pharmacotherapy of osteoarthritis.

Stitik TP, Altschuler E, Foye PM: Pharmacotherapy of osteoarthritis. Am J Phys Med Rehabil 2006;85(Suppl):S15–S28.

Corticosteroid injections for osteoarthritis.

Stitik TP, Kumar A, Foye PM: Corticosteroid injections for osteoarthritis. Am J Phys Med Rehabil 2006;85(Suppl):S51–S65.

The relationship between lower extremity injury and the hip abductor to extensor strength ratio in collegiate athletes

OBJECTIVE To determine the relationship of previous lower extremity injury and the measured ratio of hip abduction to extension strength in collegiate athletes. DESIGN Cohort study of college athletes at time of pre-participation screening physical. SETTING An NCAA Division I college. PARTICIPANTS Two hundred and thirty-six college athletes from a NCAA Division I school (162) males and (74) females. MAIN OUTCOME MEASURES The ratio of maximal hip abduction to extension strength was calculated, following raw data collection with a specially designed dynamometer anchoring station. Injury to the lower extremities, in the past year, was recorded via personal interview at the time of screening and verified by review of previous injury records. RESULTS A significant difference in the ratio of hip abduction to extension strength was noted on the left lower extremity of athletes with reported lower extremity (LE) injury compared to those without injury. Upon further review of data, hip extension weakness appears to be the likely cause of this difference. CONCLUSION Athletes with reported lower extremity injury demonstrated a significant residual difference in the ratio of hip abduction to extension strength. This may be the result of injury related muscle weakness, altered muscle firing patterns, central inhibition or unknown compensatory strategies which all may be risk factors for recurrent injury. Further research is underway to identify the cause/effect relationship of this finding. CLINICAL RELEVANCE This study may advance our understanding of potential compensatory strategies about the hip which theoretically may result from previous lower extremity injury or injuries which are incompletely rehabilitated. Additionally, this study provides some reasoning to support the screening of hip strength during the pre-participation physical, as it may be an important factor to prevent recurrent injury.