Paul Lento

Advances and utility of diagnostic ultrasound in musculoskeletal medicine.

Musculoskeletal ultrasound (US) can serve as an excellent imaging modality for the musculoskeletal clinician. Although MRI is more commonly ordered in the United States for musculoskeletal problems, both of these imaging modalities have advantages and disadvantages and can be viewed as complementary rather than adversarial. For diagnostic US, relative recent advances in technology have improved ultrasound’s ability to diagnose a myriad of musculoskeletal problems with enhanced resolution. The structures most commonly imaged with diagnostic musculoskeletal US, include tendon, muscle, nerve, joint, and some osseous pathology. This brief review article will discuss the role of US in imaging various common musculoskeletal disorders and will highlight, where appropriate, how recent technological advances have improved this imaging modality in musculoskeletal medicine. Additionally, clinicians practicing musculoskeletal medicine should be aware of the ability as well as limitations of this unique imaging modality and become familiar with conditions where US may be more advantageous than MRI.

Pathogenesis of lumbar spinal stenosis pain: why does an asymptomatic stenotic patient flare?

This article discusses the pathogenesis of lumbar spinal stenosis pain and presents a theory on why asymptomatic stenotic patients flare.

Programmatic design for teaching the introductory skills and concepts of lumbar spine procedures to physiatry residents: a prospective multiyear study.

ObjectiveThe objective of this study was to determine the effectiveness of a 2-day course teaching the introductory skills and concepts of lumbar spine procedures to physiatry residents. DesignThis is a 3-yr prospective study of a 2-day musculoskeletal course teaching the introductory skills and concepts of lumbar spinal procedures to the residents at a large academic physical medicine and rehabilitation program. The residents attending the course took multiple-choice pretests and posttests as well as participated in a procedural skills competency demonstration. ResultsForty-two residents participated. The results were stratified according to the level of training and repetition of the material and revealed gains of medical knowledge at each level of residency training (P < 0.001). The postgraduate year 2 residents seemed to have the greatest overall improvement (P = 0.04). Half of the residents scored lower than 65% on the pretest, and these residents ultimately had the largest posttest gains. Forty (95.2%) residents achieved a grade of pass in the skills-based test. The residents felt that the course was valuable or extremely valuable. ConclusionsThe comprehensive 2-day course teaching the skills and concepts of spinal interventions for physiatry residents enhances medical knowledge as an introduction to interventional spine care. Those who benefited the most were the residents who had the greatest deficit of medical knowledge on this topic before the course. This course curriculum does not replace fellowship training or closely monitored mentorship in the performance of spinal procedures.

High-Resolution Median Nerve Sonographic Measurements Correlations With Median Nerve Conduction Studies in Healthy Adults

To study relationships between median wrist and forearm sonographic measurements and median nerve conduction studies.

Posterior Knee Pain and Its Causes: A Clinician's Guide to Expediting Diagnosis

Because posterior knee pain is a relatively uncommon patient complaint, its etiology is challenging and often elusive. The differential diagnosis for posterior knee pain can be vast, so clues for distinguishing causes are important. Many clinicians are unfamiliar with this complicated anatomic area and may not have a standard clinical evaluation to establish a cause of the patients pain. Review of several known causes of knee pain can provide the examiner with a more comprehensive list of potential disorders to consider as differential diagnoses when patients present with posterior knee pain.