Samuel K. Chu

Long-term Intrathecal Baclofen: Outcomes After More than 10 Years of Treatment

To report outcomes of intrathecal baclofen (ITB) therapy for spasticity management in a cohort of patients who had received this treatment for at least 10 years.

The Kinetic Chain Revisited: New Concepts on Throwing Mechanics and Injury

The overhead throwing motion is a complex activity that is achieved through activation of the kinetic chain. The kinetic chain refers to the linkage of multiple segments of the body that allows for transfer of forces and motion. The lower extremities and core provide a base of support, generating energy that is transferred eventually through the throwing arm and hand, resulting in release of the ball. The kinetic chain requires optimal anatomy, physiology, and mechanics and is involved in all 6 phases of overhead throwing: windup, stride, arm cocking, acceleration, deceleration, and follow‐through. Breaks or deficits in the kinetic chain can lead to injury or decreased performance. Through an understanding of the mechanics and pathomechanics seen in each phase of throwing, the clinician can better evaluate and screen for potential kinetic chain deficits in the overhead throwing athlete. The purpose of this article is to review the biomechanics of the overhead throwing motion, the role of the kinetic chain in throwing, and the clinical evaluation and management of abnormal throwing mechanics and related injuries.

Intrathecal Versus Oral Baclofen: A Matched Cohort Study of Spasticity, Pain, Sleep, Fatigue, and Quality of Life

Baclofen commonly is used to manage spasticity caused by central nervous system lesions or dysfunction. Although both intrathecal and oral delivery routes are possible, no study has directly compared clinical outcomes associated with these 2 routes of treatment.

Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices

OBJECTIVE To investigate the benefits of comprehensive inpatient rehabilitation for patients after left ventricular assist device (LVAD) implantation. DESIGN A retrospective cohort study. SETTING An urban academic inpatient rehabilitation hospital. PATIENTS This study included 58 patients admitted to inpatient rehabilitation after LVAD implantation between 2009 and 2012. METHODS Chart review of demographic, clinical, and functional data for patients admitted to inpatient rehabilitation after LVAD implantation was performed. MAIN OUTCOME MEASUREMENTS Length of stay, admission and discharge Functional Independence Measure (FIM), and FIM efficiency. RESULTS The study included 47 male and 11 female patients ages 21.8-84.1 years (mean [standard deviation {SD}], 64.2 ± 11.2 years). The mean (SD) length of time between LVAD implantation and admission to rehabilitation was 27.0 ± 15.3 days. Twenty-one patients (36%) required transfer to an acute care hospital. Ten patients returned after transfer and completed inpatient rehabilitation. For the 47 total patients who completed inpatient rehabilitation, the mean (SD) length of stay was 20.3 ± 10.8 days (range, 7-50 days). Mean (SD) admission and discharge FIM scores were 68.4 ± 13.6 and 91.7 ± 11.8, respectively, with a mean (SD) difference between admission and discharge FIM scores of 23.4 ± 11.2. The mean (SD) FIM efficiency was 1.33 ± 0.65. Complications during rehabilitation included anemia that required transfusion, respiratory distress, epistaxis, gout flare, automated implantable cardioverter defibrillator firing, and gastrointestinal bleeding. CONCLUSIONS Patients with LVADs demonstrate functional gains in inpatient rehabilitation. However, there is a high incidence of complications in this population, which often requires transfer to an acute care setting.

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.

Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play.

Hamstring injuries are very common in athletes. Acute hamstring strains can occur with high-speed running or with excessive hamstring lengthening. Athletes with proximal hamstring tendinopathy often do not report a specific inciting event; instead, they develop the pathology from chronic overuse. A thorough history and physical examination is important to determine the appropriate diagnosis and rule out other causes of posterior thigh pain. Conservative management of hamstring strains involves a rehabilitation protocol that gradually increases intensity and range of motion, and progresses to sport-specific and neuromuscular control exercises. Eccentric strengthening exercises are used for management of proximal hamstring tendinopathy. Studies investigating corticosteroid and platelet-rich plasma injections have mixed results. Magnetic resonance imaging and ultrasound are effective for identification of hamstring strains and tendinopathy but have not demonstrated correlation with return to play. The article focuses on diagnosis, treatment, and return-to-play considerations for acute hamstring strains and proximal hamstring tendinopathy in the athlete.

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.

Outcomes of Inpatient Rehabilitation in Patients With Simultaneous Bilateral Total Knee Arthroplasty.

The number of total knee arthroplasty (TKA) procedures performed in the United States is increasing each year, and the number of bilateral TKA procedures has also increased during the past 2 decades. However, few studies in the literature have investigated the rehabilitation outcomes of patients who undergo bilateral TKA. This study was performed to provide information on the benefits and role of inpatient rehabilitation for patients after bilateral TKA.

Poster 347 The Effectiveness of Musculoskeletal Ultrasound for Teaching Joint Palpation to Medical Students

increasing age. For females, only stride length were statistically significant (p1⁄4.01), with increasing probability of injury with longer stride lengths. Conclusion: This is the first study that characterizes foot strike and injury rates of ultramarathon runners in a competitive race. Our data suggests that foot strike might not be associated with injuries, while stride length may be a factor influencing injury in females.