David Impastato, MD, Author at Physical Medicine and Rehabilitation Qbank Review

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So far David Impastato, MD has created 29 blog entries.

US vs Landmark

Ultrasound Guided Versus Landmark Guided Local Corticosteroid Injection for CTS PM&R News • September 2018 Continuing with our recent blog posts on the use of ultrasound, lets switch to a procedural approach. For decades, peripheral injections have been performed with landmark guidance. However, as the popularity and quality of ultrasound has been improving, ultrasound guided injections have increased in number. The majority of studies evaluating ultrasound guided injections versus landmark guided injections have shown better accuracy but not necessarily better efficacy, with the exception of a few studies. This study set to look at ultrasound guided vs landmark guided for carpal tunnel corticosteroid [...]

US vs LandmarkDavid Impastato, MD2018-09-08T03:01:35+00:00

Prolotherapy

Prolotherapy?.... What's that? PM&R News • August 2018 Prolotherapy is a regenerative injection therapy that introduces small amounts of irritant solution to the site of painful/degenerated tendon insertions, joints, and ligaments to promote growth of normal cells and tissue. The irritant solution most commonly used is hypertonic dextrose – yes, you read correctly – sugar water. Let’s start from the basics of how this works. Hypertonic dextrose solutions act by dehydrating cells at the injection site, leading to local tissue trauma, and initiating a local inflammatory cascade. Specifically, the elevation in dextrose around fibroblasts and chondrocytes results in a rise in cytokines responsible for [...]

ProlotherapyDavid Impastato, MD2018-08-13T21:31:09+00:00

Ultrasound Diagnosis of Carpal Tunnel Syndrome

Ultrasound Diagnosis of Carpal Tunnel Syndrome PM&R News • July 2018 Electrodiagnostics for carpal tunnel syndrome are well proven and very reliable. As ultrasound continues to gain popularity, physiatrists are becoming more interested in diagnosing carpal tunnel syndrome with this technology. This systematic review and meta-analysis set out to evaluate the accuracy of ultrasound diagnosis of carpal tunnel syndrome. 28 studies were included in this analysis. The studies used cutoffs at the inlet level of 9.0-12.6mm2 and 9.5-10mm2 for outlet levels. Evaluation determined there is sufficient accuracy for use in clinical settings based on diagnostic odds ratio. Accuracy was higher for inlet levels [...]

Ultrasound Diagnosis of Carpal Tunnel SyndromeDavid Impastato, MD2018-08-30T12:03:26+00:00

Ultrasound Diagnosis of Cubital Tunnel Syndrome

Ultrasound Diagnosis of Cubital Tunnel Syndrome PM&R News • June 2018 Diagnosing cubital tunnel can be challenging, as often patients may have prominent symptoms but do not meet electrodiagnostic criteria. A recent meta analysis, evaluated how well ultrasound can diagnose cubital tunnel, a technique that could supplement or potentially replace electrodiagnostic testing. 14 trials were used comparing the ulnar nerve cross sectional area at different site in individuals with and without cubital tunnel syndrome. The largest difference between symptomatic and non-symptomatic patients was found to be at the medial epicondyle. Ulnar nerve measurements of patients without cubital tunnel syndrome reached a peak of [...]

Ultrasound Diagnosis of Cubital Tunnel SyndromeDavid Impastato, MD2018-06-08T17:33:10+00:00

Utility of Wearable Technology

Can Wearable Technology Improve Home Exercise? PM&R News • May 2018 Ever wonder if issuing patients the newest technology to track their exercise and having formal coaching can improve their home exercise? Well this study, took a look at just that. Patients with peripheral artery disease were randomized into home based exercise vs usual care for a follow up of 9 months. The exercise group received four medical visits and then 8 months of technology monitoring and telephone coaching calls. The other group received no onsite visits, no wearable technology, and no coaching. The study decided to use change in 6 minute walk [...]

Utility of Wearable TechnologyDavid Impastato, MD2018-05-11T02:45:05+00:00