MSK Archives

Multiple Myeloma

Multiple Myeloma PM&R News • August 2021 Anatomy Blood: Immunoglobulin-producing Plasma cells (derived from B cells; a lymphocyte sub-type) Pathophysiology Plasma cells: neoplastic proliferation → monoclonal immunoglobulin Proliferation in the bone marrow = skeletal destruction Epidemiology U.S.: 1 – 2% of all cancers > 17% of hematologic malignancies Annual: 4-5/100,000 Worldwide: 160,000 cases 106,000 deaths/year Risk factors: Ethnicity: African Americans 2-3x > Caucasians Lowest risk: Asians from Japan, Mexicans Increased incidence: Males > females (1.4:1), ↑ BMI, older age (avg: 66 y/o), 1st degree relative (3.7x), variation of the 3p22.1 or 7p15.3 genetic loci Presentation/ Clinical Manifestations Anemia: 73% at diagnosis; 97% at some [...]

Multiple Myelomaashpt2021-08-18T14:49:13+00:00

Avascular Necrosis

Avascular Necrosis PM&R News • December 2020 A 41-year-old male presented to a chiropractor’s office for ongoing right sided low back, hip and knee pain for the past six months following jumping off a two meter high roof and landing on his feet. He had immigrated to Canada from abroad two months prior to consulting us. The patient had an antalgic limp and walked with the help of a cane. He complained of intermittent pain radiating into his right groin and anteriomedial thigh region. He stated that his symptoms were aggravated by walking and stair climbing. His pain was relieved by sitting and resting. [...]

Avascular Necrosisashpt2020-12-04T15:08:12+00:00

Intradiscal Stem Cells for Disc Disease?

Intradiscal Stem Cells for Disc Disease? PM&R News • May 2020 Lumbago, or lower back pain, is a chronic pain condition thought to effect up to 80% of adults older than 18 according to certain observational studies. One systematic review of prospective cohort studies revealed a lifetime prevalence of more than 70% for lower back pain. One of the prominent etiologies contributing to lumbago is degenerative disc disease. Contributions to spine and disc degeneration can be multivariable and include age related changes, trauma, nutrition, and hereditary components. When comparing prevalence in spine degeneration with age in asymptomatic patients aged 30-80 disc degeneration was [...]

Intradiscal Stem Cells for Disc Disease?David Impastato, MD2020-05-25T02:53:25+00:00

Blood Flow Restriction Training in the Lower Extremity

Blood Flow Restriction Training (BFRT) – True Gains? PM&R News • November 2019 By now many of you have heard of blood flow restriction training (BFRT). With this relatively novel treatment, few studies have looked at effects on both proximal and distal segments as well as the contralateral limb. So remind me again of what BFR training entails? “low-load exercise performed while wearing an inflatable tourniquet on the proximal limb, which partially restricts arterial inflow and venous return from the extremity.” In this 6-week randomized controlled-trial¹ 26 participants were observed for effects of strength, torque, work, power, and limb circumference. [...]

Blood Flow Restriction Training in the Lower Extremityashpt2019-11-10T21:22:33+00:00

Cluneal Nerve Entrapment and Low Back Pain

Cluneal Nerve Entrapment and Low Back Pain PM&R News • August 2019 The superior and middle cluneal nerves are cutaneous nerves which are purely sensory and provide most of the sensation to the low back and buttocks. The most common site of entrapment is around the iliac crest. Cluneal nerve entrapment can produce symptoms of low back pain, leg pain, and groin pain. These symptoms are often exacerbated by lumbar movements, and mimic radiculopathies. Superior cluneal nerve entrapment (SCN-E) can also cause intermittent claudication. Identification of the trigger point at the site of entrapment, and subsequent resolution of symptoms after a nerve block [...]

Cluneal Nerve Entrapment and Low Back PainDavid Impastato, MD2019-08-11T19:48:53+00:00