MSK Archives

PRP/Stem Cells for the Spine

PRP/Stem Cells for the Spine PM&R News • February, 2019 Regenerative medicine continues to be the hot topic for musculoskeletal pain and new treatments continue to evolve. Data and research on stem cells and PRP continue to be limited to small case control trials with very few higher level, long term studies existing. This study aimed to perform a systematic review and metaanalysis to provide higher level evidence and guidelines for the treatment of low back pain with regenerative medicine. In all, 21 injection studies met guidelines for inclusion, including studies for lumbar disc injections, epidural injections, facet joint injections and sacroiliac joint injections. [...]

PRP/Stem Cells for the SpineDavid Impastato, MD2019-08-22T21:19:04+00:00

Atrial Fibrillation in Endurance Athletes

Atrial Fibrillation in Endurance Athletes PM&R News • December 2018 With “Holiday Heart” season upon us, it seems appropriate to have a discussion about Atrial fibrillation. Atrial fibrillation (AF) is most commonly seen in older men and is generally associated with cardiac risk factors including hypertension and coronary artery disease leading to structural changes in the heart. However, several studies have also identified an association of paroxysmal AF in young to middle aged endurance athletes. So, if you were planning to keep your heart healthy this holiday season with marathon training or 100-mile bike rides, you may not be completely out of the woods. [...]

Atrial Fibrillation in Endurance AthletesDavid Impastato, MD2019-08-11T19:49:33+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