Uncategorized Archives

Exercise Prescription

Exercise Prescription PM&R News • November 2018 Providers see 100's of patients per month with encounters consisting of diagnosis, treatments, education, and counseling, but how many of these patients receive counseling on their exercise level. New guidelines for exercise were recently published in JAMA and it is believed that only 20% of Americans meet the new guideline criteria. The new guidelines state that at least 150 minutes of moderate-intensity aerobic activity weekly, as well as, 2 or more days a week of muscle-strengthening activities should be performed. Ages 6-17 should perform at least 60 minutes of moderate-to-vigorous-intensity activity daily. The report demonstrates numerous health benefits [...]

Exercise PrescriptionDavid Impastato, MD2018-11-28T03:51:26+00:00

Transforaminal vs interlaminar

Transforaminal vs interlaminar epidural steroid injection for lumbosacral disc herniation? PM&R News • October 2018 Back pain is the number 1 reason the population visits a physician and is one of the reasons we write about back pain treatments so often. Whether you are a spinal cord injury, amputee, or sports medicine physician, you will see back pain… daily. This systemic review and meta-analysis evaluated whether transforaminal or interlaminar epidural steroid injections have better efficacy for back pain. 12 studies were included and the conclusion showed transforaminal epidural steroid injections had significantly better outcomes up to 1 month and slightly better outcomes up [...]

Transforaminal vs interlaminarDavid Impastato, MD2018-10-27T21:35:58+00:00

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

PM&R Rounds: EMG and Nerve Injury Prognosis

EMG Predicts Clinical Outcomes PM&R ROUNDS • August 28, 2017 We believe that every PM&R doc should take a look at this article titled How Electrodiagnosis Predicts Clinical Outcome of Focal Peripheral Nerve Lesions, because it further elucidates the importance of EDX consultants in providing a prognosis for nerve lesions. For those who are in practice, CME credit is available through the AANEM. Why We Love This Article Reviews the classification tools used to determine severity of nerve injury. The authors do an excellent job in reviewing the Seddon and Sunderland classifications of nerve injury. They further relate the classifications to prognosis; from [...]

PM&R Rounds: EMG and Nerve Injury PrognosisJacques Courseault, M.D., CAQSM2017-08-28T01:46:22+00:00