Finnoff, Jonathan T.

Background: Adductor longus tendinopathy is a well-known etiology of chronic groin pain in elite athletes. Surgery is indicated for those who fail conservative treatment. No studies to date have evaluated the feasibility of an ultrasound-guided release of the proximal adductor longus tendon. Purpose/Hypothesis: The primary aim of this study was to determine the feasibility of an ultrasound-guided selective adductor longus release with a cutting wire. A secondary aim was to determine safety by avoiding injury to adjacent structures. We hypothesized that the proximal adductor longus tendon can be released under ultrasound guidance with a cutting wire without injury to adjacent neurovascular or genitourinary structures. Study Design: Descriptive laboratory study. Methods: Ten adductor longus tendons (5 cadaveric specimens) from 4 males and 1 female between 76 and 89 years of age with a mean body mass index of 21.9 kg/m 2 (range, 16.8-29.6 kg/m 2 ) were used during this study. A single experienced physician sonographer performed ultrasound-guided proximal adductor longus tendon releases on all cadaveric specimens using a cutting wire. Dissection was performed by a second physician to determine the completeness of the tendon transections and to detect injury to adjacent neurovascular or genitourinary structures. Results: All 10 adductor longus tendons were transected. Eight of 10 transections were complete, whereas in 2 transections, >99% of the tendon was transected. There were no injuries to adjacent genitourinary or neurovascular structures. Conclusion: Ultrasound-guided adductor tendon release is feasible and safe in a cadaveric model. Further translational research should be performed to determine whether these results can be replicated in the clinical setting. Clinical Relevance: Adductor longus tendinopathy frequently requires surgical intervention and prolonged time away from sport. The present study suggests that a selective adductor longus tendon release can be performed with ultrasound guidance. This procedure warrants further translational research to explore its use in clinical practice.

PurposeIncreasing stride‐rate by 5%‐10% has been used for injury prevention and rehabilitation but evidence is limited if an independent program can alter stride‐rate in runners. The objective of this study was to determine whether the preferred stride‐rate of recreational runners can be increased by 5%‐10% following a 6‐week independent training program.MethodsThirty‐eight runners running a minimum of 15 miles/wk with a preferred stride‐rate ≤85 strides/min determined during treadmill testing were randomized into two groups: (a) Experimental group was instructed to increase stride‐rate by 10% using a watch and foot pod for stride‐rate feedback; and (b) Control group was instructed to continue normal running. Compliance was tracked with a training log. One stride being defined as two sequential steps. Preferred running stride‐rate was retested at 6 weeks using the same testing protocol.ResultsThere was no significant difference in baseline preferred running stride‐rates between the experimental or control groups. A significant (P < .001) increase in stride‐rate from 79.9 ± 4.8 to 86.8 ± 5.7 strides/min (8.6% increase) was found in the experimental group. The control group did not significantly change their stride‐rate (Baseline: 80.4 ± 4.2, 6 weeks: 81.3 ± 3.3 strides/min).ConclusionA 6‐week home training program using a watch and foot pod can increase the preferred running stride‐rate by 5%‐10% in runners with a stride‐rate of 85 or less. Clinicians may be able to apply this type of gait retraining in recreational runners when designing injury prevention and rehabilitation programs.

BackgroundUltrasound has become a useful instrument in evaluating musculoskeletal pathology. Recent studies suggest that ultrasound imaging of weight‐bearing menisci may enhance the assessment of knee pathology, such as osteoarthritis (OA) and meniscal injuries.ObjectiveThe primary aim of this study was to determine the intrarater and interrater reliability of ultrasound measurements of medial meniscal extrusion (MME) after a brief training session.DesignProspective reliability study.SettingPhysical medicine and rehabilitation (PM&R) department within a tertiary care institution.ParticipantsForty‐five participants (29 female, 16 male) were recruited to serve as models, 24 of whom had healthy knees and 21 of whom had radiographically confirmed medial compartment knee OA. Three physician sonographers (1 = experienced, 1 = sports medicine fellow, 1 = post‐graduate year [PGY]‐4 PM&R resident) were recruited to serve as operators.Methods or InterventionsOperators received a brief training session on identifying and measuring MME. All operators measured bilateral MME in each model in the standing and supine positions on two separate days. Operators were blinded to all measurements.Main Outcome MeasurementsPrimary outcomes were inter‐ and intrarater intraclass correlation coefficients (ICCs) of MME measurements among operators with different levels of ultrasound experience.ResultsSupine MME intrarater reliability ICCs were 0.927, 0.885, and 0.780 for the experienced physician, sports medicine fellow, and PGY‐4 operators, respectively. Standing MME intrarater reliability ICCs were 0.941, 0.902, and 0.824 for the experienced physician, sports medicine fellow, and PGY‐4 operators, respectively. Interrater reliability ICCs were 0.896 and 0.842 for supine and standing measurements, respectively. There was a statistically significant increase in intrarater reliability with experience between the PGY‐4 resident and experienced physician operators.ConclusionsOperators with different levels of ultrasound experience demonstrated good MME measurement intra‐ and interrater reliabilities in both supine and standing positions.

Abstract: A 19-year-old female collegiate swimmer presented to our sports medicine clinic with a history and physical examination consistent with right ulnar neuropathy at the cubital tunnel. Diagnostic ultrasound (US) revealed compression of the ulnar nerve under the cubital tunnel retinaculum (CTR) with nerve swelling proximal to the site of compression. Electrodiagnostic studies confirmed the diagnosis of a moderate to severe ulnar neuropathy at the elbow. Treatment consisted of an US-guided decompression of the ulnar nerve in the cubital tunnel by cutting the CTR using a rotated stylet “v” cutting technique. The patient's symptoms resolved, and she was able to begin a swimming progression 2 weeks after the procedure. After completion of this progression, she was able to successfully resume full, unrestricted competitive collegiate swimming without return of her symptoms. To the best of our knowledge, this is the first description of an US-guided cubital tunnel decompression surgery.

Objective: Vocal cord dysfunction (VCD) is characterized by paradoxical vocal fold movement (PVFM) during inspiration. The aim of this study was to determine whether ultrasound could accurately differentiate between normal and PVFM during respirations in a resting state. Design: Prospective, single-subject design. Setting: Academic medical center. Patients: A speech-language pathologist who was able to volitionally alternate between normal and PVFM when breathing at rest was recruited to participate in the study. Interventions: The subject was instructed to randomly alternate between normal and PVFM 20 times (10 times each). A single investigator imaged the vocal folds using ultrasound and reported when the subject alternated between the 2 respiratory states. Main Outcome Measures: The subject recorded when they changed between the 2 respiratory states, whether the investigator identified with the change occurred, and if the correct respiratory state was identified. Results: The investigator recognized when the subject changed respiratory states and correctly identified the new respiratory state 100% of the time. Conclusions: The findings of the current study were promising and suggest that ultrasound may have utility in the diagnosis of VCD. However, because of the preliminary nature of these results, further research is required before recommending its clinical implementation.

ObjectiveThe primary aim of this study was to determine the inter‐ and intrarater reliability of ultrasound (US) measurements of the ischiofemoral space (IFS) following a brief training session. A secondary aim was to determine if reliability correlated with sonographer experience.DesignProspective cohort study.SettingPhysical medicine and rehabilitation department within a tertiary care institution.ParticipantsSeven male and 3 female individuals were recruited to serve as models. Nine physician sonographers (3 postgraduate year [PGY]‐2 residents, 3 PGY‐4 residents, 3 physicians) were recruited to serve as sonographers.Methods or InterventionsSonographers received a 15‐minute educational session on identifying the IFS with US, followed by 20 minutes of practice. Models were then placed in a prone position and secured to prevent hip movement. All operators measured bilateral IFSs in each model twice with a washout period between measurements. Operators were blinded to all measurements.Main Outcome MeasuresPrimary outcomes were inter‐ and intrarater reliability interclass coefficients (ICCs) of IFS measurements among the groups with different levels of US experience. Secondary outcomes included comparisons of inter‐ and intrarater reliability ICCs of IFS measurements between groups, and the difference of mean IFS measurements between groups.ResultsIntrarater reliability ICCs were 0.829, 0.680, and 0.596 for physician, PGY‐4, and PGY‐2 groups, respectively. Interrater reliability ICCs were 0.722, 0.427, and 0.558 for physician, PGY‐4, and PGY‐2 groups, respectively. No statistically significant differences in reliability were identified between groups. Mean IFS measurements were 31.2, 33.4, and 34.0 mm for physician, PGY‐4, and PGY‐2 groups, respectively. Physician measurements were significantly smaller than the PGY‐4 and PGY‐2 measurements (P < .049 and P < .01).ConclusionsFollowing a brief training session, experienced sonographers demonstrated excellent IFS measurement intrarater reliability, whereas PGY‐4 and PGY‐2 sonographers demonstrated fair intrarater reliability. All sonographers demonstrated fair interrater reliability.Level of EvidenceII

A 33-year-old elite female runner presented to a tertiary care sports medicine clinic with a 2-year history of progressive anterior thigh and circumferential leg pain with associated foot paresthesias brought on by high-intensity running. She had both external iliac artery vasospasm and chronic exertional compartment syndrome. External iliac artery vasospasm is a rare cause of exertional leg pain, particularly in the running population. This case highlights the unique features of this condition, addresses the multidisciplinary approach that led to the accurate diagnoses, and demonstrates that more than 1 etiology for exertional leg pain can coexist in an athlete.