Hurdle, Mark Friedrich B.

Background: Spinal synovial cysts are cystic dilatations of synovial sheaths that extrude into the spinal canal. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures. They are most commonly found in the lumbar spine and are rare in the cervical region, especially at the atlanto-occipital junction. Case Description: A 65-year-old presented with neck pain and headaches. The magnetic resonance imaging (MRI) revealed a degenerative cyst within the anterior foramen magnum causing anterior spinal cord and brainstem compression. Multiple surgical treatment options were discussed, and he was prescribed methylprednisolone and immobilization of his cervical spine with a rigid collar. One month later, the patient reported dramatic improvement of his symptoms, and no surgery was performed. One year later, his pain had remained much improved with the continued use of the collar and pain management (i.e., using anti-inflammatories and muscle relaxants). The 1-year follow-up MRI showed the atlanto-occipital cyst compressing the cervicomedullary junction had completely resolved along with the brainstem compression. Conclusion: A 65-year-old presented with myelopathy attributed to a large anterior foramen magnum atlanto-occipital cyst compressing the cord. Conservative management for 1 month with a rigid cervical collar and steroids resulted in marked neurological improvement; at 1 year follow-up, the patient was markedly improved with an MR that demonstrated spontaneous cyst regression.

Abstract Diversity, equity, and inclusion have been recognized as important drivers of excellence and innovation in the physician workforce. Given the historical underrepresentation of women in medicine, gender diversity is of interest. In this cross-sectional study, we sought to quantify leadership representation of female physicians in primary care sports medicine settings, including primary care sports medicine fellowship programs, select sports medicine societies, and select sports medicine-related scientific journals. Data were collected by querying the corresponding web site for each fellowship program, society, and journal and analyzed in a descriptive manner. Results showed that fewer female physicians hold primary care sports medicine leadership roles than men do. This work establishes a baseline for female representation in primary care sports medicine leadership; efforts should continue to increase the presence of women in leadership positions.

Abstract Introduction Greater trochanteric pain syndrome may often mimic pain generated from other sources. However, it is most commonly caused by gluteus medius and gluteus minimus tendinopathy or tear. The purpose of this technical report was to: 1) describe the ultrasound-guided fascial plane block technique targeting the superior gluteal nerve in the plane between gluteus medius/gluteus minimus to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome; 2) anatomically correlate the procedure with cadaveric dissections demonstrating the structures being imaged and the tissues along the needle trajectory; 3) demonstrate the feasibility of the technique with serial dissection of one cadaveric specimen following injection with color dye. Technique description The ultrasound-guided fascial plane block targeting the superior gluteal nerve to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome has been outlined with supporting ultrasound scans and anatomical dissections. The cadaveric dissections are correlated to the ultrasound scans of a healthy volunteer and provide visualization of the tissues in the needle trajectory. The feasibility study in a cadaveric specimen showed adequate stain of the superior gluteal nerve without spread to the piriformis muscle belly, the sciatic nerve, or the inferior gluteal nerve. Conclusions This ultrasound-guided fascial plane block is a feasible option for blocking the superior gluteal nerve without inadvertent involvement of the sciatic and inferior gluteal nerves. Further randomized controlled clinical trials are necessary to assess the clinical efficacy of the gluteus medius/gluteus minimus fascial plane block to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome.

Objective: To evaluate the comprehensiveness of primary care sports medicine fellowship websites and identify potential areas of improvement. Design: Cross-sectional analysis of fellowship program websites using quantitative and descriptive statistics. Setting: Internet. Participants: A total of 192 primary care sports medicine fellowship websites listed on the Electronic Residency Application Service (ERAS) website. Independent Variables: Program Specialty and Program Region. Main Outcome Measures: The presence or absence of 19 predetermined criteria on primary care sports medicine fellowship websites. Results: The average number of criteria that was included on each website was 9.8 (SD 3.5) (51.6%) of the possible 19. Programs had as few as 2 of the 19 (10.5%) criteria included on their website, and others had as many as 17 of the 19 (89.4%) criteria. Of the 192 primary care sports medicine fellowships, only 5 (2.6%) addressed at least 80% of the 19 different criteria. No primary care sports medicine fellowship website included all 19 criteria. Conclusions: Most primary care sports medicine fellowship websites do not offer comprehensive information about their programs for prospective applicants.

Over the last two decades, the clinical applications of diagnostic and interventional ultrasound have expanded rapidly. When analyzing the chest wall and thoracic region, ultrasound has previously been shown to reliably identify chest wall pathologies like rib fracture and slipping rib syndrome, as well as having fundamentally changed perioperative management and patient outcomes after the emergence of point-of-care ultrasound. In addition, ultrasound guidance has recently become more popular for multiple blocks in the field of regional anesthesia and pain medicine. In this technical report, we systematize an ultrasound-guided protocol for counting ribs and thoracic levels for both posterior and anterior approaches, which does not require level confirmation by fluoroscopy. With this protocol, we hope to create an effective educational resource to support physicians from any specialty background as they engage in point-of-care ultrasound applications in the thoracic region.

AbstractObjectiveThis case report presents an application of percutaneous peripheral nerve stimulation to the right superficial peroneal nerve to treat a patient with chronic intractable L5–S1 radiculopathy pain that conventional treatment failed to ameliorate.MethodsThe patient underwent an uneventful implantation of a percutaneous peripheral nerve stimulator. The implanted lead (15 cm in length and 1.2 mm in diameter) containing the receiver coil and 3 stimulation electrodes (Bioness Stimrouter®, Valencia, CA, U.S.A.) was implanted parallel with the trajectory of the right superficial peroneal nerve.ResultsTwo weeks after implantation of the percutaneous peripheral nerve stimulator, the patient experienced excellent pain relief and reported a significant increase in mobility. At the 3‐month follow‐up consultation, the patient reported maintenance of the reduction of pain in his right lower extremity as well as improved performance in his daily activities.ConclusionPercutaneous peripheral nerve stimulation offers an alternative treatment option for intractable pain associated with chronic radiculopathy, especially for patients in whom conventional treatment options have been exhausted. Further clinical series involving larger numbers of patients are warranted in order to assess the definitive role of percutaneous peripheral nerve stimulation for the treatment of chronic intractable radiculopathy pain.