Review of Inpatient Musculoskeletal Consults Utilizing Musculoskeletal Ultrasound Mindy Loveless, MD Clinical Assistant Professor University of Washington

Disclosure I have NO RELEVANT financial disclosures

Outline Introduction Demographics Review of Consults Outcomes

Introduction RIC inpatient musculoskeletal consult service offered in July 2013 This is a retrospective review of consults completed between July 2013 – December 2014

Demographics 50 patients 51 consults Gender: 23 Female (46%) 27 Male (54%) Average Age: 59 (range 18-90)

Admission Information Average length of stay: 40 days (range days) Average time from admission to consult: 16 days (range 0-78 days) Average time to completion of consult: 3 days (range 0-13 days) All but 1 completed within 1 week

Primary Rehab Diagnosis

Reason for MSK Consult

MSK Consult Diagnoses Shoulder Rotator cuff tear Arthritis (glenohumeral and acromioclavicular) Adhesive capsulitis Bursitis Pain due to weakness, atrophy, spasticity, and/or subluxation Calcific tendinopathy Possible brachial plexopathy Myofascial pain/trigger points Tendinopathy Slow-healing fracture (in setting of female athlete triad) Arm Critical illness myopathy/neuropathy Elbow Heterotopic ossification Wrist Tendonitis Hip Osteoarthritis Greater trochanteric pain syndrome Knee Osteoarthritis Bursitis ACL tear Muscle strain Possible lumbar radicular pain Foot Morton’s neuroma Trauma

Injections Performed Glenohumeral (N=16) Subacromial (N=7) Knee (N=4) Hip (N=2) Trigger point (N=2) Gluteus medius tenotomy (N=1) Biceps tendon sheath (N=1)

Reasons for No Injection Not Indicated (N=12) Recommended further work-up (N=5) Recommended supportive measures (N=4) No pain (N=3) Patient Declined Offered Injection (N=5) Timing of Prior Injection (N=1)

OUTCOMES

POST-STROKE SHOULDER PAIN

Post-Stroke Shoulder Pain 14/20 stroke consults had shoulder pain –12/14 hemiplegic side  8/12 underwent injection –6 glenohumeral, 2 subacromial  4/12 declined offered injection –2/14 non-hemiplegic side  Both underwent subacromial injection

Outcomes: Hemiplegic Shoulder Pain

Outcomes: Non-Hemiplegic Shoulder Pain

LOWER EXTREMITY PAIN

Outcomes: Consults with Lower Extremity Complaints 12 consults for lower extremity pain 7/12 received injections –4 knee, 2 hip, 1 gluteus medius tenotomy 5/12 did not receive injection –2 recommended further work-up –2 had no indication for injection –1 declined offered injection

Outcomes: Consults with Lower Extremity Complaints

OTHER OUTCOMES

Outcomes: Pain – All Consults 7 patients had no post-consult pain 5 received injection 2 did not receive injection 12 patients had ≥ 2 point reduction in maximum pain score post-consult 9 received injection 3 did not receive injection

Outcomes: Medications – All Consults 15 patients who received injection were on opiates prior –3/15 (20%) discontinued use of opiates following injection One patient discontinued use of lidocaine patch and one reduced use of acetaminophen

Summary 51 consults completed over 18 months Most common primary rehab diagnosis was stroke Most common reason for consultation was shoulder pain Improvements in FIM scores seen post- injection Several patients discontinued opiates and many had significant improvement in pain