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Published byLester Wells Modified over 9 years ago
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Review of Inpatient Musculoskeletal Consults Utilizing Musculoskeletal Ultrasound Mindy Loveless, MD Clinical Assistant Professor University of Washington
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Disclosure I have NO RELEVANT financial disclosures
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Outline Introduction Demographics Review of Consults Outcomes Summary
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Introduction RIC inpatient MSK ultrasound consult service offered in July 2013 This is a retrospective review of consults completed between July 2013 – December 2014 50 patients 51 consults
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Demographics Gender: 23 Female (46%) 27 Male (54%) Average Age: 58.9 (range 18-90)
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Admission Information Average length of stay: 39.8 days Average time from admission to consult: 20 days (range 3-82 days) Average time to completion of consult: 3 days (range 0-13 days) All but 1 completed within 1 week
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Primary Rehab Diagnosis
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Reason for MSK Consult Shoulder pain (N=32) Knee pain (N=7) Foot pain (N=2) Hip pain (N=2) Knee swelling (N=1) Shoulder weakness (N=1) Evaluate biceps tendon (N=1) Thigh pain (N=1) Elbow pain (N=1) Chronic pain (N=1) Wrist pain (N=1) Arm pain (N=1)
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MSK Consult Diagnoses Shoulder Rotator cuff tear Arthritis (glenohumeral and acromioclavicular) Adhesive capsulitis Bursitis Pain due to weakness, atrophy, spasticity, and/or subluxation Calcific tendinosis 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 Osteoarthritits Bursitis ACL tear Muscle strain Possible lumbar radicular pain Foot Morton’s neuroma Trauma
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Procedures 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)
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POST-STROKE SHOULDER PAIN
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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
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Outcomes: Hemiplegic Shoulder Pain
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Outcomes: Non-Hemiplegic Shoulder Pain
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OTHER OUTCOMES
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Outcomes: Lower Extremity Complaints
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Outcomes: Pain 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
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Outcomes: Medications 15 patients who received injection were on opiates prior –3/15 (20%) discontinued use of opiates following injection One additional patient discontinued use of Lidoderm patch One additional patient reduced acetaminophen use
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Summary 51 consults completed over 18 months Most common reason for consultation was shoulder pain Most common primary rehab diagnosis was stroke Improvements in FIM scores seen post- injection Many patients discontinued opiates and many had significant improvement in pain
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