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

2. Disclosure I have NO RELEVANT financial disclosures

3. Outline Introduction Demographics Review of Consults Outcomes Summary

4. 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

5. Demographics Gender: 23 Female (46%) 27 Male (54%) Average Age: 58.9 (range 18-90)

6. 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

7. Primary Rehab Diagnosis

8. 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)

9. 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

10. 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)

11. POST-STROKE SHOULDER PAIN

12. 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

13. Outcomes: Hemiplegic Shoulder Pain

14. Outcomes: Non-Hemiplegic Shoulder Pain

15. OTHER OUTCOMES

16. Outcomes: Lower Extremity Complaints

17. 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

18. 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

19. 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