Review of Inpatient Musculoskeletal Consults Utilizing Musculoskeletal Ultrasound Mindy Loveless, MD...
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Transcript of Review of Inpatient Musculoskeletal Consults Utilizing Musculoskeletal Ultrasound Mindy Loveless, MD...
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 10-109 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
40%
18%
12%
6%
6%
4%4%
4%
2% 2% 2% Stroke, N=20
Tetraplegia, N=9
Medically Complex, N=6
Other Neurologic, N=3
Paraplegia, N=3
TBI, N=2
Ortho, N=2
Non-Traumatic Brain Injury, N=2
Polytrauma, N=1
Burn, N=1
Amputation, N=1
Reason for MSK Consult
63%14%
4%
4%2%2%
2%2% 2%2%2% 2% Shoulder Pain, N=32
Knee Pain, N=7Foot Pain, N=2Hip Pain, N=2Knee Swelling, N=1Shoulder Weakness, N=1Evaluate Biceps Tendon, N=1Thigh Pain, N=1Elbow Pain, N=1Chronic Pain, N=1Wrist Pain, N=1Arm Pain, N=1
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
-20 -15 -10 -5 0 5 10 15 200
1
2
3
4
5
6
Upper Extremity Dressing FIMsHemiplegic Shoulder Pain - Injection
Days From Injection
-20 -15 -10 -5 0 5 10 15 200
1
2
3
4
5
6
7
Upper Extremity Dressing FIMsHemiplegic Shoulder Pain – No Injection
Days From Consult
Outcomes: Non-Hemiplegic Shoulder Pain
-20 -15 -10 -5 0 5 10 15 200
1
2
3
4
5
6
Upper Extremity Dressing FIMsNon-Hemiplegic Shoulder Pain - Injection
Days From Injection
LOWER EXTREMITY PAIN
Outcomes: Consults withLower 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 withLower Extremity Complaints
-25 -15 -5 5 15 250
1
2
3
4
5
6
7
Ambulation FIMs – No Injection
Days From Consult
-25 -20 -15 -10 -5 0 5 10 15 20 250
1
2
3
4
5
6
7
Ambulation FIMs - Lower Extremity Injection
Days From Injection
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