Ultrasound Use to Facilitate Challenging Procedures...
Transcript of Ultrasound Use to Facilitate Challenging Procedures...
Ultrasound Use to Facilitate Challenging Procedures in
Pediatric Rehabilitation Medicine
Troy Henning DO
Maurice Sholas MD, PhD
Rita Ayyangar MD- Course Director
Course 401 Thursday Nov 13, 2014
11:30 am to 1 pm
AAPMR Annual Assembly, San Diego 2014
Course Objectives
Learning Objective #1
Participants will demonstrate an understanding of the basic physics of ultrasound and techniques used for injection procedures in PRM including botulinum toxin injections, phenol nerve blocks, SI joint injections and Baclofen pump refills
Learning Objective #2
Participants will be able to describe ultrasound echotexture properties of muscle, nerve and tendon in longitudinal and cross section.
Learning Objective #3
They will be familiar with navigation of the coding, billing and credentialing processes surrounding US guided injection procedures common to PRM practice
Outline
Introduction
Disclosures
Brief review of challenges encountered in
common PRM procedures
US guidance- the basics
US guidance- procedure specific examples
Nuts and Bolts re: privileges and coding
Botulinum Toxin Injections
Usual Methods ( could be in combination)
Palpation
Electrical Stim/EMG
US guidance
Conditions
Torticollis
Drooling (will not be covered in this course)
Spasticity- upper and lower limbs
Muscle imbalance- Neonatal Brachial Plexopathy
Chemical Neurolysis
Phenol nerve blocks
Musculocutaneous
Obturator nerves
US guidance facilitates localization but E-stim
still necessary
Sacroiliac Joint Injections
SI joint dysfunction common cause of
biomechanical low back pain
Neuromuscular scoliosis with instrumentation to
pelvis
May be particularly problematic in CP
Tight hamstrings compound problem
Baclofen Pump
Trials
Facilitates Lumbar Puncture
Refills
Obesity
Flipped pump?
Bibliography
• Mehmet Zekai Pekkafalı, MD, Mehmet Zeki Kıralp, MD, Cıhat Çinar Ba¸sekim, MD, Emir
¸Silit, MD, Hakan Mutlu, MD, Ersin Öztürk, MD, E¸sref Kızılkaya, MD, Hasan Dursun,
MD: Sacroiliac Joint Injections Performed With Sonographic Guidance. JUM June 1,
2003 vol. 22 no. 6 553-559
• Yang TF, Wang GC, Chiu JW, Lai CJ, Chan RC, Lee SS: Ultrasound-guided refilling of an
intrathecal baclofen pump--a case report. Childs Nerv System 2013 Feb;29(2):347-9.
• Westhoff B, Seller K,Wild A, Jaeger M, Krauspe R: Ultrasound-guided botulinum toxin
injection technique for the iliopsoas muscle. Child Neurol 2003 Dec;45(12):829-32.
• Rha DW, Han SH,,,Kim HJ, Won SY, Lee SC: Ultrasound-guided lateral approach for
needle insertion into the subscapularis for treatment of spasticity. Arch Phys Med
Rehab . 2012 Jul;93(7):1147-52.
• Soldado F, Fontecha CG Marotta M,Benito D, Casaccia M Mascarenhas W ,
ZlotolowD5,Kozin SH: The role of muscle imbalance in the pathogenesis of shoulder
contracture after neonatal brachial plexus palsy: a study in a rat model. J Should
Elbow Surg 2014 Jul;23(7):1003-9
• Yalcin E, Akyuz M Ilgu O, Ozer NB. Ultrasonographically guided obturator nerve block
for bilateral adductor spasticity in a paraplegic patient. Spinal Cord (2014) 52, S24–S26
Enjoy the Course!