Ultrasound Use to Facilitate Challenging Procedures

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Ultrasound Use to Facilitate Challenging Procedures in Pediatric Rehabilitation Medicine

Course 401 Thursday Nov 13, 2014 11:30 am to 1 pm  Troy Henning DO

 Maurice Sholas MD, PhD  Rita Ayyangar MD- Course Director

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

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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 •

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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!