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Piriformis Syndrome Is Overdiagnosed 11 Robert A American Association of Neuromuscular & Electrodiagnostic Medicine AANEM CROSSFIRE: CONTROVERSIES IN NEUROMUSCULAR AND ELECTRODIAGNOSTIC MEDICINE Loren M. Fishman, MD, B.Phil Robert A.Werner, MD, MS Scott J. Primack, DO Willam S. Pease, MD Ernest W. Johnson, MD Lawrence R. Robinson, MD 2005 AANEM COURSE F AANEM 52ND Annual Scientific Meeting Monterey, California CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Loren M. Fishman, MD, B.Phil Robert A.Werner, MD, MS Scott J. Primack, DO Willam S. Pease, MD Ernest W. Johnson, MD Lawrence R. Robinson, MD 2005 COURSE F AANEM 52nd Annual Scientific Meeting Monterey, California AANEM Copyright © September 2005 American Association of Neuromuscular & Electrodiagnostic Medicine 421 First Avenue SW, Suite 300 East Rochester, MN 55902 PRINTED BY JOHNSON PRINTING COMPANY, INC. ii CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Faculty Loren M. Fishman, MD, B.Phil Scott J. Primack, DO Assistant Clinical Professor Co-director Department of Physical Medicine and Rehabilitation Colorado Rehabilitation and Occupational Medicine Columbia College of Physicians and Surgeons Denver, Colorado New York City, New York Dr. Primack completed his residency at the Rehabilitation Institute of Dr. Fishman is a specialist in low back pain and sciatica, electrodiagnosis, Chicago in 1992. He then spent 6 months with Dr. Larry Mack at the functional assessment, and cognitive rehabilitation. Over the last 20 years, University of Washington. Dr. Mack, in conjunction with the Shoulder he has lectured frequently and contributed over 55 publications. His most and Elbow Service at the University of Washington, performed some of the recent work, Relief is in the Stretch: End Back Pain Through Yoga, and the original research utilizing musculoskeletal ultrasound in order to diagnose earlier book, Back Talk, both written with Carol Ardman, were published shoulder pathology. After leaving the University of Washington, Dr. in 2005 and 1997, respectively, by W. W. Norton. At Albert Einstein Primack founded Colorado Rehabilitation and Occupational Medicine. College of Medicine, Dr. Fishman was Chief Resident in the Department He has collaborated on multiple research projects analyzing musculoskele- of Rehabilitation Medicine, and completed his General Medical tal ultrasound utility for muscle and nerve injuries. He is completing his Internship, in the Joint Tufts-Harvard Program, at Lemuel Shattuck requirements for ultrasound certification. Currently, he is the medical Hospital, in Boston. He received his MD degree in 1979 from Rush director for Special Olympics Colorado. Dr. Primack is also a clinical Presbyterian St. Lukes Medical College, Chicago, Illinois; earned his instructor in rehabilitation at Western University College of Osteopathic Bachleor of Philosophy of Mathematics from Christ Church, Oxford Medicine. University, England in 1966; and a Bachelor of Science degree with high honors from the University of Michigan, in 1962. Dr. Fishman is present- William S. Pease, MD ly Associate Editor of Topics in Geriatric Rehabilitation. He is an assistant clinical professor at Columbia College of Physicians and Surgeons in New Chair York, and at the Medical College of Wisconsin in Milwaukee. He is also in Department of Physical Medicine and Rehabilitation private practice in Manhattan. Ohio State University Columbus, Ohio Robert A. Werner, MD, MS Dr. Pease earned his medical degree in 1981 from the University of Professor Cincinnati College of Medicine, and performed a residency in physical Department of Physical Medicine and Rehabilitation medicine and rehabilitation at The Ohio State University Medical Center in 1984. He presently serves as the Ernest W. Johnson Professor and University of Michigan Chairperson in the Department of Physical Medicine and Rehabilitation Ann Arbor, Michigan at The Ohio State University College of Medicine. He is also Medical Dr. Werner earned his medical degree from the University of Connecticut Director of Dodd Rehabilitation Hospital at the Ohio State University and his masters of science at the University of Michigan. He is currently a Medical Center. Dr. Pease is a member of the Editorial Board of The professor in the Department of Physical Medicine and Rehabilitation at American Journal of Physical Medicine and Rehabilitation and has authored the University of Michigan in Ann Arbor. He is also Chief of the Physical over 40 publications, including the textbook Practical Electromyography, Medicine and Rehabilitation Service at Ann Arbor Veterans which is in its third edition. Administration Medical Center in Ann Arbor. Dr. Werner is active in sev- eral professional organizations including the American Academy of Physical Medicine and Rehabilitation, the Association of Academic Physiatrists, and the Michigan Academy of Physical Medicine and Rehabilitation. Dr. Werner is also active in the AANEM and has served on the AANEM Board of Directors and the Research, Program, and Professional Practice committees. Course Chair: Jeffrey A. Stakowski, MD The ideas and opinions expressed in this publication are solely those of the specific authors and do not necessarily represent those of the AANEM. iii Ernest W. Johnson, MD Lawrence R. Robinson, MD Emeritus Professor Professor Department of Physical Medicine and Rehabilitation Department of Rehabilitation Medicine Ohio State University University of Washington Columbus, Ohio Seattle, Washington Dr. Johnson received his medical degree from Ohio State University in Dr. Robinson attended Baylor College of Medicine and completed his res- Columbus, Ohio, interned at Philadelphia General Hospital, and complet- idency training in rehabilitation medicine at the Rehabilitation Institute of ed his residency in physical medicine and rehabilitation at Ohio State Chicago. He now serves as professor and chair of the Department of University under the sponsorship of the National Foundation of Infantile Rehabilitation Medicine at the University of Washington and is the Paralysis. He has edited the textbook Practical EMG, and authored over Director of the Harborview Medical Center Electrodiagnostic Laboratory. 143 peer-reviewed articles. He established the Super EMG continuing He is also currently Vice Dean for Clinical Affairs at the University of medical education course in 1978, and is still involved in planning and Washington. His current clinical interests include the statistical interpreta- teaching this course. Currently, Dr. Johnson is an emeritus professor at tion of electrophysiologic data, laryngeal electromyography, and the study Ohio State University. He has conducted research on electrodiagnostic of traumatic neuropathies. He recently received the Distinguished medicine in recurrent carpal tunnel syndrome and the use of H waves in Academician Award from the Association of Academic Physiatrists and this upper limb radiculopathies. Dr. Johnson is a past-president of the year is receiving the AANEM Distinguished Researcher Award. AANEM, AAPM&R, AAP, former chair of the American Board of Electrodiagnostic Medicine, and has been editor of the American Journal of Physical Medicine and Rehabilitation. iv AANEM Course v CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Contents Faculty ii Objectives iii Course Committee vi Piriformis Syndrome is Underdiagnosed 1 Loren M. Fishman, MD, B. Phil Piriformis Syndrome is Overdiagnosed 11 Robert A. Werner, MD, MS Musculoskeletal Ultrasound has Potential Clinical Utility 15 Scott J. Primack, DO Musculoskeletal Ultrasound has Limited Clinical Utility 19 Willam S. Pease, MD Tarsal Tunnel Syndrome is Underdiagnosed 23 Ernest W. Johnson, MD Tarsal Tunnel Syndrome is Overdiagnosed 29 Lawrence R. Robinson, MD CME Self-Assessment Test 33 Evaluation 35 Member Benefit Recommendations 37 Future Meeting Recommendations 39 Please be aware that some of the medical devices or pharmaceuticals discussed in this handout may not be cleared by the FDA or cleared by the FDA for the spe- cific use described by the authors and are “off-label” (i.e., a use not described on the product’s label). “Off-label” devices or pharmaceuticals may be used if, in the judgement of the treating physician, such use is medically indicated to treat a patient’s condition. Information regarding the FDA clearance status of a particular device or pharmaceutical may be obtained by reading the product’s package labeling, by contacting a sales representative or legal counsel of the manufacturer of the device or pharmaceutical, or by contacting the FDA at 1-800-638-2041. O BJECTIVES—Attending this course will provide the participant the opportunity to discuss (1) whether tarsal tunnel syndrome is over- diagnosed or underdiagnosed, (2) whether piriformis syndrome is overdiagnosed or underdiagnosed, and (3) the clinical utility of muscu- loskeletal ultrasound. P REREQUISITE—This course is designed as an educational opportunity for residents, fellows, and practicing clinical EDX physicians at an early point in their career, or for more senior EDX practitioners who are seeking a pragmatic review of basic clinical and EDX prin- ciples. It is open only to persons with an MD, DO, DVM, DDS, or foreign equivalent degree. A CCREDITATION S TATEMENT—The AANEM is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. CME CREDIT—The AANEM designates attendance at this course for a maximum of 3.25 hours in category 1 credit towards
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