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Carpal Tunnel Syndrome and Injections 3 Suehun G INJE cti ON Ryan O’Connor, DO Suehun G. Ho, MD J. Steven Schultz, MD Andrew J. Haig, MD Anthony E. Chiodo, MD ����� 2007 AANEM Course G AANEM 54thAnnual Meeting Phoenix, Arizona American of Association Neuromuscular & Electrodiagnostic Medicine Injection Ryan C. O’Connor, DO Suehun G. Ho, MD J. Steven Schultz, MD Andrew J. Haig, MD Anthony E. Chiodo, MD 2007 COURSE G AANEM 54th Annual Meeting Phoenix, Arizona Copyright © October 2007 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 PRINTED BY JOHNSON PRINTING COM P ANY , IN C . ii Injection Faculty Ryan C. O’Connor, DO J. Steven Schultz, MD Clinical Assistant Professor Associate Professor Department of Physical Medicine and Rehabilitation Department of Physical Medicine and Rehabilitation Michigan State University University of Michigan East Lansing, Michigan Ann Arbor, Michigan Dr. O’Connor completed premedical training at The American University Dr. Schultz received his medical degree from the University of Michigan in in Washington, DC and is a graduate of Nova-Southeastern University Ann Arbor, where he also completed a residency in physical medicine and College of Osteopathic Medicine in Fort Lauderdale-Davie, Florida. He rehabilitation. He is an Associate Professor in the Department of Physical completed a 1-year medical internship at Palmetto General Hospital in Medicine and Rehabilitation (PMR) at the Univerisity of Michigan Health Miami, Florida and did his residency training in physical medicine and System and Service Chief of the University of Michigan Spine Program. rehabilitation at the Albert Einstein College of Medicine/Montefiore He also served as Program Director of the PMR Pain Fellowship. His clini- Medical Center in New York City. After completing a residency in 1999, cal interests include interventional treatment of spine disorders, athletic Dr. O’Connor performed a clinical fellowship in sports and electrodiag- nerve injuries and performing arts medicine. Dr. Schultz has served on the nostic medicine at Michigan State University. He is board-certified by the AANEM Training Program, Workshop, and Course Committees and is American Board of Physical Medicine and Rehabilitation (ABPMR), the currently a member of the ABEM Examination Committee. American Board of Electrodiagnostic Medicine, and has a subspecialty board certification in pain medicine by the ABPMR. He has an academic appointment as clinical assistant professor in PMR at Michigan State Andrew J. Haig, MD University, and is a consultant to the Michigan State University Spartan Professor athletic department. Department of Physical Medicine and Rehabilitation University of Michigan Suehun G. Ho, MD Ann Arbor, Michigan Clinical Instructor Dr. Haig is a professor of Physical Medicine and Rehabilitation at the University of Michigan and volunteer faculty at the Medical College of Department of Physical Medicine and Rehabilitation Wisconsin. He is an expert on spinal disorders, leadership in rehabilitation, University of Michigan and multidisciplinary rehabilitation. He is author of over 100 scientific Ann Arbor, Michigan articles and a textbook, on the editorial board of five journals, and prin- Dr. Ho received her medical degree from Northeastern Ohio Universities cipal investigator for the National Institutes of Health-funded Michigan College of Medicine in Rootstown, Ohio. She completed a physical Spinal Stenosis Study. Among his accomplishments, he performed the medicine and rehabilitation residency and pain management fellowship at first randomized trials of multidisciplinary team assessment and the first the University of Michigan. She is board-certified by the American Board masked, controlled research trials of electrodiagnostic medicine. His work of Physical Medicine and Rehabilitation and has a subspecialty board has been honored with the American Academy of Physical Medicine and certification in pain medicine. Dr. Ho is working on sustainable medical Rehabilitation Richard and Hinda Rosenthal Award, listing on three na- rehabilitation program development with her colleagues in Ghana, West tional best doctor awards, and the University of Medicine and Dentistry Africa. of New Jersey’s national best teacher award. An executive board member of the International Society of Physical and Rehabilitation Medicine, Dr. Haig is working with West African countries to build their national reha- bilitation programs. Course Chair: Anthony E. Chiodo, 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 Anthony E. Chiodo, MD Associate Professor Department of Physical Medicine and Rehabilitation Director of Spinal Cord Injury Medicine University of Michigan Medical Center Ann Arbor, Michigan After completing his medical school training in his home state at the University of Connecticut Health Center, Dr. Chiodo started his physi- atric career at the University of Michigan Hospital where he completed his residency and neuromuscular fellowship. He had a private practice in Pediatric Rehabilitation at Methodist Hospital in Indianapolis and was the Medical Director of Physical Medicine and Rehabilitation in Farmington, New Mexico on the border of the Navajo reservation, Dr. Chiodo returned to the University of Michigan in 1998. His academic areas of interest include anatomic localization in electromyography, lumbosacral plexopa- thy after pelvic trauma, and clinic electrodiagnostics. He is board-certified in pain medicine and spinal cord injury, applying his research emphasis in electrodiagnostics to those areas of specialty as well. He has continued his work in the care for the disabled in underserved areas that he started in New Mexico by working on sustainable medical rehabilitation program development in Ghana, in West Africa. Authors had nothing to disclose. 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 specific 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 indi- cated 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. iv v Injection Contents Faculty ii Objectives iii Preactivity Questions v Course Committee vi Elbow/Lateral Epicondylar Injection 1 Ryan C. O’Connor, DO Carpal Tunnel Syndrome and Injections 3 Suehun G. Ho, MD Lumbar Facet and Sacroiliac Joint Injections in the Diagnosis and Management of Low Back Pain 9 J. Steven Schultz, MD Trochanteric Bursitis and Lateral Hip Pain 15 Andrew J. Haig, MD Plantar Fascia/Heel Injection 21 Ryan C. O’Connor, DO Trigger Point Injections 23 Anthony E. Chiodo, MD Activity and Faculty Evaluation 27 CME Self-Assessment Test 29 O BJECTIVES —After attending this session, participants will be able to (1) identify common musculoskeletal conditions that mimic peripheral nerve disorders, (2) understand the pathophysiology and treatment options for these musculoskeletal conditions, and (3) dem- onstrate injection techniques for these musculoskeletal conditions and common nerve entrapments. P REREQUISITE —This course is designed as an educational opportunity for residents, fellows, and practicing clinical EDX physi- cians at an early point in their career, or for more senior EDX practitioners who are seeking a pragmatic review of basic clinical and EDX principles. It is open only to persons with an MD, DO, DVM, DDS, or foreign equivalent degree. A CCREDIT A TI O N ST A TEMENT —The AANEM is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. CME CREDIT —The AANEM is accredited by the ACCME to provide continuing medical education (CME) for physicians. The AANEM designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s) TM. Each physician should only claim credit commensurate with the extent of their participation in the activity. This event is an Accredited Group Learning Activity as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada. CME for this activity is available 10/07 - 10/10. vi AANEM Course AANEM Course vii Pre-activity Questions BEFORE YOU BEGIN THIS ACTIVITY We need your feedback in order to improve future educational activities. On the scantron sheet provided, please rate how important each of the following aspects of the CME activity are to you using this scale: A. Extremely B. Somewhat Instructions for C. Very Little filling out your parSCORE D. Not at all sheet It is important that the CME activity: Using a #2 pencil, fill in your answers 1. Address my most pressing questions. beginning with ques- tion #1. 2. Address competencies identified by my specialty. After completion of 3. Provide fair and balanced content. this activity, go to the back of the book and 4. Provide clear evidence to support content. fill in your answers 5. Include opportunities to learn interactively from faculty and par- beginning with ques- ticipants. tion #10. 6. Provide me with supporting materials or
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