Jennifer K McDonald

Deep gluteal syndrome: role of ultrasound in its diagnosis A 54-year-old patient with left paravertebral low back pain with gluteal and lower limb radiation of 16 months' duration. In the MRI of the hemipelvis, a fibrous band can be seen that is attached to the anterior face of the sciatic nerve, extending laterally to the greater trochanter and medially to the ischial tuberosity and the quadratus femoris muscle, corresponding to type 3 of the Hernando classification. Dynamic ultrasound is performed, which shows reduced mobility of the sciatic nerve during knee and hip extension (comparative video of normal neural mobility: facebook.com/watch/?v=49781…). Ultrasound has little value for the primary diagnosis of visualization of perineural fibrous bands, although it can often be appreciated a posteriori, guided by the findings in MRI. This could be useful for realizing fenestrations of the fibrosis after perineural infiltration using ultrasound control. The great utility of ultrasound is the assessment of the mobility of the sciatic nerve during neurodynamic exercises, which in cases where it is decreased compared to the contralateral nerve, can be used as a secondary sign for the diagnosis of DGS.

Posterior parietal insufficiency of the inguinal canal (sport hernia): ultrasound diagnosis The patient has had left pubic and groin pain for three months, which prevents him from hitting and changing direction while playing soccer. On examination, he presented pain along the inguinal canal, at the insertion of the inguinal ligament on the pubic tubercle, and the insertion of the oblique and transverse muscles on the iliac crest. To rule out sport hernia, a dynamic ultrasound of the left inguinal canal is performed during Russian twist exercise (which mainly exercises the internal oblique muscle), observing deformity and bulging of the posterior wall of the inguinal canal, unlike the asymptomatic contralateral side. The patient is referred to the abdominal wall surgery service, which performs an operation that confirms the clinical and ultrasound diagnosis.

Save the date for our 2024 Annual Scientific Meeting! ⨠ Stay tuned for updates at canadianpainsociety.ca 🍁 Rendez-vous en 2024 pour la Réunion scientifique annuelle! ⨠ Restez à l’affût des nouveautés sur canadianpainsociety.ca #CanadianPain24 #DouleurCanada24

Quick trip to #AAPMR2023 #PhysiatryDay Superdome with @mittalnimish

Shoulder session live hands on scanning going on at ⁦@AAPMR⁩ . We are here until 930 AM. #AAPMR2023

Join us tomorrow November 17th at 815 AM in the Learning center for a live hands on scanning session on Shoulder Ultrasound. ⁦@AAPMR⁩ ⁦@AAPhysiatrists⁩ #AAPMR2023

All (maybe) the biceps pulley injuries resumed in 40 seconds. #mskrad

MRI guide to locate the inferior calcaneal nerve, first branch of the lateral plantar nerve (Baxter’s nerve). There are three possible entrapment sites: 1. Deep or adjacent to the fascial border of a hypertrophied abductor hallucis muscle. 2. Along the medial border of the quadratus plantae muscle. 3. Adjacent to the medial calcaneal tuberosity. Next, US. #mskrad

Medial meniscus extrusion is a common painful condition in early knee ostheoarthritis. If correctly diagnosed as the main pain source, ultrasound-guided perimeniscal injection therapy may be helpful! How and why? A short thread 🧵 1/n

@PetitDerek @DrJN_SportsMed For true ACNE (which I don’t see often) I do same as @DrJN_SportsMed

@DrJN_SportsMed @JenniferKShea You do these more superficial, no?

Consent ✅ Runner, burning abdominal pain when exercising, felt along lateral rectus (linea semilunaris) at level of umbilicus Possible ACNE syndrome (abdominal cutaneous nerve entrapment) Challenging to visualise nerve on US (see image) Diagram - correlating schematic of nerve passage through RA and entrapment point Video - US guided block (hard to visualise needle at depth but can see injectate filling area surrounding nerve)

Omg! Frozen shoulder in the 1930’s was thought to be due to “run down histrionic ”women in the literature!!! #adhesive capsulitis. Listening to the expert Dr Jennifer McDonald. @JenniferKShea

Call out for volunteers at CAPM&R!

Have to share this - incredible pics and unravels ambiguity re Morton’s and bursal pathology beautifully linkedin.com/posts/gonzalo-…

Barbotage of calcific tendinopathy (pics from today) is valuable US guided procedure. Generally, calcific deposits more than 5mm linear width and posterior acoustic shadow are amenable to barbotage. Come join to learn at USG workshop CAPMR 2023 meeting. capmr.ca/events/capmr-7…

@anesthesiadocmd @ASRA_Society @ESRA_Society @TexasUltrasound @RegionalAnaesUK @amit_pawa @JohnHagenMD @KalagaraHari @shaskinsMD @Nadia_Hdz_MD @Steve_Coppens @PeterMerjavy @L_D_White @Jerryblocksthat @BlockIt_Hot_Pod 🙋‍♂️ not an anesthesiologist or regional person.. have had multiple successful outcomes with PVB for neuropathic dermatomal lateral and anterior chest pains in cases with failed ESP's done by well trained academic anesthesia pain colleagues (seasoned sonographers).

@PetitDerek @DrJesseMorse “The little prongs here” are transverse processes (not facet joints). The described “tail bone” is the sacrum. Had to stop there- didn’t make it to the end. Let me guess- PRP/stem cells to target the “weak ligaments” is the cure?

@DrJesseMorse Yikes. Only thing I agree with here is hip pathology mimicking back pain

Back pain explained! Herniated disk? Sciatica? I try to simplify these common topics for you, as if you were standing in front of me as one of my patients. Watch & share!

@DrJN_SportsMed @PetitDerek will have some thoughts

Clinicians thoughts on the lever (or Lelli’s) test for ACL tear? Vs Lachman’s etc I’ve had 2 patients out of 10 in last 3 months with a false negative test and ACL disruption confirmed on subsequent MRI

@TJQPNI @MismatchN There is axonal loss given the muscle atrophy. I would be shocked if deltoid is normal on EMG. I also see ? Myokymia posteriorly in ? teres major- that is not normally innervated muscle.

@MismatchN Has been requested but clinical examination provides the diagnosis. The question I have posed for neurophysiology is - is this a conduction block pathology or likely now degenerative(fibs/pSW) . Also is the upper trunk also involved (are there altered MUAPS in deltoid/biceps) ?

[With consent] What can you notice about this individual? He has had difficult lifting his left arm for 15 months.

Nope

@DrJN_SportsMed @PetitDerek MR neurography would be ideal.

@JenniferKShea @PetitDerek yes i suppose depends on quality of mri - and whether rad specifically looking for it…

Very interesting I do wonder re endometriosis sometimes in my DGS cases They are all female, premenopausal & some do describe variation in pain across menstrual cycle