Low-Intensity Continuous Ultrasound For The Symptomatic Treatment Of Upper Shoulder And Neck Pain: A Randomized, Double-Blind Placebo-Controlled Clinical Trial, Stephanie Petterson, Kevin Plancher, Dominic Klyve, David Draper, Ralph Ortiz

All Faculty Scholarship for the College of the Sciences

Purpose: Low-intensity continuous ultrasound (LICUS) is an emerging high-dosimetry ultrasound-based therapy for accelerated tissue healing and the treatment of myofascial pain. In this study, LICUS treatment is clinically evaluated for chronic upper neck and shoulder pain in a randomized, multi-site, double-blind, placebo-controlled study. Patients and Methods: CONSORT guidelines were followed in conducting and reporting the clinical trial. Thirty-three participants with upper trapezius myofascial pain were randomized for treatment with active (n=25) or placebo (n=8) devices. Investigators and subjects were blinded to treatment groups. Participants self-reported pain daily, rating from 0– 10 on the numeric rating scale. If pain rating was …

An Investigation Of Stress-Related Factors And Injury Occurrence In Division Iii Ice Hockey Athletes 2020., Christian Kiesel

Master's Theses

Many variables can factor into a student athlete sustaining an injury, but one of the most interesting is stress. The Stress and Injury Model is excellent in explaining how exactly history of stressors, personality, and coping mechanisms play a pivotal role in the stress response. If these three factors cause a negative stress response, then that will lead to an athlete becoming more likely to become injured. This study used 40 ice hockey players from a Division III NCAA institution. Each participant completed the Inventory of College Students’ Recent Life Experiences (ICSRLE) and Pittsburgh Sleep Quality Index (PSQI) every month …

Medial Femoral Condyle Vascularized Bone Graft For Treatment Of Midshaft Clavicle Recalcitrant Nonunion With Use Of The Transverse Cervical Artery As An Anastomosis., Christopher M Belyea, Jefferson L Lansford, Joseph B Golden, Emily H Shin, Rey D L Gumboc

Articles, Abstracts, and Reports

Vascularized medial femoral condyle bone grafts have been reported to be a reliable treatment for recalcitrant bony nonunions of the extremities. Although clavicle fracture nonunions are rare after treatment with open reduction internal fixation, symptomatic nonunions can be a challenge. The medial femoral condyle vascularized bone graft has been described as a treatment option for clavicle nonunions with the thoracoacromial trunk as the recipient anastomosis site. This case illustrates how the transverse cervical artery and accompanying veins can be used as an anastomosis when the thoracoacromial trunk is inaccessible because of previous surgical- and infection-related scaring. At the final follow-up, …

Secukinumab Provides Sustained Low Rates Of Radiographic Progression In Psoriatic Arthritis: 52-Week Results From A Phase 3 Study, Future 5., Désirée Van Der Heijde, Philip Mease, Robert B M Landewé, Proton Rahman, Hasan Tahir, Atul Singhal, Elke Boettcher, Sandra Navarra, Xuan Zhu, Gregory Ligozio, Aimee Readie, Shephard Mpofu, Luminita Pricop

Articles, Abstracts, and Reports

OBJECTIVE: To evaluate the effect of secukinumab on radiographic progression through 52 weeks in patients with PsA from the FUTURE 5 study.

METHODS: Patients with active PsA, stratified by prior anti-TNF use (naïve or inadequate response), were randomized to s.c. secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks 1, 2 and 3 and every 4 weeks starting at week 4. Radiographic progression was assessed by change in van der Heijde-modified total Sharp score (vdH-mTSS; mean of two readers). Statistical analysis used a linear mixed-effects model (random …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Right Arm Pain, Color Change And Swelling In A 17-Year-Old Male Baseball Pitcher, Alvin Chi

Research Days

No abstract provided.

Computer Based Learning Module: Neuraxial And Peripheral Nerve Blocks, Altan Halici

Doctor of Nursing Practice Projects

Neuraxial and peripheral nerve blocks (PNB) have been present for many years, but recently these pain management techniques are gaining popularity as an alternative to the use of opioids. Neuraxial and PNB reduce the opioid usage during and after the surgery and improve postoperative recovery in terms of pain relief, pain-related sleep disruption, and reduction of side effects, such as nausea and vomiting. Conversely, inadequate pain management after surgery may delay surgical recovery, decreased patient satisfaction, increased length of hospital stay, increased readmissions and healthcare costs (Patacsil, McAuliffe, Feyh, & Sigmon, 2016).

Perioperative nurses are instrumental during the post-operative period …

Novel Infection Status Post Electrocution Requiring A 4th Ray Amputation, William R. Judson, John D. Murphy, Phillip H. Sussman, John N. Harker

West Florida Division GME Research Day 2020

• Prevotella bivia is an anaerobic, non-pigmented, Gram-negative bacillus species that is known to inhabit the human female vaginal tract and oral flora. It is most commonly associated with endometritis and pelvic inflammatory disease.^{1, 2}
• Rarely, P. bivia has been found in the nail bed, chest wall, intervertebral discs, and hip and knee joints.¹ The bacteria has been linked to necrotizing fasciitis, osteomyelitis, or septic arthritis.^{3, 4}
• Only 3 other reports have described P. bivia infections in the upper extremity with one patient requiring amputation2, and one with deep soft tissue infection requiring multiple debridements and extensive tenosynovectomy. …

Fracture Blisters, Jessica Khabra, Jinal K. Patel, Gauthier L. Stepman, Kulveer Dabb, Kenny Hernandez, Debra Angelo, Johnathan Frunzi

West Florida Division GME Research Day 2020

Fracture blisters are tense vesicles or bullae that develop on edematous skin following some acute long bone fractures. Fracture blisters are infrequently seen, as the reported incidence is 2.9% to 6.6%.¹ This rare complication, may not regularly be encountered by Physicians in the hospital. Fracture blisters typically occur within 24-48 hours following high energy trauma injuries & may last up to several weeks. Ultimately, this condition can lead to prolonged hospital stay due to an increased risk of infection and delay in surgical intervention.² Early recognition of this dermatologic complication may be helpful in reducing hospital stays.

Bilateral Posterior Fracture-Dislocation Of The Proximal Humerus After First-Time Seizure, John D. Murphy, Phillip Braunlich, Mohit Bansal

West Florida Division GME Research Day 2020

Fractures of the proximal humerus are commonly associated with osteoporosis and comprise 5.7% of all adult fractures [1]. Posterior dislocations of the shoulder comprise 2-5% of all shoulder dislocations, and when bilateral are even more infrequent, occurring less than 5%. [2,3]. Posterior dislocations are often associated with motor vehicle accidents, seizures, or electrical shock [4]. Fracture-dislocations of the proximal humerus occur in only 1% of all shoulder dislocations, thus making posterior fracture-dislocations off the proximal humerus exceedingly rare [5]. In this case report, we present a previously undescribed case presentation and treatment for bilateral posterior fracture-dislocations of the proximal humerus …

Prospective Study Of Military Special Operations Medical Personnel And Lower Extremity Fracture Immobilization In An Austere Environment, Kevin Martin, Trevor Mcbride, Alicia Unangst, Jaime Chisholm

Department of Orthopaedic Surgery Faculty Papers

Background: Austere fracture immobilization equipment and techniques are often overlooked, with few studies critically evaluating the process. The purpose of this study was to evaluate current austere splinting techniques and equipment used for lower extremity fractures while field testing a new 1-step spray-on foam splint.

Methods: This is a prospective analysis of austere splinting techniques. A cadaveric model with a distal third tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (structural aluminum malleable [SAM] splint, 6-in. ACE wrap) while being critically evaluated. The specimens were also …

The National Burden Of Orthopedic Injury: Cross-Sectional Estimates For Trauma System Planning And Optimization, Molly P. Jarman, Michael J. Weaver, Adil H. Haider, Ali Saleem, Mitchel B. Harris

Department of Surgery Docs

Background: Management of orthopedic injuries is a critical component of comprehensive trauma care. As patterns of injury incidence and recovery change in the face of emerging injury prevention efforts and technologies and an aging US population, assessment of the burden of orthopedic injury is essential to optimize trauma system planning. We sought to estimate the incidence of orthopedic injury requiring emergency orthopedic surgery in the United States.
Methods: Using nationally representative samples from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, we estimated the incidence of orthopedic injury, polytrauma with orthopedic injury, and emergency operative orthopedic …

Designing An Antibiotic Eluting Trauma Screw To Reduce Short Term Infection In Bone Fractures, Dominic Lincoln

Honors Theses

Orthopedic infection in the United States is one of the most common and severe health risks faced by trauma patients. The most prevalent infection is orthopedic and trauma device-related infection (ORDI) and often occurs in long bones at the fracture site. The purpose of this paper is to explore this infection, its causes, and solutions currently on the market while providing novel solutions to the problem. The designs proposed will be evaluated for their effectiveness and value, while attempting to keep costs low for all stakeholders. The feasibility of patenting these ideas will also be considered, as will the testing …

What Outcomes Matter To Patients After Joint Or Spine Surgery?, Robin R. Whitebird, Leif I. Solberg, Christine K. Norton, Jeanette Y. Ziegenfuss, Stephen E. Asche, Elizabeth S. Grossman

Journal of Patient-Centered Research and Reviews

Purpose: Patient-reported outcome measures (PROMs) are increasingly used in clinical care, but there have been few studies of what patients identify as the most important outcomes.

Methods: Semi-structured interviews were conducted with 65 patients undergoing hip or knee replacement, spinal discectomy/laminotomy, or a spinal fusion. Interviews focused on outcomes patients identified as important, perceived usefulness of standardized PROMs measures, and contextual situations important to their care. Data were analyzed using a directed content analysis approach.

Results: Patients identified desired outcomes that were unique and important to them. Their preferred outcomes focused in the areas of freedom from pain, getting back …

Orthopedic Injuries In Athletes, Cameron Adams

Showcase of Undergraduate Research and Creative Endeavors (SOURCE)

When thinking of athletes and orthopedic injuries, we often associate these injuries with more physical sports such as football, basketball, or even soccer. What we don’t realize is that an injury of any degree can occur in any sport, regardless of the level of physicality. An orthopedic injury is any injury to the bones, muscles, or joints of the musculoskeletal system. These injuries include, but are not limited to, ACL tears, meniscus tears, broken bones, muscle tears, sprains, dislocations, or fractures, obtained during a sport. Most injuries of this nature are hard to ignore, but depending on the area and …

Diagnosis And Management Of Common Hand Infections., Vivek K. Bilolikar, Daniel A Seigerman, Asif M. Ilyas

Rothman Institute Papers

• While many hand infections are superficial, diligent evaluation, diagnosis, and treatment of these infections are central for preventing disability and morbidity.
• Maintaining a wide differential diagnosis is important as some hand infections may mimic others.
• In geographic areas with more than a 10% to 15% prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) hand infections, empiric antibiotics should adequately cover MRSA.
• Once culture results are available, antibiotic regimens should be narrowed to reduce the development of resistant pathogens.

Walking Kinematics In Young Children With Limb Loss Using Early Versus Traditional Prosthetic Knee Prescription Protocols, Mark Daniel Geil, Zahra Safaeepour, Brian Giavedoni, Colleen Coulter

Faculty Articles

The traditional treatment protocol for young children with congenital or acquired amputations at or proximal to the knee prescribes a prosthesis without a working knee joint, based in part on the assumption that a child learning to walk cannot properly utilize a passively flexing prosthetic knee component. An alternative to this Traditional Knee (TK) protocol is an “Early Knee” (EK) protocol, which prescribes an articulating prosthetic knee in the child’s first prosthesis, during development of crawling and transitioning into and out of upright positions. To date, no study has compared samples of children with limb loss at or proximal to …

Balance Of Adults With Chronic Ankle Instability Following A 6-Week Core Stability Program, Natalie Dickol

Theses and Dissertations

Ankle injuries are one of the most common injuries in the athletic population because of the anatomy of the ankle in conjunction with dynamic activity. During injury, mechanoreceptors are damaged, effecting neuromuscular control. Lack of neuromuscular control puts patients at risk for re-injury. Chronic ankle instability (CAI) has been defined as a condition associated with recurrent sprains and persistent symptoms, including feelings of "giving way," loss of function and limited movement and continuous ankle pain. Patients with CAI are commonly shown to have functional deficits in postural control, such as overcompensating on the uninvolved limb or unable to maintain proper …

Reaching The Peak, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Computational Approach To Correcting Joint Instability In Patients With Recurrent Patellar Dislocation, Oliver Alvarez, Robert N. Steensen, Paul J. Rullkoetter, Clare K. Fitzpatrick

Mechanical and Biomedical Engineering Faculty Publications and Presentations

Patellar dislocation is a debilitating injury common in active adolescents and young adults. Conservative treatment after initial dislocation is often recommended, but almost half of these patients continue to suffer from recurrent dislocation. The objective of this study was to compare preoperative patellofemoral joint stability with stability after a series of simulated procedures, including restorative surgery to correct to pre-injury state, generic tibial tubercle osteotomy, patient-specific reconstructive surgery to correct anatomic abnormality, less invasive patient-specific surgery, and equivalent healthy controls. Three-dimensional, subject-specific finite element models of the patellofemoral joint were developed for 28 patients with recurrent patellar dislocation. A …

Sustaining The National Spinal Cord Injury Registry Of Iran (Nscir-Ir) In A Regional Center: Challenges And Solutions, Zahra Azadmanjir, Zahra Mohtasham-Amiri, Seyed-Mahdi Ziabari, Leila Kochakinejad, Hamid Haidari, Guilan University Of Medical Sciences, Hadis Sabour, Zahra Khazaeipour, Mahdi Sharif-Alhoseini, Zahra Ghodsi, Abbas Amirjamshidi, Farshad Akbarzadeh, Kazem Zendehdel, Amir Azarhomayouon, Khatereh Naghdi, Gerard Oreilly, Ellen Merete, Alexander Vaccaro, Edward C. Benzel, Seyed Behzad Jazayeri, Vafa Rahimi-Movaghar

Department of Orthopaedic Surgery Faculty Papers

Background: The National Traumatic Spinal Cord Injury Registry in Iran (NSCIR-IR), was implemented initially in three hospitals as a pilot phase from 11 Oct 2015 to 19 Jun 2016 and has been active in eight centers from 19 Jun 2016. Poursina Hospital, a trauma care referral center in Rasht, Guilan Province of Iran is one of the registry sites, and has been involved in registering eligible patients since 1 Jan 2016. This study aimed to identify the challenges and solutions for sustaining the NSCIR-IR in a regional center.

Methods: This was a mixed-methods study. For the quantitative analysis, a retrospective …

Optimizing The Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures In A Rotator Cuff Model, Austin V. Stone, T. David Luo, Aman Sharma, Kerry A. Danelson, Michael De Gregorio, Michael T. Freehill

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory.

Hypothesis: Leaving the medial row untied and using a suture bridge technique with suture tape will offer more even pressure distribution across the repair site without compromising total contact force. …

Comparison Of Pre- And Post-Operative Shoulder Muscle Emg Profiles In Reverse Total Shoulder Arthroplasty Patients, Emily Lau, Sreten Franovic, Noah Kuhlmann, Eric C. Makhni Md, Stephanie Muh Md

Medical Student Research Symposium

Background: Deltoid muscle function is central in reverse total shoulder arthroplasty (RTSA) function; however, there is limited information available regarding changes in deltoid activity before and after surgery. Few tests exist to evaluate specific muscle metrics pre and post operatively. Surface Electromyographic (EMG) is non-invasive and allows for observation of motions with multifaceted analysis of movement with minimal patient demand. Understanding the changes in shoulder muscle activation, namely in the deltoid, in patients pre and post-RTSA can further advance understanding of the procedure and rehabilitation efforts.

Methods: Nine individuals were recruited for this study: all patients underwent RTSA by a …

Application Of Laser Technology In The Non-Surgical Management Of Periprosthetic Joint Infection (Pji); Novel Insights From Peri-Implantitis, Kareem Giovanni Elhage, Mohamed Awad, Ahmad Hasan, Brendan Farley, Khaled Saleh

Medical Student Research Symposium

Introduction: The management of periprosthetic joint infection (PJI) is challenging, and its socio-economic impact is significant. Moreover, the incidence of MRSA and other resistant organisms are on the rise. Recently, laser technology has been incorporated into treatment protocols of dental peri-implantitis. This review explores the possibility of using laser technology to manage peri-implantitis.

Methods: This article will provide a detailed, comprehensive, and perspective review of the existing evidence of laser technology in management of dental peri-implantitis.

Results: Dental literature investigated the efficacy of several types of lasers. It was shown that diode lasers improved periodontal probing depth (PPD) and bleeding …

The Use Of Urine Drug Testing For Risk Stratification And Efficacious Drug Monitoring In Pain Management Settings, Ahmad I. Hasan, Kareem Elhage, Brendan Farley, Khaled J. Saleh

Medical Student Research Symposium

Objective: To understand the current landscape of urine drug testing (UDT) guidelines as part of risk assessment for opioid abuse, and to offer recommendations towards adopting universal screening guidelines.

Background: There has been an opioid epidemic within the United States, and the role of prescription opioids has been well established. Despite proposed recommendations, there has yet to be a published universal screening guideline on the use of UDT in the setting of opioid abuse risk stratification as well as postoperative drug monitoring.

Methods: We explored current guidelines for UDT on two levels. First, we explore general indications for UDT within …

Upper-Extremity Injuries Are The 2nd Most Common Workplace Injuries From 1992 To 2018, Nikhil R. Yedulla, Dylan S. Koolmees, Eric B. Battista, Syed S. Raza, Zachary A. Montgomery, Charles S. Day

Medical Student Research Symposium

Musculoskeletal injuries occur frequently in the workplace, yet it is unclear whether upper-extremity, lower-extremity, or trunk injuries are the most prevalent. We hypothesize that: (1) trunk injuries are the most common in the overall workplace, and (2) upper-extremity injuries are more common in labor-based industries than non-labor industries. Workplace related injury data from 1992 to 2018 was collected from the Bureau of Labor Statistics “Workplace Injuries & Illnesses” database. Occurrence of trunk, upper-extremity, and lower-extremity injuries in major industries (agriculture, construction, manufacturing, and healthcare) were aggregated during this time period and compared. Overall workplace related injury occurrence in major industries …

Proximal Tibial Replacement In Revision Knee Arthroplasty For Non-Oncologic Indications., Brianna Fram, Eric B. Smith, Gregory K. Deirmengian, John A. Abraham, John Strony, Michael B. Cross, Danielle Y. Ponzio

Rothman Institute Papers

Proximal tibial metaphyseal bone loss compromises the alignment and fixation of components during revision total knee arthroplasty. In massive, segmental defects with loss of collateral ligamentous support and lack of bone to support the use of prosthetic augments or metaphyseal cones or sleeves, a hinged proximal tibial replacement or a so-called "megaprosthesis" should be available. While proximal tibial replacement is the reconstructive method of choice in the setting of bone tumor resection, applications in non-oncologic joint arthroplasty are rare and may offer an opportunity for limb salvage in dire clinical scenarios with massive proximal tibial bone loss. This report reviews …

Total Knee Arthroplasty Gap Balancer, Christina Grigorian, Andrew Beckley, Alexandra Rockett

Biomedical Engineering

California Polytechnic State University’s Biomedical Engineering Department worked in conjunction with local San Luis Obispo orthopedic surgeon Dr. Dimitri Delagrammaticas. The goal of the project was to create a surgical tool that assists a surgeon in measuring knee gap distance and balancing collateral ligament tension during a total knee arthroplasty (TKA) surgery. The final product of this project was completed in five months and initially began with understanding our sponsor’s expectations for the device. A portion of time was devoted to conducting research to understand the process of a knee replacement surgery, the requirements of the device, and the limitations …

Youth Single-Sport Specialization In Professional Baseball Players., Patrick S Buckley, Michael C Ciccotti, Meghan Bishop, Patrick Kane, Stephen Selverian, Dominique Exume, John D'Angelo, William Emper, Kevin B Freedman, Sommer Hammoud, Steven B Cohen, Michael G Ciccotti

Rothman Institute Papers

Background: An increasing number of youth baseball athletes are specializing in playing baseball at younger ages.

Purpose: The purpose of our study was to describe the age and prevalence of single-sport specialization in a cohort of current professional baseball athletes. In addition, we sought to understand the trends surrounding single-sport specialization in professional baseball players raised within and outside the United States (US).

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: A survey was distributed to male professional baseball athletes via individual team athletic trainers. Athletes were asked if and at what age they had chosen to specialize in …

Correlation Of Early Outcomes And Intradiscal Interleukin-6 Expression In Lumbar Fusion Patients., John D Koerner, Dessislava Z Markova, Greg D Schroeder, Christopher L Antonacci, Joseph Mendelis, Alexander R Vaccaro, D Greg Anderson, Chris K Kepler

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: To determine if there is correlation between intradiscal levels of interleukin-6 (IL-6) and early outcome measures in patients undergoing lumbar fusion for painful disc degeneration.

METHODS: Intervertebral disc tissue was separated into annulus fibrosus/nucleus pulposus and cultured separately in vitro in serum-free medium (Opti-MEM). Conditioned media was collected after 48 hours. The concentration of IL-6 was quantified using enzyme-linked immunosorbent assay. Pearson correlation coefficients quantified relationships between IL-6 levels and pre- and postoperative visual analogue scale (VAS) back pain and Oswestry Disability Index (ODI), as well as change in VAS/ODI.

RESULTS: Sixteen discs were harvested from 9 patients undergoing …