Monthly Archives: November 2020

Musculoskeletal Ultrasonography, The Perspective of a Medical Ultrasonography Instructor

by Laura Currie, B.S., RT(R), RDMS, RVT, RMSKS

As a sonography student in 1986, the subject of my graduation project was “Ultrasound Evaluation of the Rotator Cuff”.  The procedure was in its infancy on the West Coast but beginning to see increased use in some regions of the country.  The scans were performed by Radiologists with a particular interest in sonography and a willingness to accept the challenge.

I was fortunate to have worked with one of those Radiologist, Dr. Charles Pope, in Raleigh, NC from 1988 – 2005.  Dr. Pope had a great working relationship with many of the Orthopedic Physicians in the capital city and they referred patients for shoulder ultrasounds first to rule out rotator cuff tears.   Two days per week were reserved for shoulder patients and we averaged 16-20 rotator cuff scans per week.  As ultrasound technology advanced, we were increasingly confident in diagnosing partial thickness tears, avulsion fractures and tendon calcifications in addition to complete tears.  MRI procedures were seldom required for these patients.

In 2005 I relocated to Wilmington and began teaching in the CFCC Medical sonography program.  I was surprised to find that ultrasound was not being used to diagnose rotator cuff tears in my new community.  For the past 15 years, I have followed the growing MSK Sonography modality and watched from afar as it expanded to include scans of all upper and lower extremity joints.  Yet after 15 years of continued growth in the MSK sonography field, my community remains underserved in this modality.  While it is being used for guided therapeutics and surveillance of rheumatoid arthritis treatments, the use of ultrasound to diagnose joint/tendon injuries and pathologies has been quite slow to catch on here.

One reason for this delay is that MSK sonography is very operator dependent and our community lacks experienced MSK sonography practitioners.  As with any new medical technique or procedure, appropriate training and practice is necessary.  Some Radiologists have ultrasound scanning experience, but may not be comfortable in their ability to acquire MSK images. Orthopedic Physicians may also have been exposed to ultrasound use in their residencies and fellowships but the learning curve is steep and requires consistent exposure and practice.

Diagnostic Medical Sonographers already possess the foundation needed to learn MSK sonography and thus are able to hone the required skills at a faster pace.  CFCC sought the opinion of the sonographers in our community and found sufficient levels of interest and desire to learn MSK sonography.  In response to this interest, CFCC offered our first MSK Sonography Program in the spring of 2020.   Our curriculum includes instruction in anatomy, scan techniques, protocols and pathologies of all upper and lower extremity joints.  Students also learn the dynamic techniques that can be performed while scanning, which gives ultrasound an advantage over MRI scans.

Our first class of students included sonographers, Physical Therapists and Physicians Assistants from North Carolina, Virginia and California.  Two sonographers in Wilmington completed the first MSK course and are ready to scan shoulders, elbows, wrists, hands, hips, knees, ankles and feet.  Our Medical Sonography program plans to continue training additional sonographers and Physicians each year with the next MSK sonography course starting on January 7, 2021.

Education and training are essential to the availability of these cost-effective and convenient MSK sonography procedures in our community.  Now that this training is available, what else needs to be done before MSK sonography can move forward in Wilmington?  Is there an established dialogue between local Orthopedic Physicians and Radiologists to discuss interest in referring patients for MSK Sonography procedures and the procedures that are available?  I look forward to hearing about MSK Sonography progress in the near future.

 

Laura Currie is a North Carolina native and a graduate of Greensboro College, Moses Cone Radiologic Technology Program and the UNC-CH Medical Sonography Program.   She has worked as a staff sonographer at Duke University Medical Center and as a Supervisor and sonographer at Wake Radiology Diagnostic Imaging in Raleigh, NC.  

Laura is registered through the American Registry of Diagnostic Medical Sonographers holding RDMS credentials in Abdomen, OB-GYN and Neonatal Neurosonography specialties.  She also holds the RVT credentials for vascular technology and most recently earned the new RMSKS credential for musculoskeletal sonography.  In addition, Laura is a registered Radiologic Technologist. 

Laura is the Clinical Coordinator for the Medical Sonography Program at Cape Fear Community College and teaches sonographic physics, vascular sonography, obstetrical sonography and musculoskeletal sonography.  She is a past president of the North Carolina Ultrasound Society and has worked with the Society as a member of the Board of Directors and an Administrator to bring quality continuing education to sonographers throughout the Carolinas.

Ultrasonography in Evaluating Rotator Cuff Tears

by Richard J. Nasca M.D., FAAOS

Nearly half a million people are affected with rotator cuff tears each year. Most, but not all, patients with rotator cuff tears give a history of injury to the shoulder at the onset of their pain, decreased range of motion with altered function and persistent night pain that interferes with their sleep.

The examiner will find weakness of the torn rotator cuff muscles during manual muscle testing, a disconnect in scapulohumeral rhythm and poor control of the unsupported, abducted upper extremity.

A reliable, non-radiographic method for confirming the diagnosis would be welcomed by patients and providers. Several studies comparing, Ultrasonography and magnetic resonance imaging (MRI) have demonstrated ultrasound to be as reliable and accurate in confirming full thickness rotator cuff tears as MRI. (1,2,3,4)

Ultrasound is readily available during an office visit, more cost effective than MRI and can be used when metal artifact would be an issue with MRI. Unlike MRI, ultrasound can be done without delay bypassing the difficulty in getting insurance approval and scheduling MRI, all of which can sidetrack definitive treatment.

Considering that ultrasound has been found to be reliable and accurate in confirming full thickness rotator cuff tears when performed by experienced operators using high-quality units, why is there still the need to order MRI which may not be readily available, very expensive and sometimes an uncomfortable experience for a claustrophobic patient to undergo?

Other than concerns about the quality of the unit and experience of the operator, I can see no reason that if a tear is seen on ultrasound and the history and physical examination also support the diagnosis, the surgeon should feel compelled to order an MRI. Rather it would seem prudent and reasonable for him or her to perform surgical repair with confidence.

References:

  1. Diagnostic Accuracy of Ultrasound in Rotator Cuff Tears, Okoroba KR, Fidal MS, Tramer JS, Davis KD. Ultrasonography; Nov 2018, 38(3),1-15.
  2. Effect of surgeon -sonographer interaction on ultrasound diagnosis of rotator cuff tears: a five -year cohort study in 775 shoulders. Kurz AZ, Kelly MJ Hackett L, Murrell GA. J Shoulder Elbow Surg 2016;25:1385-1394.
  3. Diagnostic accuracy of ultrasound for rotator cuff tears in adults: A systemic review and meta-analysis. Smith TO, Back T, Toms AP, Hing CB. Clinical Radiology 2011; 66: 1036-1048
  4. Accuracy of MRI, MR arthrography and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. De Jesus JO, Parker L, Frangos AJ, Nazarian LN. AJR Am J Roentgenol 2009,192:1701-1707
  5. Detection and measurements of rotator cuff tears with sonography: analysis of diagnostic errors. Teefey SA, Middelton WD, Payne WT, Yamaguchi K. AMJ Am JRotengen 2005;184:1768-1773.

Dr. Nasca was born in Elmira NY and is a graduate of Georgetown College and Georgetown Medical School. He completed his internship at the Hospital of the University of Pennsylvania and post graduate training in Surgery and Orthopaedics at Duke University Medical Center and Affiliated Hospitals. Dr. Nasca served as Chief of the Amputee and Hand Services at the Philadelphia Naval Hospital caring for Vietnam casualties.

Dr. Nasca held teaching appointments in orthopaedic surgery at the University of Arkansas School of Medicine and the University of Alabama School of Medicine.  During his time in practice he specialized in caring for patients with spine deformities, injuries and disorders. 

 

 

 

 

 

 

 

 

 

It’s Time for Fix the Oppressive U.S. Healthcare System

by Alejandro Badia, MD, FACS  

Respected Surgeon Offers Seven Solutions to Save U.S. Healthcare

 Miami, Florida – Dr. Alejandro Badia is no stranger to the flaws and frustrations of the U.S. healthcare system. A leading hand surgeon with a medical degree from NYU, multiple accolades, and decades of experience, Dr. Badia has spent more than a quarter-century in the trenches of U.S. healthcare. His new book Healthcare from the Trenches is an open discussion of the failure of the U.S. healthcare system from the perspectives of its “providers” and patients—perspectives today’s healthcare debate sorely lacks.

Dr. Badia shares the input from 27 contributors including physicians, therapists, nurses, hospital administrators, offering these seven solutions:

  1. Involve healthcare providers in the healthcare conversation—not just politicians, lobbyists, and insurance administrators who have no medical training or experience in patient care.
  2. Get rid of the middle-man—administrators and insurance companies—in the healthcare system to create a more efficient and less bloated system. Additional administrators only add to the cost of healthcare while doing nothing to contribute to actual care.
  3. Require Hospitals and Health Insurance companies become Non-Profit. Eliminate multi-million dollar salaries to executives for ‘withholding’ care to keep costs down and their paychecks UP!
  4. Encourage more all-in-one facilities so patients do not need to wait weeks for results they should be able to see in a few hours. Not only does this streamline care, but it significantly reduces costs as well.
  5. Require increased transparency in healthcare pricing.
  6. Teach Doctors to collaborate rather than compete. They must stand together in the healthcare debate, offering solutions rather than capitulating to lobbyists and insurance companies.
  7. Educate the public on the issues doctors and patients face from today’s inefficient healthcare system. Change can only come from a public that demands it.

“Instead of simply squatting under the dark cloud of our current healthcare system, Dr. Badia stands tall and offers the opinions and perspectives of healthcare providers and patients.”

– Grady Harp, Amazon Top 50 Hall of Fame Reviewer, 5-stars

Dr. Badia explains, “Despite the political debates and media coverage on healthcare policy and reform, there remains little or no feedback from the people in the trenches—the physicians and other health care professionals who provide care to the patients. That’s why I wrote Healthcare from the Trenches. My hope is that a broader discussion of the issues can be a catalyst to positive change.”

Dr. Badia is the founder and chief medical officer of the Florida-based OrthoNOW®, a pioneering network of single-specialty, immediate orthopedic care centers in South Florida.

“Dr. Badia passionately believes that the key participants in every healthcare transaction deserve a voice, and this is just what Healthcare from the Trenches does.”

– Susan Keefe, Midwest Book Review and Columbia Book Review, 5-stars

 “The goal is to provide the patient with the care they need, at the time they need it, minimizing any interference to that process,” says Dr. Badia. “This is a life and death matter and people are dying because of a flawed system. It’s time for every American to be educated about the root causes of our healthcare crisis and demand meaningful reform.”

Healthcare in the Trenches: An Insider Account of the Complex Barriers of U.S. Healthcare from the Providers and Patients’ Perspective, ISBN 978-0-57868-099-6 (Paperback) $19.97, AISN B088PSH2RL (eBook) $2.99, 2020, Badia Hand to Shoulder, 465 pages, available at Amazon or www.DrBadiaBook.com

Alejandro Badia, M.D., F.A.C.S. has been in the trenches with our broken healthcare system since 1989

A hand and upper extremity orthopedic surgeon at Badia Hand to Shoulder Center in Miami, Florida, Dr. Badia previously served as Chief of Hand Surgery at Baptist Hospital of Miami. He studied physiology at Cornell University and obtained his medical degree at New York University, where he also trained in orthopedics. A hand fellowship at Alleghany General Hospital in Pittsburgh was followed by an AO Trauma fellowship in Freiburg, Germany. He runs an active international hand fellowship and previously organized a yearly Miami meeting for surgeons and therapists that was devoted to upper limb arthroscopy and arthroplasty. In 2005, Dr. Badia cofounded the Miami Anatomical Research Center (M.A.R.C.), one of the world’s largest surgical cadaveric training labs.

In 2008, he completed the Badia Hand to Shoulder Center, a fully integrated clinical facility for the upper limb also encompassing the Surgery Center at Doral, rehabilitation and an MRI imaging facility. More recently, Dr. Badia inaugurated OrthoNOW®, the first intermediate orthopedic urgent care center in South Florida. OrthoNOW® was officially franchised in early 2013 and is actively engaging healthcare entrepreneurs and surgeons, in North America and abroad, to open immediate orthopedic care facilities.

For more information on Dr. Badia, visit DrBadia.com, Orthonowcare.com, and DoralDOC.com.

Media Contact: For a review copy of Healthcare from the Trenches or to arrange an interview with Dr. Alejandro Badia, contact Scott Lorenz of Westwind Communications Book Marketing at scottlorenz@westwindcos.com or by phone at 248-705-2214. Follow Lorenz on twitter @abookpublicist

For more information about Dr. Badia’s book, click on Healthcare from the Trenches.