Poster Number-65 - Application of Musculoskeletal Ultrasonogram for Same Day Diagnosis and Interventions in the Setting of a Physiatrist’s Office - a Rewarding Experience in Chronic Pain Management.

Application of  Musculoskeletal Ultrasonogram for Same Day Diagnosis and Interventions  in the Setting of a Physiatrist’s Office - a Rewarding Experience in Chronic Pain Management.

Purpose:

Management of chronic musculoskeletal pain is complex. Accurate diagnosis and injection procedures of focal pain can be beneficial. We explored the possibility of using Musculoskeletal Ultrasonogram for same day evaluation, diagnosis and ultrasound guided injection procedures in our clinic  and found the experience rewarding. This is a preliminary report of a retrospective descriptive study of 61 patients who were referred to our weekly Musculoskeletal Pain clinic in Physical Medicine Department in Al Farwaniya Hospital, Kuwait, during May- June 2022. 

Methods:

Medical records of all adult patients who consulted in our weekly Musculoskeletal Pain clinic were scrutinized for the period from May to June 2022. Data was  collected with regards to demography, referral diagnosis, reason for referral, Ultrasonogram findings, and final treatment given. Numerical Rating Pain scores on first visit and on follow up visit after four weeks, were noted. Patients with inflammatory arthritis were excluded.

Results:

Total number of patients = 61. 21 were male and 40 were female. Mean age = 57.45 years. Of the joints evaluated , knee constituted 47.5% and shoulder, 36%.  In  80.32 %  of patients, in addition to the primary referral diagnosis, new additional diagnosis was confirmed  after performing Ultrasound examination. In 78.6%  patients, this additional diagnosis was the main source of pain and treatment plan was modified based on the new findings.  
60.6%  patients underwent  ultrasound guided injection procedures including soft tissue and joint injection procedures such as  Xylocaine, Steroids and Platelet Rich Plasma either in the same visit or by appointment. In all these patients who received injections, pain medications were tapered or stopped. The Mean pain score in the patients who underwent intervention was 8.37 on first visit  and 3.86  on  follow up visit. Mean difference was 4.38. p value calculated using Wilcoxon Signed – Rank Test was 0.00001 which was statistically significant.

 

Conclusion:

Ultrasonogram is an important diagnostic and therapeutic office tool in Musculoskeletal pain clinic. When used as an extension of clinical examination by a trained Physiatrist, it improves diagnosis and helps in guiding joint and soft tissue injection procedures resulting in a significant improvement in pain scores, a mutually rewarding experience for both the patients and the Physiatrist.

References: 1. Sahoo RK, H. Peng PW. Role of ultrasound in chronic pain management. Indian J Pain 2020;34:151-9
2. Daniels EW, Cole D, Jacobs B, Phillips SF. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Orthop J Sports Med. 2018 Feb 22;6(2):2325967118756576. doi: 10.1177/2325967118756576. PMID: 29511701; PMCID: PMC5826008.