Ultrasound Use to Facilitate Challenging Procedures in

Pediatric Rehabilitation Medicine

Troy Henning DO

Maurice Sholas MD, PhD

Rita Ayyangar MD- Course Director

Course 401 Thursday Nov 13, 2014

11:30 am to 1 pm

AAPMR Annual Assembly, San Diego 2014

Course Objectives

Learning Objective #1

Participants will demonstrate an understanding of the basic physics of ultrasound and techniques used for injection procedures in PRM including botulinum toxin injections, phenol nerve blocks, SI joint injections and Baclofen pump refills

Learning Objective #2

Participants will be able to describe ultrasound echotexture properties of muscle, nerve and tendon in longitudinal and cross section.

Learning Objective #3

They will be familiar with navigation of the coding, billing and credentialing processes surrounding US guided injection procedures common to PRM practice

Outline

Introduction

Disclosures

Brief review of challenges encountered in

common PRM procedures

US guidance- the basics

US guidance- procedure specific examples

Nuts and Bolts re: privileges and coding

Botulinum Toxin Injections

Usual Methods ( could be in combination)

Palpation

Electrical Stim/EMG

US guidance

Conditions

Torticollis

Drooling (will not be covered in this course)

Spasticity- upper and lower limbs

Muscle imbalance- Neonatal Brachial Plexopathy

Chemical Neurolysis

Phenol nerve blocks

Musculocutaneous

Obturator nerves

US guidance facilitates localization but E-stim

still necessary

Sacroiliac Joint Injections

SI joint dysfunction common cause of

biomechanical low back pain

Neuromuscular scoliosis with instrumentation to

pelvis

May be particularly problematic in CP

Tight hamstrings compound problem

Baclofen Pump

Trials

Facilitates Lumbar Puncture

Refills

Obesity

Flipped pump?

Bibliography

• Mehmet Zekai Pekkafalı, MD, Mehmet Zeki Kıralp, MD, Cıhat Çinar Ba¸sekim, MD, Emir

¸Silit, MD, Hakan Mutlu, MD, Ersin Öztürk, MD, E¸sref Kızılkaya, MD, Hasan Dursun,

MD: Sacroiliac Joint Injections Performed With Sonographic Guidance. JUM June 1,

2003 vol. 22 no. 6 553-559

• Yang TF, Wang GC, Chiu JW, Lai CJ, Chan RC, Lee SS: Ultrasound-guided refilling of an

intrathecal baclofen pump--a case report. Childs Nerv System 2013 Feb;29(2):347-9.

• Westhoff B, Seller K,Wild A, Jaeger M, Krauspe R: Ultrasound-guided botulinum toxin

injection technique for the iliopsoas muscle. Child Neurol 2003 Dec;45(12):829-32.

• Rha DW, Han SH,,,Kim HJ, Won SY, Lee SC: Ultrasound-guided lateral approach for

needle insertion into the subscapularis for treatment of spasticity. Arch Phys Med

Rehab . 2012 Jul;93(7):1147-52.

• Soldado F, Fontecha CG Marotta M,Benito D, Casaccia M Mascarenhas W ,

ZlotolowD5,Kozin SH: The role of muscle imbalance in the pathogenesis of shoulder

contracture after neonatal brachial plexus palsy: a study in a rat model. J Should

Elbow Surg 2014 Jul;23(7):1003-9

• Yalcin E, Akyuz M Ilgu O, Ozer NB. Ultrasonographically guided obturator nerve block

for bilateral adductor spasticity in a paraplegic patient. Spinal Cord (2014) 52, S24–S26

Enjoy the Course!