Musculoskeletal Clinic Research Articles

Musculoskeletal Clinical Online Cases With a Focus on Anatomy for Preclinical Learners.

While musculoskeletal disorders are leading causes of medical visits, musculoskeletal education is underrepresented in US medical curricula. Previous studies have demonstrated that undergraduate medical students often fail to demonstrate competency surrounding musculoskeletal disorders. More educational content is needed to support musculoskeletal knowledge in learners. We developed an online, case-based musculoskeletal module for second-year medical students alongside their standard course material and presented clinical cases with multiple-choice question quizzes regarding the presentation, diagnosis, and anatomic correlation of musculoskeletal conditions. Cases, under 10 minutes each, targeted common, medically important areas of musculoskeletal health. Grades in the required musculoskeletal course were significantly and positively correlated with online module quiz performance. 258 (73%) of 354 students completed at least one quiz, and students completed an average of 14 out of 15 quizzes. Learners who completed more than 50% of the quizzes performed significantly better in the course than those who completed fewer quizzes; this was true for a formative internal course exam (p = .035), an NBME customized assessment (p = .008), and the course overall (p = .021). Additional analyses of students' perceptions revealed that students valued the self-directed online learning environment. The high completion rate (73%) for the online module also signaled student value in the content and format. This module represents educational material that has been demonstrated to improve medical student musculoskeletal learning. Additionally, the module could be expanded to address inadequacies in orthopedic education among other students, such as allied health learners.

The effectiveness of sacral lateral branch radiofrequency neurotomy for posterior sacroiliac joint complex pain in patients selected by dual sacral lateral branch blocks; A real-world cohort study

BackgroundPrevious study of spinal neurotomy procedures indicates that stringent block selection improves outcomes. However, this pattern is not established for sacral lateral branch radiofrequency neurotomy (SLBRFN). Few SLBRFN studies have used stringent block selection criteria such as ≥80 % pain reduction following dual sacral lateral branch blocks (SLBB). ObjectiveEvaluate the effectiveness of SLBRFN in patients with ≥80 % pain relief following dual SLBBs. MethodsRetrospective single-arm cohort study of consecutive patients from two Canadian musculoskeletal and pain clinics who underwent first-time SLBRFN after report of ≥80 % pain relief following dual diagnostic SLBBs. Patients were identified by electronic medical record query between 2016 and 2022. The primary outcome was the proportion of individuals with a ≥50 % reduction in the numeric pain rating scale (NPRS) score three months after SLBRFN. Secondary outcomes included the proportion of responders achieving the minimal clinically important difference (MCID) on the pain disability quality-of-life questionnaire (PDQQ), and the duration and mean percentage of pain relief among those with recurrent symptoms after a successful SLBRFN. ResultsOf the 70 participants included, 32 (45.7 %; 95 % CI = 34.6–57.3) reported a ≥50 % reduction in NPRS, and 35 (50.0 %; 95 % CI = 38.6–61.4) achieved the MCID on the PDQQ at 3-months. Among the 17 patients who reported a return of symptoms, the mean duration of relief was 8.0 ± 3.5 months, and the mean percentage of pain relief was 77.9 % ± 16.4 %. Logistic regression models revealed that the use of multi-tined RF probes and lower patient BMI were associated with treatment success. Discussion/conclusionSLBRFN reduced pain and disability in approximately 50 % of patients at 3 months when selected using relatively restrictive selection criteria. Treatment success was associated with multi-tined RF probe type and lower patient BMI. Larger prospective studies assessing long-term outcomes are needed to further evaluate the impact of different selection criteria and techniques on SLBRFN effectiveness.

The Relevance of Diet in Musculoskeletal Clinical Practice—A Narrative Review

The Relevance of Diet in Musculoskeletal Clinical Practice—A Narrative Review

Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial.

Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain. To assess symptomatic benefits of methotrexate in knee OA (KOA). A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41). 15 secondary care musculoskeletal clinics in the United Kingdom. A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion. Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia. The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs). A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren-Lawrence grade 3 to 4) were randomly assigned to methotrexate (n = 77) or placebo (n = 78). Follow-up was 86% (n = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; P = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; P = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; P = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2). Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance. Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months. Versus Arthritis.

Comparison of Pain With Ultrasound-Guided Intra-Articular Hip Injections With and Without Prior Subcutaneous Local Anesthesia.

To compare pain levels of intra-articular hip steroid injections performed with and without prior subcutaneous local anesthesia (LA) injection. Randomized prospective study. University-based musculoskeletal clinic. Forty-one adult patients undergoing a first-time ultrasound-guided unilateral intra-articular hip steroid injection. Subjects were randomized into 1 of 2 groups: intra-articular hip injection with prior subcutaneous LA with 2 mL of lidocaine 1% (With LA) or hip injection without prior subcutaneous LA (Without LA). Visual analog scale (VAS) pain scores (0-100) were collected before and after each injection. Visual analog scale pain score for the intra-articular hip injection. Of the 41 total subjects, 18 were randomized to the Without LA group and 23 to the With LA group. There was no significant difference in baseline (preprocedure) VAS scores between the Without LA (mean ± SD = 39.2 ± 27.2) and With LA (41.2 ± 24.0) groups (P = 0.864). The mean ± SD VAS score for the subcutaneous LA injection in the With LA group was 20.4 ± 16.1. There was no significant difference in VAS scores for the intra-articular hip injection between the Without LA (48.5 ± 27.7) and With LA (39.5 ± 25.7) groups (P = 0.232). Subcutaneous injection of lidocaine before an intra-articular hip injection did not significantly decrease pain from the intra-articular hip injection. Providers may perform intra-articular hip injections with a 22-gauge 3.5-inch spinal needle without the need for an extra subcutaneous LA injection.

Can ultrasound-guided medial branch blocks be used to select patients for cervical facet joint radiofrequency neurotomy? A matched retrospective cohort validation study.

Medial branch blocks are used to select patients for cervical facet joint radiofrequency neurotomy (CRFN). Blocks are typically performed under fluoroscopic guidance (ie, fluoroscopy-guided blocks [FLBs]). The validity of ultrasound-guided blocks (USBs) is not well established. No prior research has compared cervical USB validity and FLB validity with CRFN outcome used as the criterion standard. To evaluate cervical USB versus FLB validity with CRFN outcome used as the criterion standard. Demographic and outcome data were extracted from the electronic medical records of 2 affiliated musculoskeletal pain management clinics for all patients between 2015 and 2023 inclusive who had cervical USB leading to CRFN. CRFN outcomes of each USB patient were compared with those of a matched FLB patient from the radiofrequency neurotomy (RFN) outcome database of the same clinics. Matching variables included patient age, sex, pain duration, diagnostic/prognostic block paradigm, and CRFN number. Each patient completed a numeric rating scale (NRS) pain score and Pain Disability Quality-of-Life Questionnaire (PDQQ) just before and 3months after CRFN. At repeat CRFN, patients provided a retrospective estimate of the duration and average magnitude (percentage) of relief after the CRFN. USB and FLB groups were comprised of 27 patients (58 RFNs) and 38 patients (58 RFNs), respectively. Post-RFN NRS pain severity and PDQQ-Spine scores demonstrated comparable (P > .05) absolute improvements, proportion of patients achieving ≥50% improvement, and attainment of the minimum clinically important difference. Retrospective estimates of pain relief magnitude and duration were also comparable. This study finds cervical USB and FLB to be comparably valid as defined by their ability to predict CRFN outcome. Within the limitations of operator competence, USB can be used to select patients for CRFN.

CSP2023: 15 - The development and implementation of a bespoke Musculoskeletal Clinical Champion role

CSP2023: 15 - The development and implementation of a bespoke Musculoskeletal Clinical Champion role

P095 Association between autism and chronic musculoskeletal pain; a single tertiary adolescent rheumatology centre experience

Abstract Background/Aims Autism is a common neurodevelopmental disorder and can present with atypical sensorimotor function and altered pain response. Evidence suggests that patients with autism have a different processing mechanism which can alter pain perception. Pain evaluation and management is often insufficient in patients with autism. Chronic musculoskeletal pain in adolescents is common and is frequently associated with other co-morbidities. The adolescent musculoskeletal pain service at University College London Hospital uses a multidisciplinary approach to provide treatment and ongoing support for young people with chronic musculoskeletal pain up to the age of 19 years, bridging significant and often stressful life events such as exams and moving away from home. Methods A retrospective review of patient records was conducted between October 2021 and October 2023. New patients attending the adolescent chronic musculoskeletal pain clinic at University College London Hospital were identified and the prevalence of autism was noted. The presence of other co-morbidities and symptoms was also recorded. Statistical analysis was undertaken using GraphPad Prism (Fisher’s exact test) to determine any differences between patients with and without a diagnosis of autism. Results Retrospective data was obtained on 82 new patients aged between 13 and 18 years seen in the adolescent chronic musculoskeletal pain clinic. 28 patients (34%) had a diagnosis of autism. A higher proportion of autistic patients with chronic musculoskeletal pain were male compared to those without autism (36% vs 11%, p = 0.016). More patients with autism reported co-existing mental health difficulties, especially anxiety and depression (68% vs 37%, p = 0.011). Conversely, patients without autism reported a higher incidence of postural orthostatic tachycardia symptoms (POTS) or symptoms of postural dizziness (57% vs 25%, p = 0.009). Other co-morbidities and symptoms were found to be similar between patients with and without autism (headaches 18% vs 39%, abdominal pain 36% vs 54%, fatigue 61% vs 46%, sleep difficulties 68% vs 54%, attention deficit hyperactivity disorder 18% vs 9%). Conclusion This small retrospective study demonstrates that over a third of new patients seen in the adolescent chronic musculoskeletal pain service are autistic. This suggests a possible link between autism and chronic pain but more research is needed to evaluate this and larger studies are required. Patients with chronic musculoskeletal pain and autism were more likely to be male and have mental health difficulties compared to those without autism. The high incidence of mental health difficulties highlights the need for multidisciplinary team working, in particular psychological support. The results of this study have important implications for training and suggest that novel treatment strategies are needed to help advance therapies for chronic musculoskeletal pain in young people with autism. Disclosure E. Williams: None. S. Mavrommatis: None. J. Glanville: None. M. Leandro: None. D. Sen: None. C. Fisher: None.

HIF-1A INITIATES VASCULAR RECRUITMENT AND IRREVERSIBLE FIBROSIS IN TENDON

Tendinopathy is the most common form of chronic tendon disorders, accounting for up 30% of all musculoskeletal clinic visits [1]. In tendon disease, the largely avascular tendon tissue often becomes hypervascularized and fibrotic [2]. As blood vessel growth and angiogenic signaling molecules are often induced by the lack of adequate nutrients and oxygen, hypoxic signaling is speculated to be a root cause of tendon neovascularization and tendinopathy [3,4,5]. However, how the vascular switch is initiated in tendons, and how vascularization contributes to tendon pathology remains unknown. In this talk, we provide evidence that HIF-1α is implicated in tendon disease and HIF-1α stabilization in human tendon cells induces vascular recruitment of endothelial cells via VEGFa secretion. More interesting, HIF-1α stabilization in tendon cells in vivo, seems to recapitulate all main features of fibrotic human tendon disease, including vascular ingrowth, matrix disorganization, changes in tissue mechanics, cell proliferation and innervation. Surprisingly, in vivo knock-out of VEGFa rescued angiogenesis in the tendon core but it did not affect tendon mechanical properties and tissue pathophysiological changes, suggesting that blood vessels ingrowth might not be a primary cause but a consequence of HIF-1α activation.

Rapid Design of a Student-Centred App for Musculoskeletal Clinical Skills: An Example of a Theoretically Informed Approach to Developing Apps for Learning.

The process to design mobile apps for learning are infrequently reported and focus more on evaluation than process. This lack of clear process for health professional education mobile apps may explain the lack of quality mobile apps to support medical student learning. The goal of this project was to develop a student informed ready for production wireframe model of a minimally viable mobile app to support learning of musculoskeletal (MSK) clinical skills. The Information Systems Research (ISR) framework and Design Thinking were combined for the mobile app design. The process followed the cycles and modes of the combined framework to; systematically review available apps, use a focus group to identify attributes of the app valued by students, define the initial plan for the mobile app, develop an app prototype, and test and refine it with students. The student focus group data had five themes: 1) interactive usability, 2) environment, 3) clear and concise layout, 4) anatomy and pathology, 5) cultural safety and 'red flags'. The prototyping of the app went through three cycles of student review and improvement to produce a final design ready for app development. We used a student-centred approach guided by design frameworks to design a minimally viable product mobile app to support learning of MSK clinical skills in ten weeks with a small team. The framework supported nonlinear, iterative, rapid prototyping. Student data converged and diverged with the MSK teaching methods literature. Of note our students requested cultural safety learning in the app design, suggesting mobile apps could support cultural safety learning.

ADvAnced PhysioTherapy in MuSculosKeletal Triage: Investigating prognostic factors, healthcare utilisation and clinical outcomes (ADAPT MSK) - a cohort study protocol.

Clinical specialist physiotherapist-led musculoskeletal triage clinics were introduced nationally in Ireland in 2011 to improve patient care and reduce waiting times for secondary care orthopaedics and rheumatology. Evidence has shown them to be effective in reducing waiting lists, however there are currently no data on longitudinal patient outcomes following clinic attendance. The primary aim of this cohort study is to identify predictors of pain and function outcomes up to one year following musculoskeletal triage review. Secondary aims include measuring self-reported use of healthcare resources over the 12-month follow-up period and to explore musculoskeletal phenotypes based on established prognostic factors for musculoskeletal pain. This is a prospective cohort study. ADvAnced PhysioTherapy in MuSculosKeletal Triage (ADAPT MSK) will recruit a cohort of 252 adults through musculoskeletal triage clinics across five secondary care sites in Ireland. The STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines will be adhered to for future reporting. Adults (≥ 18 years old) attending physiotherapist-led musculoskeletal triage clinics with musculoskeletal pain, who do not require surgical or consultant-led medical care will be considered for participation. Participant demographics, health literacy, healthcare utilisation, and self-report questionnaires on pain, function, musculoskeletal health, musculoskeletal risk stratification, fear of movement, and psychological distress will be obtained at baseline, with follow-ups at three, six, and 12 months. Primary outcomes are pain intensity and function. Secondary outcomes include musculoskeletal risk stratification status, musculoskeletal health, healthcare utilisation, and work-related factors. Descriptive statistics will be used to profile the participants and predictors of outcome will be assessed using multivariable linear regression. Musculoskeletal phenotypes will be explored using latent class analysis. Results will be disseminated via peer-reviewed journal publication and presentation at national and international conferences. Engagement with a public patient involvement (PPI) panel will explore dissemination strategies for public and service user engagement.

Superficial Vein Thrombosis After Intra-articular Particulate Steroid Injection for Knee Osteoarthritis.

Intra-articular steroid injections for knee osteoarthritis are a routine procedure in musculoskeletal clinics. While their role in osteoarthritis care is debatable, they serve as an important therapeutic option to relieve osteoarthritis-associated pain. Potential risks are self-limited (increased pain flare, local skin irritation, flushing, insomnia) or severe (septic arthritis, intravascular medication placement, and the deleterious effect on cartilage and bone). In our experience, more serious adverse events are rare. In this case, we present a complication secondary to intra-articular steroid administration that has not previously been reported in the literature: superficial vein thrombosis. This will raise awareness among clinicians, improve the informed consent process, and provide an approach for the management of subsequent injections.

103 Botulinum Toxin Type A (Botox) Injection for Plantar Fasciitis: An Audit of Findings

Abstract Introduction Plantar fasciitis is commonly seen in the musculoskeletal clinic and accounts for around 8-10% of running injuries. NICE recommended corticosteroid injections for patients whose “symptoms are having a significant impact on the person”, however, symptoms lasted for 4 weeks post injection. The use of Botox for the treatment of myofascial pain has increased, with studies showing greater reduction in patients symptoms and improved duration of action. Material and methods 42 patients (27 male, 15 female) were included in this audit. All patients received 100 units of botox. Inclusion/Exclusion criteria All patients who had clinically diagnosed plantar fasciitis and had received the first line treatments of stretching and orthotics. Patients yet to begin a stretching program or had systemic disease or previous surgery were excluded. Outcome measure A patient assessed (VAS) and a physician assessed (Heel Tenderness Index) outcome measure was used. Results 42 patients were assessed. VAS All the patients reported an improvement in symptoms at the 4 week follow up, 38 (90.48%) of whom reported pain free. Of the remaining 4 all advised their symptoms had improved by at least 50% HTI 38 (90.48%) had no pain on palpation of the heel post injection, whilst prior to the injection all patients had pain in differing degrees. 15 patients (35.71%) had severe pain prior to the injection, post injection no patient had severe pain. 40 (95.24%) patients had improved HTI scores. Conclusions Botox is effective in the treatment of plantar fasciitis, however, its effectiveness in the longer term needs to be assessed.

Cross-Cultural Adaptation and Validation of a Marathi Version of the Versus Arthritis Musculoskeletal Health Questionnaire (MSK-HQ).

Introduction Musculoskeletal (MSK) well-being plays a crucial role in determining one's quality of life. Musculoskeletal Health Questionnaire (MSK-HQ) score is a tool recently developed by the Versus Arthritis group of Oxford University in English to measure MSK health. Marathi is a regional language in western India spoken by more than 100 million people. There is a scarcity of valid and reliable tools to measure MSK health in this language. Hence, we decided to cross-culturally adapt and translate MSK-HQ to Marathi. Method We translated MSK-HQ score to Marathi (MSK-HQ-Ma) as per the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. We tested its internal consistency, construct validity and reproducibility. It was compared with other health status scores EQ-5D-5L and overall health using the Visual Analogue Scale (VAS). Test-retest reliability was tested in those subjects who were having stable MSK health after two weeks. Results We recruited 158 consecutive subjects attending musculoskeletal clinics who had Marathi as their native language. Mean age was 44.8±17 years, females were 78 (49%).It showed good internal consistency (Cronbach's alpha = 0.95). For construct validity we found a strong correlation between MSK-HQ-Ma and EQ-5D-5L values (Spearman's r = 0.82, p<0.001). There was also a good correlation between MSK-HQ-Ma and overall health by VAS (Spearman's r = 0.76, p<0.001). An excellent test-retest reliability (Spearman's r = 0.94, p<0.001) was seen in 105 subjects who had stable MSK condition after two weeks of first appearance. Conclusion The MSK-HQ-Ma instrument has demonstrated good consistency, reliability and construct validity when evaluating the musculoskeletal health of individuals who can understand the Marathi language. Hence it can be used as a validated tool for the evaluation of musculoskeletal health in western India where Marathi is a commonly used language.

MRI Advancements in Musculoskeletal Clinical and Research Practice.

Over the past decades, MRI has become increasingly important for diagnosing and longitudinally monitoring musculoskeletal disorders, with ongoing hardware and software improvements aiming to optimize image quality and speed. However, surging demand for musculoskeletal MRI and increased interest to provide more personalized care will necessitate a stronger emphasis on efficiency and specificity. Ongoing hardware developments include more powerful gradients, improvements in wide-bore magnet designs to maintain field homogeneity, and high-channel phased-array coils. There is also interest in low-field-strength magnets with inherently lower magnetic footprints and operational costs to accommodate global demand in middle- and low-income countries. Previous approaches to decrease acquisition times by means of conventional acceleration techniques (eg, parallel imaging or compressed sensing) are now largely overshadowed by deep learning reconstruction algorithms. It is expected that greater emphasis will be placed on improving synthetic MRI and MR fingerprinting approaches to shorten overall acquisition times while also addressing the demand of personalized care by simultaneously capturing microstructural information to provide greater detail of disease severity. Authors also anticipate increased research emphasis on metal artifact reduction techniques, bone imaging, and MR neurography to meet clinical needs.

Short term effects of intraarticular triamcinolone acetonide injection on serum testosterone, luteinizing hormone, and follicle stimulating hormone levels in male veterans: A prospective pilot study.

Despite the common practice of intraarticular corticosteroid injections (ICSIs) for peripheral joint disease, little is known about their systemic effects on the hypothalamic-pituitary-gonadal axis. To assess the short-term effects of ICSIs on serum testosterone (T), luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels together with changes in Shoulder Pain and Disability Index (SPADI) scores in a veteran population. Prospective pilot study. Outpatient musculoskeletal clinic. Thirty male veterans, median age 50 (range 30-69) years. Ultrasound-guided glenohumeral joint injection using 3 mL of 1% lidocaine HCl and 1 mL of 40 mg triamcinolone acetonide (Kenalog). Serum T, FSH, and LH levels, Quantitative Androgen Deficiency in the Aging Male (qADAM), and SPADI questionnaires at baseline, 1, and 4 week(s) post procedure. At 1 week post injection, serum T levels decreased by 56.8 ng/dL (95% confidence interval (CI): 91.8, 21.7, p = .002) compared with baseline. Between 1 and 4 weeks post injection, serum T levels increased by 63.9 ng/dL (95% CI: 26.5, 101.2, p = .001), recovering to near baseline levels. SPADI scores were reduced at 1 week (-18.3, 95% CI: -24.4, -12.1, p < .001) and 4 weeks (-14.5, 95% CI -21.1, -7.9, p < .001). A single ICSI can temporarily suppress the male gonadal axis. Future studies are needed to evaluate for long-term effects of multiple injections at a single setting and/or higher corticosteroid doses on male reproductive axis function.

AB102. SOH23ABS_250. A profile of patients with shoulder pain attending the musculoskeletal triage clinic in Connolly Hospital

Background: Clinical specialist physiotherapists (CSP) have been assessing patients in musculoskeletal (MSK) triage clinics nationally since 2010. There is a close correlation between physiotherapists and surgeons in making the correct diagnosis. Physiotherapy involving a structured exercise program is the first line treatment for patients with rotator cuff related shoulder pain (RCRSP) and is recommended prior to orthopaedic consultant referral. The benefit of an early magnetic resonance imaging (MRI) in these patients is questionable and may cause patients undue concern about normal age-related changes in their shoulder.

Medical Student-Run Free Orthopaedic Clinic: Impact of Coordinator Role on Specialty Selection

Background: Medical student-run free clinics provide opportunities for future physicians to accrue practical experience early in their medical education. Subspecialty clinics including orthopaedics provide a unique opportunity to gain exposure to musculoskeletal anatomy and pathology. These clinics are organized and managed by a student clinic coordinator. In this study, we seek to understand the impact that being the clinic coordinator of the musculoskeletal clinic plays in specialty selection. &#x0D; Methods: A descriptive study was conducted by gathering electronic survey responses from former student clinic coordinators at the Penn State College of Medicine student-run musculoskeletal clinic from years, 2009 to 2017. The respondents described the influence of the coordinator role on residency selection. Additionally, the survey consisted of a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) regarding the student’s motivation for participating in the clinic as a coordinator.&#x0D; Results: From 2009 to 2017, there were 18 LionCare Orthopaedic Surgery Clinic Coordinators with a male-to-female ratio was 1.25:1. Residency specialty selection was Orthopaedic Surgery (n=8, 44.4%), Physical Medicine &amp; Rehabilitation (4, 22.2%), Family Medicine (2, 11.1%), Cardiothoracic Surgery (1, 5.6%), General Surgery (1, 5.6%), Obstetrics &amp; Gynecology (1, 5.6%), and Emergency Medicine (1, 5.6%). The most commonly cited reason for participation as clinic coordinator was “interest in helping an underserved population.” &#x0D; Conclusions: The study illustrates an association between the role of orthopaedic clinic coordinator and entering a specialty focused on musculoskeletal care. More than half of the students who participated as a clinic coordinator pursued specialties involving musculoskeletal care (Orthopaedics and Physical Medicine &amp; Rehabilitation). Student-run medical clinics present an opportunity to provide early exposure to musculoskeletal medicine and potential avenue for orthopaedic education and mentorship.

A Case Study on Management of Asthigata Vata W.S.R. AVN of Femoral Head

Avascular necrosis of femoral head is a growing condition in the musculoskeletal clinic. This is mainly osteonecrosis caused by injury or occlusion in the blood vessels that supply bone tissue. AVN of femoral head is the most common type of necrosis because the artery that supplies this area is so narrow that it is easily injured, which then causes a lack of nutrition leading to necrosis. Modern medicine has no specific cures other than surgery. Moreover, it is expensive and unpredictable. In Ayurveda, Vata, Pitta, Rakta Dosha, Asthi, and Majja Kshaya play a major role in the pathogenesis of AVN. This article is aimed to nourish, repair, and regenerate Asthi Dhatu &amp; Vatashamana. The current study, at the age of 28, diagnosed AVN of the femoral head was treated with Udvartana, Kshara Basti, Ksheera Basti, and Shasthika Shali Pinda Sveda which plays a significant effect in the improvement of pathology.

Management of chronic non-cancer pain in primary care.

Management of chronic non-cancer pain in primary care.