Grand Rounds Recap 11.6.24

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R1 Core content: multiple sclerosis WITH Dr. boggust

  • MS is a demyelinating disease affecting young people, with females more frequently affected

  • MS can present with a variety of neurologic symptoms. Those affecting the limbs, bladder, bowels and eyes are most common.

  • Evaluation is most commonly with MRI of the brain and spinal cord with and without contrast after exclusion of other life-threatening conditions.

  • Patients with an established diagnosis of MS may have symptoms due to a new demyelinating event or worsening of prior symptoms due to underlying stressor such as a UTI or URI.

  • Treatment is typically with high dose steroids for new attacks, with disease modifying therapy used in the long term.

R4 capstone: WITH Dr. grisoli

More than 1 in 4 adults in the US has some type of disability

Disability

  • A physical, mental, cognitive or developmental condition that impairs a persons ability to participate in daily activities or interactions

Abelism

  • Defining people by their disabilities

  • Assumptions, attitudes and inclusions

  • Discrimination and prejudice

Healthcare for the Disabled

  • 41% of physicians confident in ability to provide equal quality care

  • 57% welcomed disabled patients into their practice

Disabled patients have equal right to life, liberty and the pursuit of happiness

Each of us can take active steps to confront ableism and increase inclusion

Ultrasound grand rounds WITH Dr. minges

Muscles, tendons, ligaments, bones, cartilage, joints/bursae

  • MSK imaging Tips

    • Stand-off pad: an echo-conductive substance that you put in between the probe and the object your ultrasounding

    • Water bath

    • Tendons and ligaments:

      • Fibrillated material, more hyperechoic. Organized with regular contour

      • Can appear similar to nerves, although typically more echogenic

      • When imaging a tendon, want to image from the origin to the insertion

      • Image in both long and transverse plane

      • Dynamic images are a must: Move the joint, move the probe

      • Compare both sides

      • Evaluate for anisotropy

    • Bones

      • The interface at the surface of the normal cortical bone is hyperechoic, regular and uninterrupted, reflecting the US beam almost entirely. The normal periosteum is visible as a thin hypoechoic line along the surface of the bone.

    • Joints

      • All different shapes and sizes

      • Primarily evaluating for dislocation and joint effusion

    • Muscles

      • Evaluating for hematomas and tears

      • Same as tendons, look all the way from origin to insertion, as well as in transverse and longitudinal

  • Take away

    • MSK is not that intimidating

    • Ultrasound outperforms XR in the diagnostic evaluation of most- non-bone MSK pathology