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Evaluation

Skills Lab/Hands-On Demonstration Proposals

Session Name: Skills Labs

1809 - A Pain in the Rear: Ultrasound Evaluation of Chronic Gluteal Pain

Saturday, November 18, 2023
1:30 PM – 4:30 PM CT
Location: CC R02
In-Person Ticketed

    Skills Lab Director(s)

  • Mahmood Gharib, MD

    Assistant Professor, Medical Director Spine Health Program
    University of Minnesota
    Edina, Minnesota

    Disclosure(s): No financial relationships to disclose

    • Skills Lab Faculty(s)

  • Travis Cleland, DO

    Staff Physiatrist
    Crystal Clinic Orthopedic Center
    Copley, Ohio

    No financial relationships to disclose.

  • Reina Nakamura, DO

    Assistant Clinical Professor
    University of Michigan
    Ann Arbor, Michigan

    Disclosure(s): No financial relationships to disclose

  • Donald Kasitinon, MD

    Assistant Professor
    University of Texas Southwestern Medical School
    Dallas, Texas

    Disclosure(s): No financial relationships to disclose

  • JO

    Jordan Orr, MD

    Sports Medicine Physiatrist
    Providence Swedish
    Seattle, Washington

    Disclosure(s): No financial relationships to disclose

Lab Marketing

Description: : The complexity of structures in the gluteal region and the myriad of potential pain generators can make diagnosis and management of patient’s with musculoskeletal conditions challenging. Causes of gluteal pain include pathology intrinsic to the buttock musculature and associated tendons and fascia, such as piriformis muscle pain/syndrome, ischiofemoral impingement affecting the quadratus femoris muscle, gluteus muscle origin tendinosis, greater trochanteric pain syndrome, the hamstring muscle complex or obturator internus tears as a source of pain. Other potential etiologies include sacrioiliac joint pain, numerous peripheral nerves – sciatic neuropathy, pudendal or cluneal neuralgia, or the hip joint itself. Lumbar spinal etiology can directly affect gluteal pain through innervated structures (eg radiculopathy or lumbar spinal stenosis) or play an indirect role through referred sources (eg discovertebral pain or facet arthropathy).

High-resolution musculoskeletal ultrasound allows physiatrists to enhance their clinical diagnosis and treatment options in the context of pain location through diagnostic evaluation and interventions

Why is this lab needed? : Given the lack of well-validated diagnostic criteria for many underlying clinical presentations of chronic gluteal pain, physiatric practice is dependent on a thorough understanding of the relevant anatomy to enhance clinical evaluation. With the introduction of high-resolution musculoskeletal ultrasound, physicians can enhance their diagnosis in the context of pain location through education on sonoanatomy, diagnostic evaluation – where pertinent, and interventions including approach and technique.

Lab Outline/Format:: Skills lab will start with a brief, high-level overview of gluteal pain pathology (20 minutes). This will be followed by break out into skills stations to include sonoanatomy, diagnostic discussion (where appropriate) and injection approach. There will be 5 timed stations (32min/station). Each faculty will provide a brief scanning tutorial (2-5min) followed by hands-on scanning by participants.

1. Didactic introduction: Identification of pain structures, key/relevant physical exam findings
2. Posterior crest and sciatic notch: Cluneal nerve, gluteal origin, sacroiliac joint, piriformis muscle, sciatic nerve
3. Lateral hip: Trochanter/gluteal insertion – Gluteus medius/minimus, Gluteus Maximus and IT band
4. Ischial area #1 – Obturator internus, quadratus femoris (ischiofemoral impingement), sciatic nerve, posterior femoral cutaneous nerve (PFCN)
5. Ischial area #2 – Sacrotuberous ligament, pudendal nerve, conjoined hamstring tendon/ischiogluteal bursa
6. Hip pathology (eg FAI, OA) resulting in deep gluteal pain: Anterior hip joint

Learning Objectives:

  • Understand pathology contributing to gluteal pain based on history and physical examination
  • Identify surface anatomical landmarks through manual- and sonopalpation contributing to gluteal pain
  • Recognize contributing ultrasound structures/sonoanatomy in the context of pain location
  • Understand the interventional approach and injection windows for related pathologies