Physical Medicine and Rehabilitation Clinics of North America, Feb 1, 2004
DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients ... more DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients with anatomic spinal stenosis have the added component of neurogenic compromise. Based on physiologic principles, level-by-level prolongation of DSEP latencies, reduction of amplitude, asymmetry, or a complete absence of response is associated with dysfunction in that particular afferent neurologic pathway. This dysfunction does not correspond to the exact level of stenosis noted on MRI because the rootlets in the lumbar and sacral regions pass through multiple spinal segments as they course rostrally through the spinal canal. Given that LSSS typically develops over time, the degree of abnormality likely would correspond to the physiologic slowing occurring in the multiple rootlets of the cauda equina. These recordings are not easy to perform and interpret, but when done correctly, they provide the best evidence for the type of neurophysiologic dysfunction in LSSS that responds favorably to surgical decompression. Similarly, DSEPs might provide a means of neurophysiologically monitoring clinically significant findings in a program of conservative management.
Tourniquet paralysis is an uncommon complication of surgery, and self-inflicted tourniquet paraly... more Tourniquet paralysis is an uncommon complication of surgery, and self-inflicted tourniquet paralysis has never been documented to our knowledge. We report a patient with bilateral self-induced tourniquet paralysis of the lower extremities, whose symptoms were initially attributed to an acute demyelinating sensorimotor polyneuropathy based on clinical presentation and electrodiagnostic study. After investigations failed to reveal a cause, he was found to have placed tourniquets on his legs because of a rare obsession with limb amputation known as apotemnophilia. Significant spontaneous partial resolution of clinical symptoms was noted after 6 weeks. Electrophysiologic evidence of segmental demyelination of multiple motor nerves localized to the same region may help to distinguish this condition from other forms of acute demyelinating polyneuropathy.
Physical Medicine and Rehabilitation Clinics of North America, Nov 1, 2006
Part of the beauty of making music is that it can be done for decades. There are numerous example... more Part of the beauty of making music is that it can be done for decades. There are numerous examples of outstanding instrumentalists who have performed well into their 80s and 90s. Individuals should be encouraged to continue to perform and even to learn to play an instrument late in life. The joy of performing, either for oneself or for others, is not precluded by age'' [1]. Approaching the musculoskeletal system of the instrumentalist as it relates to play of their instrument presents a variety of unique challenges. Certainly, similarities exist between the risk of injury resulting from repetitive behaviors performed in industry or while playing an instrument. Musicians behave differently than injured workers in the worker's compensation system, however. Performing artists also draw comparisons to athletes. Consider that some may have hypermobility, some may have short fifth fingers or lack independent sublimis control of the fourth and fifth digits. Effective evaluation starts with knowledge and understanding how the instrument is played, observing techniques, and determining if a change in fit, function, or guidelines for playtime may preserve the ability to play into late life. Many factors may be involved in the development of injury in the instrumentalist. The physician and health care providers caring for the instrumentalist must identify activities that may be worsening a complaint to determine whether there may be modifications that may facilitate decrease in symptoms. Although instruments are not the same, there are similarities in principle and concepts common chores of supporting the instruments, repetitive key depression, instrument maintenance, and tuning. In addition, individual anatomic variation may influence the interface of the instrumentalist with their chosen instrument. When obtaining history from the instrumentalist, one
Archives of Physical Medicine and Rehabilitation, 2005
Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) m... more Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) matched the American Association of Electrodiagnostic Medicine (AAEM) 1993 practice parameters for electrodiagnostic evaluation of carpal tunnel syndrome (CTS). Design: Cohort study using 1998-1999 Medicare billing data. Setting: Washington State. Participants: State Medicare beneficiaries who underwent CTR in 1999 (NÏ1567) Interventions: Not applicable. Main Outcome Measures: Compliance with the AAEM practice parameters. Results: Of the 324 receiving surgery, 24 (20.7%) did not have any electrodiagnostic testing before surgery. One hundred seventy-one (10.9%) had testing performed that did not lead to the diagnosis of CTS. One thousand seventy-two (68.4%) patients were diagnosed with CTS through electrodiagnostic testing; 155 (9.9%) had less than 2 sensory nerves studied, 114 (7.3%) had less than 2 motor nerves studied, and 65 (4.2%) of the studies met neither the standard (sensory nerve testing) nor guideline (motor nerve testing). In a multivariate analysis, neurologists were more likely than physiatrists not to meet the AAEM standards (adjusted relative risk [adj RR]Ï1.61; 95% confidence interval [CI], 1.13-2.31) and patients living in rural areas were more likely to have no or inadequate testing (adj RRÏ1.6; 95% CI, 1.3-1.9). Conclusions: Over one third of Medicare patients undergoing CTR in Washington State in 1999 may have had an inappropriate electrodiagnostic workup before the surgery. Policymakers should consider mandating an appropriate electrodiagnostic test before approving CTR.
Archives of Physical Medicine and Rehabilitation, 2005
Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) m... more Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) matched the American Association of Electrodiagnostic Medicine (AAEM) 1993 practice parameters for electrodiagnostic evaluation of carpal tunnel syndrome (CTS). Design: Cohort study using 1998-1999 Medicare billing data. Setting: Washington State. Participants: State Medicare beneficiaries who underwent CTR in 1999 (NÏ1567) Interventions: Not applicable. Main Outcome Measures: Compliance with the AAEM practice parameters. Results: Of the 324 receiving surgery, 24 (20.7%) did not have any electrodiagnostic testing before surgery. One hundred seventy-one (10.9%) had testing performed that did not lead to the diagnosis of CTS. One thousand seventy-two (68.4%) patients were diagnosed with CTS through electrodiagnostic testing; 155 (9.9%) had less than 2 sensory nerves studied, 114 (7.3%) had less than 2 motor nerves studied, and 65 (4.2%) of the studies met neither the standard (sensory nerve testing) nor guideline (motor nerve testing). In a multivariate analysis, neurologists were more likely than physiatrists not to meet the AAEM standards (adjusted relative risk [adj RR]Ï1.61; 95% confidence interval [CI], 1.13-2.31) and patients living in rural areas were more likely to have no or inadequate testing (adj RRÏ1.6; 95% CI, 1.3-1.9). Conclusions: Over one third of Medicare patients undergoing CTR in Washington State in 1999 may have had an inappropriate electrodiagnostic workup before the surgery. Policymakers should consider mandating an appropriate electrodiagnostic test before approving CTR.
When spinal injections are performed, a needle is placed in or around the spine making the risk o... more When spinal injections are performed, a needle is placed in or around the spine making the risk of complications unavoidable. Spinal structures or adjacent organs are at risk for direct needle trauma, infection, hematoma, hemorrhage, nerve damage, stroke, allergic reaction, or spinal anesthesia with cardiorespiratory arrest. As a result, physician knowledge and patient preparation and monitoring are critical in maximizing patient safety during the procedure being performed. This review describes complications that may result from commonly performed spinal injections and their treatment.
When spinal injections are performed, a needle is placed in or around the spine making the risk o... more When spinal injections are performed, a needle is placed in or around the spine making the risk of complications unavoidable. Spinal structures or adjacent organs are at risk for direct needle trauma, infection, hematoma, hemorrhage, nerve damage, stroke, allergic reaction, or spinal anesthesia with cardiorespiratory arrest. As a result, physician knowledge and patient preparation and monitoring are critical in maximizing patient safety during the procedure being performed. This review describes complications that may result from commonly performed spinal injections and their treatment.
The objective of this paper is to review the literature of cervical transforaminal injections, re... more The objective of this paper is to review the literature of cervical transforaminal injections, resulting complications, and to suggest a safe technique. A systematic review of the literature was performed. Both the MEDLINE and EMBASE databases were searched for any article relating to cervical epidural injections, cervical transforaminal injections, and complications relating to cervical epidural or cervical transforaminal injections. Finally, a method for performing a cervical transforaminal injection safely is described. The review of the literature revealed: 1. There is a paucity of literature regarding cervical transforaminal injections; 2. There is no accepted standard technique for performing cervical transforaminal injections; and 3. More research and study must be performed regarding the risk versus benefit, technique, and outcome of cervical transforaminal injections.
Electrical stimulation of the right cervical medial branches with or without the third occipital ... more Electrical stimulation of the right cervical medial branches with or without the third occipital nerves was performed in nine subjects for a total of forty-eight medial branches and eight third occipital nerves. The referral patterns of each nerve or nerve branch was mapped on a human line diagram. These diagrams were compared to facet joint (zygapophyseal joint, facet joint), myofascial, and discogenic referral patterns already published by various authors. [corrected] To determine the referral patterns of the cervical medial branches and the third occipital nerve. The cervical medial branch referral patterns created by electrical stimulation may differ from those reported from other etiologies and may prove to be useful when considering various cervical pain syndromes. The third occipital nerve and third through eighth medial branches of the cervical posterior rami of nine subjects with and without a history of neck pain were electrically stimulated under fluoroscopic imaging. All...
Objective: The objective of this paper is to review the literature of cervical trans- foraminal i... more Objective: The objective of this paper is to review the literature of cervical trans- foraminal injections, resulting complications, and to suggest a safe technique. Methods: A systematic review of the lit- erature was performed. Both the MEDLINE and EMBASE databases were searched for any article relating to cervical epidural injec- tions, cervical transforaminal injections, and complications relating to cervical epidural
Physical Medicine and Rehabilitation Clinics of North America, 2004
DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients ... more DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients with anatomic spinal stenosis have the added component of neurogenic compromise. Based on physiologic principles, level-by-level prolongation of DSEP latencies, reduction of amplitude, asymmetry, or a complete absence of response is associated with dysfunction in that particular afferent neurologic pathway. This dysfunction does not correspond to the exact level of stenosis noted on MRI because the rootlets in the lumbar and sacral regions pass through multiple spinal segments as they course rostrally through the spinal canal. Given that LSSS typically develops over time, the degree of abnormality likely would correspond to the physiologic slowing occurring in the multiple rootlets of the cauda equina. These recordings are not easy to perform and interpret, but when done correctly, they provide the best evidence for the type of neurophysiologic dysfunction in LSSS that responds favorably to surgical decompression. Similarly, DSEPs might provide a means of neurophysiologically monitoring clinically significant findings in a program of conservative management.
Physical medicine and rehabilitation clinics of North America, 2004
DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients ... more DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients with anatomic spinal stenosis have the added component of neurogenic compromise. Based on physiologic principles, level-by-level prolongation of DSEP latencies, reduction of amplitude, asymmetry, or a complete absence of response is associated with dysfunction in that particular afferent neurologic pathway. This dysfunction does not correspond to the exact level of stenosis noted on MRI because the rootlets in the lumbar and sacral regions pass through multiple spinal segments as they course rostrally through the spinal canal. Given that LSSS typically develops over time, the degree of abnormality likely would correspond to the physiologic slowing occurring in the multiple rootlets of the cauda equina. These recordings are not easy to perform and interpret, but when done correctly, they provide the best evidence for the type of neurophysiologic dysfunction in LSSS that responds favorably...
Physical Medicine and Rehabilitation Clinics of North America, Feb 1, 2004
DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients ... more DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients with anatomic spinal stenosis have the added component of neurogenic compromise. Based on physiologic principles, level-by-level prolongation of DSEP latencies, reduction of amplitude, asymmetry, or a complete absence of response is associated with dysfunction in that particular afferent neurologic pathway. This dysfunction does not correspond to the exact level of stenosis noted on MRI because the rootlets in the lumbar and sacral regions pass through multiple spinal segments as they course rostrally through the spinal canal. Given that LSSS typically develops over time, the degree of abnormality likely would correspond to the physiologic slowing occurring in the multiple rootlets of the cauda equina. These recordings are not easy to perform and interpret, but when done correctly, they provide the best evidence for the type of neurophysiologic dysfunction in LSSS that responds favorably to surgical decompression. Similarly, DSEPs might provide a means of neurophysiologically monitoring clinically significant findings in a program of conservative management.
Tourniquet paralysis is an uncommon complication of surgery, and self-inflicted tourniquet paraly... more Tourniquet paralysis is an uncommon complication of surgery, and self-inflicted tourniquet paralysis has never been documented to our knowledge. We report a patient with bilateral self-induced tourniquet paralysis of the lower extremities, whose symptoms were initially attributed to an acute demyelinating sensorimotor polyneuropathy based on clinical presentation and electrodiagnostic study. After investigations failed to reveal a cause, he was found to have placed tourniquets on his legs because of a rare obsession with limb amputation known as apotemnophilia. Significant spontaneous partial resolution of clinical symptoms was noted after 6 weeks. Electrophysiologic evidence of segmental demyelination of multiple motor nerves localized to the same region may help to distinguish this condition from other forms of acute demyelinating polyneuropathy.
Physical Medicine and Rehabilitation Clinics of North America, Nov 1, 2006
Part of the beauty of making music is that it can be done for decades. There are numerous example... more Part of the beauty of making music is that it can be done for decades. There are numerous examples of outstanding instrumentalists who have performed well into their 80s and 90s. Individuals should be encouraged to continue to perform and even to learn to play an instrument late in life. The joy of performing, either for oneself or for others, is not precluded by age'' [1]. Approaching the musculoskeletal system of the instrumentalist as it relates to play of their instrument presents a variety of unique challenges. Certainly, similarities exist between the risk of injury resulting from repetitive behaviors performed in industry or while playing an instrument. Musicians behave differently than injured workers in the worker's compensation system, however. Performing artists also draw comparisons to athletes. Consider that some may have hypermobility, some may have short fifth fingers or lack independent sublimis control of the fourth and fifth digits. Effective evaluation starts with knowledge and understanding how the instrument is played, observing techniques, and determining if a change in fit, function, or guidelines for playtime may preserve the ability to play into late life. Many factors may be involved in the development of injury in the instrumentalist. The physician and health care providers caring for the instrumentalist must identify activities that may be worsening a complaint to determine whether there may be modifications that may facilitate decrease in symptoms. Although instruments are not the same, there are similarities in principle and concepts common chores of supporting the instruments, repetitive key depression, instrument maintenance, and tuning. In addition, individual anatomic variation may influence the interface of the instrumentalist with their chosen instrument. When obtaining history from the instrumentalist, one
Archives of Physical Medicine and Rehabilitation, 2005
Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) m... more Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) matched the American Association of Electrodiagnostic Medicine (AAEM) 1993 practice parameters for electrodiagnostic evaluation of carpal tunnel syndrome (CTS). Design: Cohort study using 1998-1999 Medicare billing data. Setting: Washington State. Participants: State Medicare beneficiaries who underwent CTR in 1999 (NÏ1567) Interventions: Not applicable. Main Outcome Measures: Compliance with the AAEM practice parameters. Results: Of the 324 receiving surgery, 24 (20.7%) did not have any electrodiagnostic testing before surgery. One hundred seventy-one (10.9%) had testing performed that did not lead to the diagnosis of CTS. One thousand seventy-two (68.4%) patients were diagnosed with CTS through electrodiagnostic testing; 155 (9.9%) had less than 2 sensory nerves studied, 114 (7.3%) had less than 2 motor nerves studied, and 65 (4.2%) of the studies met neither the standard (sensory nerve testing) nor guideline (motor nerve testing). In a multivariate analysis, neurologists were more likely than physiatrists not to meet the AAEM standards (adjusted relative risk [adj RR]Ï1.61; 95% confidence interval [CI], 1.13-2.31) and patients living in rural areas were more likely to have no or inadequate testing (adj RRÏ1.6; 95% CI, 1.3-1.9). Conclusions: Over one third of Medicare patients undergoing CTR in Washington State in 1999 may have had an inappropriate electrodiagnostic workup before the surgery. Policymakers should consider mandating an appropriate electrodiagnostic test before approving CTR.
Archives of Physical Medicine and Rehabilitation, 2005
Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) m... more Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) matched the American Association of Electrodiagnostic Medicine (AAEM) 1993 practice parameters for electrodiagnostic evaluation of carpal tunnel syndrome (CTS). Design: Cohort study using 1998-1999 Medicare billing data. Setting: Washington State. Participants: State Medicare beneficiaries who underwent CTR in 1999 (NÏ1567) Interventions: Not applicable. Main Outcome Measures: Compliance with the AAEM practice parameters. Results: Of the 324 receiving surgery, 24 (20.7%) did not have any electrodiagnostic testing before surgery. One hundred seventy-one (10.9%) had testing performed that did not lead to the diagnosis of CTS. One thousand seventy-two (68.4%) patients were diagnosed with CTS through electrodiagnostic testing; 155 (9.9%) had less than 2 sensory nerves studied, 114 (7.3%) had less than 2 motor nerves studied, and 65 (4.2%) of the studies met neither the standard (sensory nerve testing) nor guideline (motor nerve testing). In a multivariate analysis, neurologists were more likely than physiatrists not to meet the AAEM standards (adjusted relative risk [adj RR]Ï1.61; 95% confidence interval [CI], 1.13-2.31) and patients living in rural areas were more likely to have no or inadequate testing (adj RRÏ1.6; 95% CI, 1.3-1.9). Conclusions: Over one third of Medicare patients undergoing CTR in Washington State in 1999 may have had an inappropriate electrodiagnostic workup before the surgery. Policymakers should consider mandating an appropriate electrodiagnostic test before approving CTR.
When spinal injections are performed, a needle is placed in or around the spine making the risk o... more When spinal injections are performed, a needle is placed in or around the spine making the risk of complications unavoidable. Spinal structures or adjacent organs are at risk for direct needle trauma, infection, hematoma, hemorrhage, nerve damage, stroke, allergic reaction, or spinal anesthesia with cardiorespiratory arrest. As a result, physician knowledge and patient preparation and monitoring are critical in maximizing patient safety during the procedure being performed. This review describes complications that may result from commonly performed spinal injections and their treatment.
When spinal injections are performed, a needle is placed in or around the spine making the risk o... more When spinal injections are performed, a needle is placed in or around the spine making the risk of complications unavoidable. Spinal structures or adjacent organs are at risk for direct needle trauma, infection, hematoma, hemorrhage, nerve damage, stroke, allergic reaction, or spinal anesthesia with cardiorespiratory arrest. As a result, physician knowledge and patient preparation and monitoring are critical in maximizing patient safety during the procedure being performed. This review describes complications that may result from commonly performed spinal injections and their treatment.
The objective of this paper is to review the literature of cervical transforaminal injections, re... more The objective of this paper is to review the literature of cervical transforaminal injections, resulting complications, and to suggest a safe technique. A systematic review of the literature was performed. Both the MEDLINE and EMBASE databases were searched for any article relating to cervical epidural injections, cervical transforaminal injections, and complications relating to cervical epidural or cervical transforaminal injections. Finally, a method for performing a cervical transforaminal injection safely is described. The review of the literature revealed: 1. There is a paucity of literature regarding cervical transforaminal injections; 2. There is no accepted standard technique for performing cervical transforaminal injections; and 3. More research and study must be performed regarding the risk versus benefit, technique, and outcome of cervical transforaminal injections.
Electrical stimulation of the right cervical medial branches with or without the third occipital ... more Electrical stimulation of the right cervical medial branches with or without the third occipital nerves was performed in nine subjects for a total of forty-eight medial branches and eight third occipital nerves. The referral patterns of each nerve or nerve branch was mapped on a human line diagram. These diagrams were compared to facet joint (zygapophyseal joint, facet joint), myofascial, and discogenic referral patterns already published by various authors. [corrected] To determine the referral patterns of the cervical medial branches and the third occipital nerve. The cervical medial branch referral patterns created by electrical stimulation may differ from those reported from other etiologies and may prove to be useful when considering various cervical pain syndromes. The third occipital nerve and third through eighth medial branches of the cervical posterior rami of nine subjects with and without a history of neck pain were electrically stimulated under fluoroscopic imaging. All...
Objective: The objective of this paper is to review the literature of cervical trans- foraminal i... more Objective: The objective of this paper is to review the literature of cervical trans- foraminal injections, resulting complications, and to suggest a safe technique. Methods: A systematic review of the lit- erature was performed. Both the MEDLINE and EMBASE databases were searched for any article relating to cervical epidural injec- tions, cervical transforaminal injections, and complications relating to cervical epidural
Physical Medicine and Rehabilitation Clinics of North America, 2004
DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients ... more DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients with anatomic spinal stenosis have the added component of neurogenic compromise. Based on physiologic principles, level-by-level prolongation of DSEP latencies, reduction of amplitude, asymmetry, or a complete absence of response is associated with dysfunction in that particular afferent neurologic pathway. This dysfunction does not correspond to the exact level of stenosis noted on MRI because the rootlets in the lumbar and sacral regions pass through multiple spinal segments as they course rostrally through the spinal canal. Given that LSSS typically develops over time, the degree of abnormality likely would correspond to the physiologic slowing occurring in the multiple rootlets of the cauda equina. These recordings are not easy to perform and interpret, but when done correctly, they provide the best evidence for the type of neurophysiologic dysfunction in LSSS that responds favorably to surgical decompression. Similarly, DSEPs might provide a means of neurophysiologically monitoring clinically significant findings in a program of conservative management.
Physical medicine and rehabilitation clinics of North America, 2004
DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients ... more DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients with anatomic spinal stenosis have the added component of neurogenic compromise. Based on physiologic principles, level-by-level prolongation of DSEP latencies, reduction of amplitude, asymmetry, or a complete absence of response is associated with dysfunction in that particular afferent neurologic pathway. This dysfunction does not correspond to the exact level of stenosis noted on MRI because the rootlets in the lumbar and sacral regions pass through multiple spinal segments as they course rostrally through the spinal canal. Given that LSSS typically develops over time, the degree of abnormality likely would correspond to the physiologic slowing occurring in the multiple rootlets of the cauda equina. These recordings are not easy to perform and interpret, but when done correctly, they provide the best evidence for the type of neurophysiologic dysfunction in LSSS that responds favorably...
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Papers by Seneca Storm