Papers by Jeffrey Strakowski
PM&R, 2018
right and 1.4 cm on the left. Diagnostic ultrasound was used to better define these calcification... more right and 1.4 cm on the left. Diagnostic ultrasound was used to better define these calcifications with relation to the surrounding tissues and demonstrated that the right osteochondral body was 1.4 cm L Â 1.2 cm W and 3.55 cm proximal to the olecranon while the left osteochondral body was 1.7 cm L Â 1.33 cm W and 5.37 cm proximal to the olecranon. The patient was sent for a right elbow MRI, as part of further evaluation. However, it could not be completed as the patient was claustrophobic. Discussion: Osseous bodies are typically formed in intra-articular spaces following disruption to the articular surface. This disruption may occur as the result of direct/indirect trauma, or chronic disease processes such as osteoarthritis, Charcot's disease or synovial chondromatosis. In the case of this patient, the osseous bodies were identified within the muscle fibers, rather than the joint space. Years of repetitive subclinical trauma from the jackhammer vibrations, as opposed to a single inciting event or a classic disease process, likely spurred the development of these bodies. Conclusions: Osseous bodies are usually found in joint spaces where they cause symptoms of pain and reduced range of motion. However, long-term subclinical trauma can cause these bodies to occur within the tendinous structures where they can cause a similar syndrome.
Clinical Neurophysiology, 2018
h i g h l i g h t s Experts routinely use ultrasound to evaluate both common and rare disorders o... more h i g h l i g h t s Experts routinely use ultrasound to evaluate both common and rare disorders of nerve and muscle. Accumulated evidence now puts diagnostic neuromuscular ultrasound on par with EMG and NCS. Medical centers must acquire ultrasound equipment to keep electrodiagnostic laboratories current.
By reading, you can know the knowledge and things more, not only about what you get from people t... more By reading, you can know the knowledge and things more, not only about what you get from people to people. Book will be more trusted. As this ultrasound evaluation of focal neuropathies, it will really give you the good idea to be successful. It is not only for you to be success in certain life you can be successful in everything. The success can be started by knowing the basic knowledge and do actions.
American Journal of Physical Medicine & Rehabilitation, 2002
PM&R, 2016
The thenar motor branch (TMB) of the median nerve may be affected in carpal tunnel syndrome and c... more The thenar motor branch (TMB) of the median nerve may be affected in carpal tunnel syndrome and can be injured during carpal tunnel surgery. Although ultrasound has been used to identify small nerves throughout the body, the sonographic evaluation of the TMB has not been investigated formally. To document the ability of ultrasound to visualize the TMB of the median nerve in an unembalmed cadaveric model. Prospective laboratory investigation. Procedural skills laboratory at a tertiary medical center. On the basis of anatomical descriptions, dissection and clinical experience, a technique was developed to sonographically identify the presumed TMB of the median nerve at the distal carpal tunnel. A single, experienced examiner then identified the presumed TMB in 10 unembalmed, cadaveric upper limb specimens (4 right, 6 left) obtained from 9 donors (4 male, 5 female) ages 76-85 years with body mass indices of 18.2-29.5 kg/m(2) with both 12-3 MHZ and 16-7 MHz linear array transducers. The same examiner then injected 0.2-0.3 mL of diluted colored latex into and around the presumed TMB using direct ultrasound guidance. At a minimum of 24 hours postinjection, specimens were dissected under loupe magnification to determine the location of the latex injectate. The location of latex injectate relative to the anatomically identified TMB. A vertical, linear, hypoechogenic region was sonographically identified arising from the median nerve at the distal carpal tunnel in all 10 specimens and was hypothesized to represent the vertical segment of the TMB. Both transducers allowed identification of the TMB, although localization was subjectively facilitated by the higher frequency transducer. All 10 sonographically guided injections placed latex into and around the TMB of the median nerve, confirming that ultrasound had accurately identified the TMB. Sonographic evaluation of the TMB of the median nerve is technically feasible and should be considered when clinically indicated. Further research and clinical experience is necessary to define the role of sonographic TMB imaging in the evaluation and management of patients with carpal tunnel syndrome.
Archives of Physical Medicine and Rehabilitation, Jun 1, 2004
DePalma MJ, Strakowski JA, Mandelker EM, Zerick WR. An instance of an atypical intraspinal cyst p... more DePalma MJ, Strakowski JA, Mandelker EM, Zerick WR. An instance of an atypical intraspinal cyst presenting as S1 radiculopathy: a case report and brief review of pathophysiology. Arch Phys Med Rehabil 2004;85:1021–5.Intraspinal cysts are rare, but typically they originate from a degenerate zygapophyseal joint. These cysts have been commonly referred to as juxtafacet cysts and occur concomitantly with lumbar and occasionally lower-limb radicular pain. Documented cases have shown pseudoarthroses developing from nonhealing pars defects. Histologic analyses have found synovial tissue within these fibrocartilaginous accumulations. We present a case of S1 radiculopathy indicated by an intraspinal pseudocyst arising as a complication of a chronic spondylolytic defect. A brief review of the related pathophysiology is also included.
American Journal of Physical Medicine Rehabilitation Association of Academic Physiatrists, Jul 1, 2001
Electromyographers must reliably differentiate between H reflexes and F waves when recording from... more Electromyographers must reliably differentiate between H reflexes and F waves when recording from the soleus muscle in the evaluation of S1 radiculopathy. The use of F waves in root-level injuries is questioned, whereas H reflexes have shown value in the evaluation of S1 radiculopathy. We studied the relationship between the tibial H reflex and F wave latencies in the limbs of 40 subjects. After recording the H wave latency, we changed the gain to 200 microV/cm and increased the stimulation to supramaximal for ten additional responses without moving the recording or stimulating electrodes. We also calculated the predicted H wave latency with the standard formula. Forty subjects, mean age 32 yr, consented and participated. The mean of the average F wave was 1.76 ms longer than the ipsilateral H reflex latency. The mean side-to-side difference of the average F wave was 0.56 ms. The H reflex latency side-to-side difference was 0.36 ms. The findings suggest that the average F wave latencies have a predictive value in the clinical context similar to the H reflex.
British journal of sports medicine, 2015
Focal neuropathies represent a rare but clinically important and potentially challenging aetiolog... more Focal neuropathies represent a rare but clinically important and potentially challenging aetiology of pain in athletes. Diagnostic ultrasound is commonly used in the evaluation of nerve entrapments, and has several advantages over other imaging modalities, including high resolution, portability, lack of ionising radiation, low cost, point-of-care access, ease of contralateral comparison and capability of Doppler and dynamic imaging techniques. In this review, we discuss the use of ultrasound for the evaluation of injuries to the brachial plexus including 'stingers,' suprascapular nerve, ulnar nerve, radial nerve, common fibular nerve, tibial nerve and interdigital nerves of the foot at selected common sites of entrapment.
Physical medicine and rehabilitation clinics of North America, 2010
There has been an increase in the use of ultrasound (US) to help guide interventional procedures ... more There has been an increase in the use of ultrasound (US) to help guide interventional procedures involving the musculoskeletal system. To perform these procedures safely and accurately, two steps must occur. First, the appropriate structure must be localized using diagnostic US imaging. Second, a needle must be guided under constant visualization toward the targeted tissue. Although US imaging can help place the needle and, hence, therapeutic medication more accurately, there is still debate about whether or not image-guided procedures result in improved outcomes. This article discusses the advantages and disadvantages of performing US-guided injections and describes injection principles and techniques. Studies examining the efficacy of US-guided procedures are reviewed.
Physical medicine and rehabilitation clinics of North America, 2006
Runners are susceptible to a variety of potential injuries because of the considerable stress of ... more Runners are susceptible to a variety of potential injuries because of the considerable stress of this activity. This can create a challenge for the treating practitioner; however, many of the common ailments occur in a reasonably predictable pattern. A careful history and physical examination are necessary for accurate diagnosis. Having a good understanding of these injuries as well of the role of biomechanical factors and common training errors can assist with appropriate care. Further development in the knowledge of soft tissue trauma, gait, and diagnostic and therapeutic modalities should lead to improved management of the injuries facing these athletes.
PM&R, 2011
Objective: The patient is a healthy man who used to run 20-30 miles per week. He has noticed prog... more Objective: The patient is a healthy man who used to run 20-30 miles per week. He has noticed progressive difficulty running over a span of a couple months secondary to right buttock pain. Now he can only run about 5 minutes before the pain prevents him from continuing. When asked to walk, his pelvis was shifted to the right and his upper body leaned toward the left. His physical examination revealed normal muscle strength throughout, except 4/5 strength in right hip abduction and tenderness to palpation in the right piriformis area. When asked to stand on his right leg, his contralateral pelvis did not tilt inferiorly, which is what would be expected with a weak gluteus medius. Conservative treatment of physical therapy and trigger point injections did not improve his gait or pain. A magnetic resonance image of the lumbar spine showed multiple levels of degenerative changes in the disks and facets, most notably a moderate-severe L4-5 herniated disk. An electromyography and/or nerve conduction studies showed a right L5 radiculopathy, which correlates with his symptoms. A week later, the patient underwent a right L5 transforaminal epidural steroid injection. Patients or Programs: A 35-year-old man with right buttock pain who runs marathons. Setting: Outpatient rehabilitation hospital. Results: One month after the transforaminal epidural steroid injection, the patient stated that his leg pain was 90% better and that his posture improved dramatically. He was slowly increasing his running distances with no problems. Discussion: Marathon runners with back and/or leg pain may have underlying disk pathology masked by good muscle build. The lack of pelvic tilt was most likely secondary to compensated musculature or taut muscles and/or ligaments on the ipsilateral side. Conclusions: Although Trendelenburg test/gait is a good indicator for gluteus medius weakness, a negative test does not rule it out.
PM&R, 2013
M.N. is a 35-year-old otherwise healthy female software engineer with a 2-year history of intermi... more M.N. is a 35-year-old otherwise healthy female software engineer with a 2-year history of intermittent right hand numbness that has worsened in the past 2-3 months. She endorses numbness in the hand, worse in the thumb, index, and middle fingers. Typing and driving aggravate her symptoms, and she frequently wakes up at night with numbness in the hand. She also endorses intermittent neck pain that she believes is unrelated and occasional numbness in the forearm. She denies any weakness or history of dropping items.
Obstetrics & Gynecology, 2011
Foot drop has been described as an infrequent complication from common peroneal nerve injury rela... more Foot drop has been described as an infrequent complication from common peroneal nerve injury related to external compression and forceful knee flexion while pushing during vaginal delivery. Past recommendations include placing the hands at the posterior thighs rather than the legs to avoid this complication. A 32-year-old woman developed unilateral foot drop after vaginal delivery. Electromyography was diagnostic for an acute compression neuropathy of the common peroneal nerve above the knee. The patient's likely mechanism of injury occurred during delivery from external compression by the patient's dominant hand to the distal posterior thigh while under epidural anesthesia. Labor and delivery teams should be aware that nerve injury is also possible at the distal thigh with excessive external pressure.
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Papers by Jeffrey Strakowski