sean mulvaney | Ohio State University (original) (raw)
Papers by sean mulvaney
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2015
Multiple case series published in the peer-reviewed medical literature have demonstrated the safe... more Multiple case series published in the peer-reviewed medical literature have demonstrated the safety and efficacy of right-sided stellate ganglion block (SGB) for the treatment of anxiety symptoms associated with posttraumatic stress disorder (PTSD). As this is a new indication for a well-established procedure, there is relatively little information available to assist clinicians in determining the utility of SGB for their patients. Presented are clinical guidelines to assist the provider with patient selection, patient education, and follow-up. Also described is a technique to perform SGB under ultrasound-guidance. Although additional rigorous clinical research is needed to further investigate SGB for the treatment of anxiety symptoms associated with PTSD, these guidelines can also assist clinical investigators in their participant selection, design, and conduct of future research as it pertains to this important topic.
Regenerative Medicine Options for Chronic Musculoskeletal Conditions : A Review of the Literature
Specifically, regenerative medicine also stands in contrast to treatment modalities that impair t... more Specifically, regenerative medicine also stands in contrast to treatment modalities that impair the body’s ability to facilitate endogenous repair mechanisms such as anti-inflammatory drugs (2,3); destructive modalities (e.g., radio frequency ablation of nerves, botulinum toxin injections) (4); and surgical methods that permanently alter the functioning of a joint, including joint fusion, spine fixation, and partial or total arthroplasty. When compared to other allopathic options (including knee and hip arthroplasty with a 90-day mortality rate of 0.7% in the Western hemisphere) (5), regenerative medicine treatment modalities have a lower incidence of adverse events with a growing body of statistically significant medical literature illustrating both their safety and efficacy (6).
Self-reported combat-related symptom scores change after witnessing a teammate's improvement following stellate ganglion block for post-traumatic stress symptoms
Journal of Science and Medicine in Sport, 2017
Objective: Determine whether a two-level cervical sympathetic chain block may be more effective t... more Objective: Determine whether a two-level cervical sympathetic chain block may be more effective than a standard C6 level stellate ganglion block (SGB) for the treatment of posttraumatic stress disorder (PTSD). Background: A right-sided SGB has many medical publications supporting its safety and efficacy for the treatment of PTSD. However, in clinical practice, some patients do not respond to a C6 level SGB as anticipated. Currently, there are no published reports describing a two-level sympathetic block (2LSB) as a treatment modality. Thus, the purpose of this investigation is to initially assess safety and efficacy of this novel procedure as compared to the standard procedure. Methods: The PTSD Checklist (PCL-5) is routinely collected for patients prior to SGB or 2LSB for PTSD. We retrospectively evaluated baseline (T0) and 4 weeks (T1) PCL-5 scores in post-SGB/2LSB in our center. Results: One-hundred and forty-seven of 328 consecutive subjects underwent SGB (group 1) or 2LCB (grou...
Journal of Investigative Medicine, 2021
The stellate ganglion block (SGB) procedure has been used successfully for over 10 years to treat... more The stellate ganglion block (SGB) procedure has been used successfully for over 10 years to treat post-traumatic stress symptoms in thousands of US military service members, civilians, and veterans in select hospitals in Europe and North America. Primarily through targeting the autonomic nervous system, the SGB procedure serves as an invaluable adjunct to trauma-focused psychotherapy. Without published best practices for emerging therapies, clinicians are left on their own to determine how best to apply new treatments to their patient populations. The aim of this qualitative research was to compile attitudes and recommendations from therapists with expertise in using SGB for treating symptoms of post-traumatic stress disorder, so that their experiences could be disseminated widely to clinicians without SGB expertise. An 18-item survey was developed and distributed electronically to a group of behavioral health professionals of various specialties between May and June 2020. Of survey...
The Successful Use of Left-sided Stellate Ganglion Block in Patients That Fail to Respond to Right-sided Stellate Ganglion Block for the Treatment of Post-traumatic Stress Disorder Symptoms: A Retrospective Analysis of 205 Patients
Military Medicine
Introduction Ultrasound-guided stellate ganglion block (SGB) is an injection of local anesthetic ... more Introduction Ultrasound-guided stellate ganglion block (SGB) is an injection of local anesthetic (8mL of 0.5% ropivacaine) in the neck to temporarily block the cervical sympathetic trunk which controls the body’s fight-or-flight response. This outpatient procedure takes less than thirty minutes and is immediately effective. Our goal was to determine if a left-sided stellate ganglion block is effective for treating posttraumatic stress disorder (PTSD) symptoms. While right-sided SGB has been extensively studied, left-sided SGB has not been formally evaluated for this indication. Materials and Methods Our hypothesis was that patients who fail to improve following a right-sided SGB will report significant improvement following a left-sided SGB. A retrospective chart review was conducted for patients who received SGB for PTSD symptoms between August 2019 and March 2020. All procedures were performed at an established musculoskeletal practice by the same anesthesia/pain fellowship-traine...
JAMA Psychiatry
IMPORTANCE This is the first multisite, randomized clinical trial of stellate ganglion block (SGB... more IMPORTANCE This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms. OBJECTIVE To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total symptom severity scores from baseline to 8 weeks. DESIGN, SETTING, AND PARTICIPANTS This multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers. Only physicians performing the procedures and the procedure nurses were aware of the intervention (but not the participants or assessors); their interactions with the participants were scripted and limited to the 2 interventions. Active-duty service members on stable psychotropic medication dosages who had a PTSD Checklist-Civilian Version (PCL-C) score of 32 or more at screening were included. Key exclusion criteria included a prior SGB treatment, selected psychiatric disorders or substance use disorders, moderate or severe traumatic brain injury, or suicidal ideation in the prior 2 months. INTERVENTIONS Paired right-sided SGB or sham procedures at weeks 0 and 2. MAIN OUTCOMES AND MEASURES Improvement of 10 or more points on mean CAPS-5 total symptom severity scores from baseline to 8 weeks, adjusted for site and baseline total symptom severity scores (planned a priori). RESULTS Of 190 screened individuals, 113 (59.5%; 100 male and 13 female participants; mean [SD] age, 37.3 [6.7] years) were eligible and randomized (74 to SGB and 39 to sham treatment), and 108 (95.6% of 113) completed the study. Baseline characteristics were similar in the SGB and sham treatment groups, with mean (SD) CAPS-5 scores of 37.6 (11.2) and 39.8 (14.4), respectively (on a scale of 0-80); 91 (80.0%) met CAPS-5 PTSD criteria. In an intent-to-treat analysis, adjusted mean total symptom severity score change was −12.6 points (95% CI, −15.5 to −9.7 points) for the group receiving SGB treatments, compared with −6.1 points (95% CI, −9.8 to −2.3 points) for those receiving sham treatment (P = .01). CONCLUSIONS AND RELEVANCE In this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03077919
Military medicine, Sep 1, 2016
This study assessed which symptoms are most impacted following stellate ganglion block (SGB) used... more This study assessed which symptoms are most impacted following stellate ganglion block (SGB) used to treat post-traumatic stress disorder (PTSD) symptoms. 30 active military service members with combat-related PTSD self-referred to their physician and psychologist. Patients were offered a SGB as part of their treatment program. Primary outcome was the magnitude of change for the 17 items on the PTSD Checklist-Military (PCL-M), which was administered the week before SGB, 1 week after SGB, and 2 to 4 months later. Mean PCL-M score decreased from 49 at baseline to 32, 1 week after the procedure (p < 0.001). 2 to 4 months after SGB, patients maintained an average PCL-M of 32. Patients reported greatest improvement in the first week after SGB for the following symptoms: irritability or angry outbursts, difficulty concentrating, and sleep disturbance. 2 to 4 months later, patients reported greatest improvement in the following: feeling distant or cut off, feeling emotionally numb, irri...
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2015
Multiple case series published in the peer-reviewed medical literature have demonstrated the safe... more Multiple case series published in the peer-reviewed medical literature have demonstrated the safety and efficacy of right-sided stellate ganglion block (SGB) for the treatment of anxiety symptoms associated with posttraumatic stress disorder (PTSD). As this is a new indication for a well-established procedure, there is relatively little information available to assist clinicians in determining the utility of SGB for their patients. Presented are clinical guidelines to assist the provider with patient selection, patient education, and follow-up. Also described is a technique to perform SGB under ultrasound-guidance. Although additional rigorous clinical research is needed to further investigate SGB for the treatment of anxiety symptoms associated with PTSD, these guidelines can also assist clinical investigators in their participant selection, design, and conduct of future research as it pertains to this important topic.
Military medicine, 2015
To measure key neurocognitive performance effects following stellate ganglion block (SGB) adminis... more To measure key neurocognitive performance effects following stellate ganglion block (SGB) administered to treat post-traumatic stress disorder (PTSD) symptoms. Eleven patients diagnosed, screened, and scheduled for SGB to treat their PTSD symptoms were administered a panel of eight cognitive measures before and 1 to 3 weeks after undergoing this procedure. PTSD symptoms were evaluated using the Posttraumatic Stress Disorder Checklist-Military. One to three weeks post-SGB, none of the patients showed any statistically significant decline in neurocognitive performance. Rather, there was a clear trend in improvement, with four out of eight measures reaching statistical significance following SGB. All patients improved in PTSD symptoms with a mean improvement on Posttraumatic Stress Disorder Checklist-Military of 29. In this case series of 11 patients, SGB effectively treated PTSD symptoms and did not impair reaction time, memory, or concentration. Therefore, SGB should be considered as...
Ultrasound-guided percutaneous neuroplasty of the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica: a case report and description of a new ultrasound-guided technique
Current sports medicine reports
The lateral femoral cutaneous nerve (LFCN) can be visualized with ultrasound imaging using a high... more The lateral femoral cutaneous nerve (LFCN) can be visualized with ultrasound imaging using a high frequency linear transducer. The entrapment of the LFCN, often near the lateral aspect of the inguinal ligament, is accepted as an etiology of meralgia paresthetica (MP). This case report describes an ultrasound-guided, percutaneous technique that utilizes injected fluid to facilitate blunt dissection (or hydrodissection) to perform an external neuroplasty of the LFCN. This procedure resulted in immediate, long-term relief of pain associated with severe, chronic MP. This procedure may potentially represent an alternate treatment for patients with contraindications or partial contraindications to surgical neurolysis, nerve transection (usually described as being performed under general anesthesia), or corticosteroid injection, or in patients not responding to conservative treatment measures.
A review of viscosupplementation for osteoarthritis of the hip and a description of an ultrasound-guided hip injection technique
Current sports medicine reports
Viscosupplementation of the hip for symptomatic osteoarthritis appears to be safe and effective i... more Viscosupplementation of the hip for symptomatic osteoarthritis appears to be safe and effective in more than 25 yr of use in Europe. More than 11 studies suggest that viscosupplementation in the hip is as effective as viscosupplementation in the knee. It appears to be a safe and reasonable alternative to nonsteroidal antiinflammatory drugs or intra-articular steroids for the treatment of osteoarthritis pain. Viscosupplementation in the hip may delay the need for hip replacement surgery. Viscosupplementation in the hip appears to work better in patients with fewer radiographic changes of osteoarthritis. Placement of viscosupplement in the hip under real-time ultrasound or fluoroscopic guidance is safe and well tolerated. Hip joint communication with the iliopsoas bursa may be a factor in studies of the effectiveness of viscosupplementation in the hip.
Calf muscle therapy for Achilles tendinosis
American family physician, 2003
The Outdoor Athlete
Sports Medicine for the Primary Care Physician, Third Edition, 2004
Military Medicine, 2014
Objective: Report the successful use of stellate ganglion blocks (SGBs) in 166 active duty servic... more Objective: Report the successful use of stellate ganglion blocks (SGBs) in 166 active duty service members with multiple combat deployments experiencing anxiety symptoms associated with post-traumatic stress disorder (PTSD). Background: Successful treatment of PTSD symptoms with SGB has been reported previously. This is the largest published case series evaluating SGB with a minimum of 3 months follow-up. Methods: Following clinical interview including administration of the PTSD Checklist (PCL), 166 service members with symptoms of PTSD elected to receive a SGB. All patients received a SGB on the right side at the level of the sixth cervical vertebrae (C6). The PCL was administered the day before treatment to establish a baseline, repeated 1 week later, and then monthly out to 3 months. A positive response was considered to be an improvement in the PCL score by 10 or greater points. Follow-up PCL scores from 3 to 6 months were obtained and analyzed for 166 patients. Results: In a military population with multiple combat deployments, over 70% of the patients treated had a clinically significant improvement in their PCL score which persisted beyond 3 to 6 months postprocedure. Conclusion: Selective blockade of the right cervical sympathetic chain at the C6 level is a safe and minimally invasive procedure that may provide durable relief from anxiety symptoms associated with PTSD.
Pain Practice, 2010
Objective: Report the successful use of stellate ganglion blocks (SGBs) in two patients experienc... more Objective: Report the successful use of stellate ganglion blocks (SGBs) in two patients experiencing symptoms of posttraumatic stress disorder (PTSD). Background: Successful treatment of PTSD with SGB has been reported previously. A similar protocol was employed at Walter Reed Army Medical Center to treat two soldiers with chronic, combat-related PTSD. Methods: Both patients received a SGB on the right side at C6 level. The patients' PTSD symptoms were evaluated using the Post-traumatic Stress Disorder Checklist (PCL). The PCL was administered the day prior to treatment, to establish a baseline, and the day after treatment. The PCL was also utilized during follow-up visits to quantify the patient's symptomotology. The SGB was administered by an anesthesiologist and the psychometric tests administered by a psychologist. Results: Both patients experienced immediate, significant and durable relief as measured by the PCL (score minimum 17, maximum 85). In both instances, the pre-treatment score suggested a PTSD diagnosis whereas the post-treatment scores did not. One patient requested repeat treatment after 3 months, and the post-treatment score remained below the PTSD cutoff after 7 additional months of follow-up. Both patients discontinued all antidepressant and antipsychotic medications while maintaining their improved PCL score. Conclusion: Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications.
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2015
Multiple case series published in the peer-reviewed medical literature have demonstrated the safe... more Multiple case series published in the peer-reviewed medical literature have demonstrated the safety and efficacy of right-sided stellate ganglion block (SGB) for the treatment of anxiety symptoms associated with posttraumatic stress disorder (PTSD). As this is a new indication for a well-established procedure, there is relatively little information available to assist clinicians in determining the utility of SGB for their patients. Presented are clinical guidelines to assist the provider with patient selection, patient education, and follow-up. Also described is a technique to perform SGB under ultrasound-guidance. Although additional rigorous clinical research is needed to further investigate SGB for the treatment of anxiety symptoms associated with PTSD, these guidelines can also assist clinical investigators in their participant selection, design, and conduct of future research as it pertains to this important topic.
Regenerative Medicine Options for Chronic Musculoskeletal Conditions : A Review of the Literature
Specifically, regenerative medicine also stands in contrast to treatment modalities that impair t... more Specifically, regenerative medicine also stands in contrast to treatment modalities that impair the body’s ability to facilitate endogenous repair mechanisms such as anti-inflammatory drugs (2,3); destructive modalities (e.g., radio frequency ablation of nerves, botulinum toxin injections) (4); and surgical methods that permanently alter the functioning of a joint, including joint fusion, spine fixation, and partial or total arthroplasty. When compared to other allopathic options (including knee and hip arthroplasty with a 90-day mortality rate of 0.7% in the Western hemisphere) (5), regenerative medicine treatment modalities have a lower incidence of adverse events with a growing body of statistically significant medical literature illustrating both their safety and efficacy (6).
Self-reported combat-related symptom scores change after witnessing a teammate's improvement following stellate ganglion block for post-traumatic stress symptoms
Journal of Science and Medicine in Sport, 2017
Objective: Determine whether a two-level cervical sympathetic chain block may be more effective t... more Objective: Determine whether a two-level cervical sympathetic chain block may be more effective than a standard C6 level stellate ganglion block (SGB) for the treatment of posttraumatic stress disorder (PTSD). Background: A right-sided SGB has many medical publications supporting its safety and efficacy for the treatment of PTSD. However, in clinical practice, some patients do not respond to a C6 level SGB as anticipated. Currently, there are no published reports describing a two-level sympathetic block (2LSB) as a treatment modality. Thus, the purpose of this investigation is to initially assess safety and efficacy of this novel procedure as compared to the standard procedure. Methods: The PTSD Checklist (PCL-5) is routinely collected for patients prior to SGB or 2LSB for PTSD. We retrospectively evaluated baseline (T0) and 4 weeks (T1) PCL-5 scores in post-SGB/2LSB in our center. Results: One-hundred and forty-seven of 328 consecutive subjects underwent SGB (group 1) or 2LCB (grou...
Journal of Investigative Medicine, 2021
The stellate ganglion block (SGB) procedure has been used successfully for over 10 years to treat... more The stellate ganglion block (SGB) procedure has been used successfully for over 10 years to treat post-traumatic stress symptoms in thousands of US military service members, civilians, and veterans in select hospitals in Europe and North America. Primarily through targeting the autonomic nervous system, the SGB procedure serves as an invaluable adjunct to trauma-focused psychotherapy. Without published best practices for emerging therapies, clinicians are left on their own to determine how best to apply new treatments to their patient populations. The aim of this qualitative research was to compile attitudes and recommendations from therapists with expertise in using SGB for treating symptoms of post-traumatic stress disorder, so that their experiences could be disseminated widely to clinicians without SGB expertise. An 18-item survey was developed and distributed electronically to a group of behavioral health professionals of various specialties between May and June 2020. Of survey...
The Successful Use of Left-sided Stellate Ganglion Block in Patients That Fail to Respond to Right-sided Stellate Ganglion Block for the Treatment of Post-traumatic Stress Disorder Symptoms: A Retrospective Analysis of 205 Patients
Military Medicine
Introduction Ultrasound-guided stellate ganglion block (SGB) is an injection of local anesthetic ... more Introduction Ultrasound-guided stellate ganglion block (SGB) is an injection of local anesthetic (8mL of 0.5% ropivacaine) in the neck to temporarily block the cervical sympathetic trunk which controls the body’s fight-or-flight response. This outpatient procedure takes less than thirty minutes and is immediately effective. Our goal was to determine if a left-sided stellate ganglion block is effective for treating posttraumatic stress disorder (PTSD) symptoms. While right-sided SGB has been extensively studied, left-sided SGB has not been formally evaluated for this indication. Materials and Methods Our hypothesis was that patients who fail to improve following a right-sided SGB will report significant improvement following a left-sided SGB. A retrospective chart review was conducted for patients who received SGB for PTSD symptoms between August 2019 and March 2020. All procedures were performed at an established musculoskeletal practice by the same anesthesia/pain fellowship-traine...
JAMA Psychiatry
IMPORTANCE This is the first multisite, randomized clinical trial of stellate ganglion block (SGB... more IMPORTANCE This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms. OBJECTIVE To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total symptom severity scores from baseline to 8 weeks. DESIGN, SETTING, AND PARTICIPANTS This multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers. Only physicians performing the procedures and the procedure nurses were aware of the intervention (but not the participants or assessors); their interactions with the participants were scripted and limited to the 2 interventions. Active-duty service members on stable psychotropic medication dosages who had a PTSD Checklist-Civilian Version (PCL-C) score of 32 or more at screening were included. Key exclusion criteria included a prior SGB treatment, selected psychiatric disorders or substance use disorders, moderate or severe traumatic brain injury, or suicidal ideation in the prior 2 months. INTERVENTIONS Paired right-sided SGB or sham procedures at weeks 0 and 2. MAIN OUTCOMES AND MEASURES Improvement of 10 or more points on mean CAPS-5 total symptom severity scores from baseline to 8 weeks, adjusted for site and baseline total symptom severity scores (planned a priori). RESULTS Of 190 screened individuals, 113 (59.5%; 100 male and 13 female participants; mean [SD] age, 37.3 [6.7] years) were eligible and randomized (74 to SGB and 39 to sham treatment), and 108 (95.6% of 113) completed the study. Baseline characteristics were similar in the SGB and sham treatment groups, with mean (SD) CAPS-5 scores of 37.6 (11.2) and 39.8 (14.4), respectively (on a scale of 0-80); 91 (80.0%) met CAPS-5 PTSD criteria. In an intent-to-treat analysis, adjusted mean total symptom severity score change was −12.6 points (95% CI, −15.5 to −9.7 points) for the group receiving SGB treatments, compared with −6.1 points (95% CI, −9.8 to −2.3 points) for those receiving sham treatment (P = .01). CONCLUSIONS AND RELEVANCE In this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03077919
Military medicine, Sep 1, 2016
This study assessed which symptoms are most impacted following stellate ganglion block (SGB) used... more This study assessed which symptoms are most impacted following stellate ganglion block (SGB) used to treat post-traumatic stress disorder (PTSD) symptoms. 30 active military service members with combat-related PTSD self-referred to their physician and psychologist. Patients were offered a SGB as part of their treatment program. Primary outcome was the magnitude of change for the 17 items on the PTSD Checklist-Military (PCL-M), which was administered the week before SGB, 1 week after SGB, and 2 to 4 months later. Mean PCL-M score decreased from 49 at baseline to 32, 1 week after the procedure (p < 0.001). 2 to 4 months after SGB, patients maintained an average PCL-M of 32. Patients reported greatest improvement in the first week after SGB for the following symptoms: irritability or angry outbursts, difficulty concentrating, and sleep disturbance. 2 to 4 months later, patients reported greatest improvement in the following: feeling distant or cut off, feeling emotionally numb, irri...
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2015
Multiple case series published in the peer-reviewed medical literature have demonstrated the safe... more Multiple case series published in the peer-reviewed medical literature have demonstrated the safety and efficacy of right-sided stellate ganglion block (SGB) for the treatment of anxiety symptoms associated with posttraumatic stress disorder (PTSD). As this is a new indication for a well-established procedure, there is relatively little information available to assist clinicians in determining the utility of SGB for their patients. Presented are clinical guidelines to assist the provider with patient selection, patient education, and follow-up. Also described is a technique to perform SGB under ultrasound-guidance. Although additional rigorous clinical research is needed to further investigate SGB for the treatment of anxiety symptoms associated with PTSD, these guidelines can also assist clinical investigators in their participant selection, design, and conduct of future research as it pertains to this important topic.
Military medicine, 2015
To measure key neurocognitive performance effects following stellate ganglion block (SGB) adminis... more To measure key neurocognitive performance effects following stellate ganglion block (SGB) administered to treat post-traumatic stress disorder (PTSD) symptoms. Eleven patients diagnosed, screened, and scheduled for SGB to treat their PTSD symptoms were administered a panel of eight cognitive measures before and 1 to 3 weeks after undergoing this procedure. PTSD symptoms were evaluated using the Posttraumatic Stress Disorder Checklist-Military. One to three weeks post-SGB, none of the patients showed any statistically significant decline in neurocognitive performance. Rather, there was a clear trend in improvement, with four out of eight measures reaching statistical significance following SGB. All patients improved in PTSD symptoms with a mean improvement on Posttraumatic Stress Disorder Checklist-Military of 29. In this case series of 11 patients, SGB effectively treated PTSD symptoms and did not impair reaction time, memory, or concentration. Therefore, SGB should be considered as...
Ultrasound-guided percutaneous neuroplasty of the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica: a case report and description of a new ultrasound-guided technique
Current sports medicine reports
The lateral femoral cutaneous nerve (LFCN) can be visualized with ultrasound imaging using a high... more The lateral femoral cutaneous nerve (LFCN) can be visualized with ultrasound imaging using a high frequency linear transducer. The entrapment of the LFCN, often near the lateral aspect of the inguinal ligament, is accepted as an etiology of meralgia paresthetica (MP). This case report describes an ultrasound-guided, percutaneous technique that utilizes injected fluid to facilitate blunt dissection (or hydrodissection) to perform an external neuroplasty of the LFCN. This procedure resulted in immediate, long-term relief of pain associated with severe, chronic MP. This procedure may potentially represent an alternate treatment for patients with contraindications or partial contraindications to surgical neurolysis, nerve transection (usually described as being performed under general anesthesia), or corticosteroid injection, or in patients not responding to conservative treatment measures.
A review of viscosupplementation for osteoarthritis of the hip and a description of an ultrasound-guided hip injection technique
Current sports medicine reports
Viscosupplementation of the hip for symptomatic osteoarthritis appears to be safe and effective i... more Viscosupplementation of the hip for symptomatic osteoarthritis appears to be safe and effective in more than 25 yr of use in Europe. More than 11 studies suggest that viscosupplementation in the hip is as effective as viscosupplementation in the knee. It appears to be a safe and reasonable alternative to nonsteroidal antiinflammatory drugs or intra-articular steroids for the treatment of osteoarthritis pain. Viscosupplementation in the hip may delay the need for hip replacement surgery. Viscosupplementation in the hip appears to work better in patients with fewer radiographic changes of osteoarthritis. Placement of viscosupplement in the hip under real-time ultrasound or fluoroscopic guidance is safe and well tolerated. Hip joint communication with the iliopsoas bursa may be a factor in studies of the effectiveness of viscosupplementation in the hip.
Calf muscle therapy for Achilles tendinosis
American family physician, 2003
The Outdoor Athlete
Sports Medicine for the Primary Care Physician, Third Edition, 2004
Military Medicine, 2014
Objective: Report the successful use of stellate ganglion blocks (SGBs) in 166 active duty servic... more Objective: Report the successful use of stellate ganglion blocks (SGBs) in 166 active duty service members with multiple combat deployments experiencing anxiety symptoms associated with post-traumatic stress disorder (PTSD). Background: Successful treatment of PTSD symptoms with SGB has been reported previously. This is the largest published case series evaluating SGB with a minimum of 3 months follow-up. Methods: Following clinical interview including administration of the PTSD Checklist (PCL), 166 service members with symptoms of PTSD elected to receive a SGB. All patients received a SGB on the right side at the level of the sixth cervical vertebrae (C6). The PCL was administered the day before treatment to establish a baseline, repeated 1 week later, and then monthly out to 3 months. A positive response was considered to be an improvement in the PCL score by 10 or greater points. Follow-up PCL scores from 3 to 6 months were obtained and analyzed for 166 patients. Results: In a military population with multiple combat deployments, over 70% of the patients treated had a clinically significant improvement in their PCL score which persisted beyond 3 to 6 months postprocedure. Conclusion: Selective blockade of the right cervical sympathetic chain at the C6 level is a safe and minimally invasive procedure that may provide durable relief from anxiety symptoms associated with PTSD.
Pain Practice, 2010
Objective: Report the successful use of stellate ganglion blocks (SGBs) in two patients experienc... more Objective: Report the successful use of stellate ganglion blocks (SGBs) in two patients experiencing symptoms of posttraumatic stress disorder (PTSD). Background: Successful treatment of PTSD with SGB has been reported previously. A similar protocol was employed at Walter Reed Army Medical Center to treat two soldiers with chronic, combat-related PTSD. Methods: Both patients received a SGB on the right side at C6 level. The patients' PTSD symptoms were evaluated using the Post-traumatic Stress Disorder Checklist (PCL). The PCL was administered the day prior to treatment, to establish a baseline, and the day after treatment. The PCL was also utilized during follow-up visits to quantify the patient's symptomotology. The SGB was administered by an anesthesiologist and the psychometric tests administered by a psychologist. Results: Both patients experienced immediate, significant and durable relief as measured by the PCL (score minimum 17, maximum 85). In both instances, the pre-treatment score suggested a PTSD diagnosis whereas the post-treatment scores did not. One patient requested repeat treatment after 3 months, and the post-treatment score remained below the PTSD cutoff after 7 additional months of follow-up. Both patients discontinued all antidepressant and antipsychotic medications while maintaining their improved PCL score. Conclusion: Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications.