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Scottish Rite Is Advancing the Use of Musculoskeletal Ultrasound in Pediatric Orthopedics and Beyond

Scottish Rite Is Advancing the Use of Musculoskeletal Ultrasound in Pediatric Orthopedics and Beyond

by | Feb 12, 2024 | Research & Innovation

In many practices, musculoskeletal ultrasound (MSK US) is housed solely in radiology. At Scottish Rite for Children, we are fortunate to also have two practitioners with advanced training and certification in using this tool in clinic. Sports medicine physician Jacob C. Jones, M.D., RMSK, and rheumatology practitioner Heather Benham, D.N.P., APRN, CPNP-PC, RHMSUS, use ultrasound to diagnose and treat patients for a variety of conditions.

Together, Jones and Benham have developed a comprehensive course to teach health care professionals the fundamentals of MSK US. Their extensive ultrasound backgrounds and genuine interest in teaching have come together to produce an impactful experience for the attendees.

More than 70 participants from professions including orthopedic surgeons, sports medicine physicians, orthopedic and emergency medicine fellows, physical therapists, advanced practice providers and research personnel have completed the program. Traveling from more than 15 states and two countries, the attendees have all indicated they would be interested in returning for an advanced course and many have referred others to the program.

There are several elements that make this program one-of-a-kind.

  • All faculty have expertise in the use of MSK US in pediatrics.
  • Guest faculty are invited from institutions such as Boston Children’s Hospital, Nationwide Children’s Hospital and Texas Children’s Hospital.
  • Pediatric models participate in the scanning sessions.
  • Injection sessions integrate a variety of tools including custom-made joint models.
  • Didactic and scanning sessions alternate throughout the day.

Jones and Benham look forward to developing an advanced course to offer in conjunction with the fundamentals course. Join our wait list to hear about it first!

Groundbreaking Preclinical Study of Perthes Disease

Groundbreaking Preclinical Study of Perthes Disease

by | Nov 3, 2023 | Research & Innovation

Our research team is working to provide a new treatment method for teenage and adolescent patients who are diagnosed with Legg-Calve-Perthes disease.
 
In this groundbreaking preclinical study of Perthes disease, UT Southwestern Medical Center professor of Orthopaedic Surgery Harry Kim, M.D., M.S., et al., discovered a new effective method to speed up and improve healing of the dead bone using a minimally invasive biomaterial. Currently, there is no effective treatment for teenagers and adolescents who develop Perthes disease/femoral head bone death. This new treatment consists of injecting a growth factor, BMP2, within a delivery agent, hydrogel. This allowed for rapid and consistent healing of the dead bone.

Published September 2023 in npj Regenerative Medicine. Read the complete study.

Healio Orthopedics Today: Accelerated severity of illness score may enhance predictions for pediatric osteomyelitis

Healio Orthopedics Today: Accelerated severity of illness score may enhance predictions for pediatric osteomyelitis

by | Aug 9, 2023 | Press Coverage, Research & Innovation

Accelerated severity of illness score may provide an enhanced predictive model for cases of complicated osteomyelitis in children, according to data presented at the Musculoskeletal Infection Society Annual Meeting. 

“The accelerated severity of illness score has resolved a number of model weaknesses and exhibits unparalleled sensitivity and specificity reported as the AUC,” Norman A. Lapin, Ph.D., said in his presentation.

Read the full Orthopedics Today recap.

One-of-a-Kind Program Teaches Pediatric Fundamentals in Musculoskeletal Ultrasound

One-of-a-Kind Program Teaches Pediatric Fundamentals in Musculoskeletal Ultrasound

by | Jun 19, 2023 | Research & Innovation

The use of musculoskeletal ultrasound (MSK US) is becoming increasingly popular and a point of emphasis in trainee education; however, most training programs focus on conditions in adults. Scottish Rite for Children experts have developed an introductory program to help new users learn about the unique skills and applications in the pediatric setting.

After a successful inaugural course in 2022, Scottish Rite hosted a second MSK US program. The feedback continues to show that we have a unique conference, and we plan to continue offering the program regularly.

This interactive, hands-on program features faculty from a variety of pediatric subspecialities including radiology, rheumatology and sports medicine. Attendees traveled to Frisco, Texas from across the country and internationally with a variety of clinical certifications including physical therapists, sonographers, nurse practitioners, physicians as well as radiology administrators.

Staff were encouraged to hear that all attendees indicated they were “very likely” or “definitely” going to recommend this course to others. Asked about the best part of the program, attendees’ responses are indicative of what future participants should expect:

  • All the hands-on activities intermixed with patient lecture beforehand; the teachers were incredibly kind.
  • Having pediatric patients!! Variety of faculty. Loved having MDS, RMSK, US Sonographer and radiologists. Truly a fantastic course.
  • Short lectures alternating with hands-on
  • Hands-on practice in SMALL groups with EXPERIENCED mentors.
  • It was so helpful having pediatric models – I really learned a lot from the hands-on sessions!
  • Multi-modal approach to learning
  • The dual hands-on and lecture content kept my mind and body awake and elevated the overall learning experience!

Jacob C. Jones, M.D., RMSK, says, “The program is intended to offer an introduction to ultrasound basics including settings, scanning and injection techniques focused on skeletally immature patients.” Throughout the day, more than 20 children and teens ranging from 5 to 19 shared their time with our learners.

After a lecture introducing scanning for rheumatologic conditions, participants observed and practiced scanning patients with active joint inflammation. Nurse practitioner Heather Benham, D.N.P., APRN, CPNP-PC, RhMSUS explains, “We are grateful for these patients and the other children volunteers who make this course so special. It is very difficult to teach these principles when scanning healthy joints.”

During one scanning session, Scottish Rite sonographer Kelly Sherrard, RDMS, demonstrated the techniques of evaluating newborns for developmental dysplasia of the hips. Three-month-old twins served as our models for this exciting addition to the program. The expertise required for this population makes it difficult to include this training in the program, but attendees expressed their appreciation for the demonstration and the complexity of the skill.

Join the email list so you can gain early access to registration for future courses. Our next program is being planned for November 2023.

Sports Medicine Research Featured at National Meeting

Sports Medicine Research Featured at National Meeting

by | May 24, 2023 | Research & Innovation

Several of our physicians and trainees attended the American Medical Society for Sports Medicine (AMSSM) annual meeting recently. At this event, individuals are selected to share progress and results on projects that impact the care of athletes of all ages. Our team shared several pediatric-focused studies. Additionally, Jane S. Chung, M.D., served as faculty for a pre-conference event teaching participants how to transform a clinical question into a successful research project. Each of these activities reflects our organization’s commitment to provide the best care, continued learning and teaching through research and academic endeavors. Here are several projects our Center for Excellence in Sports Medicine research team, and trainees, extensions of our team, presented at this meeting.

AMSSM Grant-Funded Project Presented by Lead Investigator
Jane S. Chung, M.D., is conducting a study with the Movement Science Lab team to evaluate movement in pediatric ballet dancers. The larger project includes evaluating demographics, surveys and movement data to determine how ballet dancers respond to training demands of the art. The project presented at this event is titled, “Athletic identity and Injury Patterns in Pediatric Ballet Dancers,” and began to explain how ballet dancers think about their identity as an athlete and found that pediatric ballet dancers, particularly those who trained more and reported a prior history of injury strongly identify with their sport.

 

The purpose of the AMSSM Foundation Research Grant Award program is to foster original scientific investigations by members of AMSSM. Research proposals that investigate issues within the broad discipline of sports medicine will be considered, including clinical practice, injury prevention and rehabilitation, basic science, epidemiology and education. – 

Sport-Related Concussion Projects Presented by Trainees
David Mikhail, B.S., is a medical student at UT Southwestern Medical Center who presented “A Longitudinal Evaluation of Differences Between First and Second Concussion Among Pediatric Patients.” In collaboration with faculty mentor Shane M. Miller, M.D., David reviewed 31 pediatric cases in The North Texas Concussion Registry (ConTex).

A man is giving a presentation at a conference called rising to the challenge | CAMS RISING THE CHALLENGE A Longitudinal Evaluation of Differences in Presentation Between First and Second Concussions in Pediatric Patients UT Southwester SCOTTISH RITE ConTex SAMSS

Comparing variables between sport-related concussions within and between patients, the study aimed to identify the effects of a second concussion on young athletes. Findings included:

  • Pediatric patients presented similarly following first and second concussion and demonstrated similar time to return-to-play.
  • Neurocognitive abilities were not shown to be negatively impacted by a subsequent concussion.

Also representing data from the ConTex registry, Joshua A. Beitchman, M.D., M.B.S., UT Southwestern Medical School second-year resident in pediatric neurology, presented “Endophenotype presentation of athletes with concussion contingent upon sex and time since injury.” Working closely with his mentor and pediatric sports neurologist, Mathew Stokes, M.D., Dr. Beitchman, used a complex system called phenotyping to begin to explain the very difficult task of identifying treatment strategies earlier in the care of concussions. He says, “since concussed athletes experience symptoms differently based on sex and time since injury, predicting outcomes or the prognosis is challenging.” This study is making progress on these challenges in treating athletes with a concussion. A specific direction coming out of this effort is to further evaluate how mood and sleep affect recovery and learn interventions that will address these successfully in this population.

SM EDICINE Annual Meeting SAMESH Co-Authors RISING THE CHALLENGE. A man stands at a podium at an annual meeting

Pediatric Musculoskeletal Ultrasound Expert Shares Results of Novel Study
Sports medicine physician Jacob C. Jones, M.D., RMSK, presented “Increased Ultrasonographic Humeral Retrotorsion in Young Overhead Athletes with Little League Shoulder or Elbow.” This study adds to a small, but growing volume of evidence in the use of musculoskeletal ultrasound in the evaluation and research of pediatric sport-related conditions.

Comparing the shoulders of throwing athletes with and without shoulder or elbow pain with similar athletes in other overhead sports such as gymnastics, the study aimed to describe how the bone is remodeled, or changed, with a high volume of throwing. This study will aid in the understanding of growth-related, training-related and sport-related changes in the shoulder with sports that have a high volume of throwing such as baseball. In particular, studies like this will help to understand why some athletes develop pain with these activities and some do not.

Nighttime Bracing Coupled with Physiotherapeutic Scoliosis-specific Exercises Can Reduce Adolescent Spinal Curves

Nighttime Bracing Coupled with Physiotherapeutic Scoliosis-specific Exercises Can Reduce Adolescent Spinal Curves

by | May 17, 2023 | Research & Innovation

Scoliosis is one of the most common pediatric orthopedic conditions and presents very differently depending on the patient. Research into nonoperative treatment methods has shown promising results for using a Providence or nighttime brace in addition to physiotherapeutic scoliosis-specific exercises (PSSE).

Scottish Rite for Children pediatric orthopedic surgeon Amy L. McIntosh, M.D., and a  team of physical therapists, orthotists, and others conducted this prospective comparative study to evaluate the effectiveness of PSSE in skeletally immature patients with adolescent idiopathic scoliosis treated with nighttime bracing (PSSE group) compared with the standard of care of nighttime bracing alone (control group). Their findings were published in the Journal of Pediatric Orthopaedics in the article “The Addition of Daytime Physiotherapeutic Scoliosis-Specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression.”

Skeletally immature patients with adolescent idiopathic scoliosis (AIS) who have moderate curves are treated with thoracolumbosacral orthoses, which are designed for nighttime wear. The effectiveness of PSSE in addition to nighttime bracing compared with nighttime bracing alone was unknown. Patients in this study met the following inclusion criteria: diagnosis of AIS, Providence brace treatment, ages 10 to 16 years, thoracolumbar or lumbar primary curve <35 degrees, Risser stage 0, and females <1-year postmenarchal.

Patients in this group completed at least eight hours of one-on-one outpatient physical therapy sessions from a Schroth-based (Barcelona Scoliosis Physical Therapy School) certified physical therapist. All patients participated in Schroth therapy at Scottish Rite for Children and were given a standardized exercise prescription algorithm. They also committed to performing a home exercise program for a minimum of 15 minutes a day, five days a week, for at least one year. They were encouraged to maintain a corrective posture throughout the day during activities of daily living.

The primary outcome measures were curve magnitude of the primary curve and the rate of curve progression. Curve magnitude was digitally measured using the Cobb method, and baseline curves averaged 25 degrees, which is at the lowest bracing threshold recommended by the Scoliosis Research Society. These patients either presented with a Cobb  angle ≥ 25 degrees or had demonstrated curve progression to a Cobb angle ≥ 25 degrees.

Both groups demonstrated positive results, 22% of curves improved at skeletal maturity, and only 9% required surgery. However, the PSSE group had no change in curve magnitude at the final visit compared with curve progression in the control group (1 vs. 7 degrees, P<0.01). Furthermore, the PSSE group had a lower rate of curve progression >5 degrees at the final visit (14% vs. 43%, P<0.01). The PSSE group also had less conversion to full-time bracing after 1 year (5% vs. 24%, P=0.046), but the differences were no longer significant at the final visit (14% vs. 27%).

Their research confirms that Schroth-based physical therapy, in conjunction with wearing a brace at night, reduces curve progression after one year and at skeletal maturity. This information is helpful to patients and their families experiencing scoliosis and could be used as an encouragement for compliance with the treatment.

Learn more about scoliosis and orthopedic research.