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An Obvious and Potentially Neglected Cause of Buttock Pain: Gluteus Maximus Dysfunction

Video Author: Chueh-Hung Wu
Mathieu Boudier-Revéret
Published on: 03.20.2019

Two cases referred as “piriformis syndrome” which received needling of gluteus maximus and piriformis, showing prominent twitch responses in GMax only.

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Creator: Paul Winston
Duration: 10:17
Cryoneurotomy is a novel percutaneous treatment of spasticity. A retrospective chart review identified 11 patients with chronic flexed-elbow spasticity, who received a diagnostic nerve block (DNB) and demonstrated increased range of motion and/or reduced spasticity. All patients subsequently received cryoneurotomy of the musculocutaneous nerve branch to the brachialis muscle and 3 patients had an additional radial nerve cryoneurotomy to the brachioradialis muscle. Manual and video evaluations took place before and after DNB, and at least 5 months post-cryoneurotomy (mean 12.5 months). This video vignette demonstrates the reproduction of the DNB effects and changes to spasticity and range of motion.
Creator: Michael Wainberg
Duration: 4:22
This patient education video prepares the patient for their telemedicine Hand Clinic evaluation. Elements include localization of the patient’s chief complaint and simultaneous inspection and self-palpation of the elbow, forearm, wrist and hands.The video depicts the components of the virtual physical exam: Range of motion, sensation, strength testing, functional testing, and special tests/provocative maneuvers.
Creator: Eric Altschuler
Duration: 2:05
The screen on the left shows the patient’s physical therapist and occupational therapist performing and demonstrating a bed-to-chair transfer. The screen on the right shows the patient’s family member watching the training session at home. (Both the patient and family member in the video are depicted by PM&R residents.)
Creator: Ke-Vin Chang
Duration: 00:57
US imaging revealed partial detachment of the medial gastrocnemius muscle fibers from the deep aponeurosis. A fusiform and anechoic compartment was seen separating the medial gastrocnemius and underlying soleus muscles. Strain US elastography was applied. During rhythmic compressions, the color of the lesion (mostly being red) was significantly different from that of the surrounding area (being either blue or green). As the target had much more elasticity than the adjacent muscles, we speculated that its main component was fluid. US guided aspiration was performed.
Creator: Ke-Vin Chang
Duration: 00:41
On the painful side, the accessory abductor digiti minimi muscle was observed. The muscle traveled through the Guyon’s canal and approximated distally to the abductor digiti minimi muscle. The palmar cutaneous branch of the ulnar nerve was seen arising from the radial side of its main trunk and radial to the ulnar artery and veins. The nerve was squeezed inside the Guyon’s canal by the accessory abductor digiti minimi muscle, rendering the nerve fascicle more flattened than that of the contralateral side.
Creator: Mathieu Boudier-Revéret Ming-Yen Hsiao
Duration: 4:47
In this article, we report unusual findings of multiple accessory limb muscles (ALMs) in a single individual: bilateral tensor fascia suralis, bilateral flexor digitorum accessorius longus, and bilateral peroneus tertius.
Creator: Byung Joo Lee & Donghwi Park
Duration: 0:44
Video 1: This video shows dynamic ultrasound of a 60-year-old man with posterosuperior labral tear. Although there is not definite a posterosuperior labral tear in neutral posture, a detachment of posterosuperior labral tear were seen in dynamic ultrasound during abduction and external rotation posture. The abduction and external rotation motion of the glenohumeral joint usually induces the humeral head to rotate externally, which gives stress to the posterosuperior labrum. In a normal posterosuperior labrum, only a slightly blunted posterosuperior labrum without any detachment is detected during abduction and external rotation motion. However, this motion can induce posterior and medial detachment of the labrum in patients with damaged PS labrum.
Duration: 1:04
With this video, we want to draw attention to a very rare cause of meralgia paresthetica; inguinal lymph node enlargement. We also want to emphasize the superiority of ultrasound of the lateral femoral cutaneous nerve before the injection in treatment of meralgia paresthetica.
Creator: Eric Altschuler, MD, PhD
Duration: 0:22
This video shows subtle dysmetria on the finger-to-nose test in the right hand: The patient loses the smooth trajectory about 75% of the way through the reaching process, then has small amplitude oscillations before reaching the target. (Normal left hand finger-to-nose.)
Creator: Chueh-Hung Wu
Mathieu Boudier-Revéret
Duration: 2:27
Two cases referred as “piriformis syndrome” which received needling of gluteus maximus and piriformis, showing prominent twitch responses in GMax only.
Creator: Byung Joo Lee & Donghwi Park
Duration: 0:28
Video 1: This is a dynamic ultrasonography of normal individual. Posterosuperior labrum appears as a fibrillary hyperechoic triangle, coursing around the shoulder joint capsule. During the ABER maneuver, there was no detachment of labrum or joint fluid leakage, although the PS labrum was pressed slightly by the pressure from ABER posture.
Creator: Byung Joo Lee & Donghwi Park
Duration: 0:35
Video 2: This is a dynamic ultrasonography of a 36-year-old man with posterosuperior labral tear. Although the PS labrum appears as a fibrillary hyperechoic triangle in neutral position, hypoechoic lesion is distinct in PS labrum. During the ABER maneuver, leakage of the joint fluid through torn PS labrum can be seen. In this case the fluid flow through the tear is admittedly a subtle finding and the presence of a GHJ effusion (not seen in this case) may make this examination more difficult.
Creator: Chueh-Hung Wu, Mathieu Boudier-Revéret
Duration: 2:28
The case of a 26-year-old man with lateral antebrachial cutaneous nerve entrapment within a post-surgical scar at the forearm is presented with both diagnostic and therapeutic ultrasound images.
Creator: Wei-Ting Wu
Duration: 00:35
Using a curvilinear transducer in the oblique coronal plane, and the probe is placed between the coracoid process and acromioclavicular joint. A hypoechoic slip inside the hyperechoic triangular labrum is identified. Proximal portion of the biceps tendon (long head) appeared intact. With forcefully pulling the arm downward, the slip was enlarged with fluid filling the gap.
Creator: James Hallinan, Edward Smitaman and Brady Huang
Duration: 1:53
This video shows dynamic ultrasound images with real-time ankle movements. Dynamic scanning in the transverse view showed peroneus longus muscle herniation at the lateral leg during ankle dorsiflexion and eversion. A corresponding MRI also shows the muscle herniation.
Creator: Tsung-Yung Tang; Shau-Gang Shyu; Chueh-Hung Wu
Duration: 2:19
This video demonstrates an ultrasound-guided 5-in-1 injection for trigger point injection in the trapezius, levator scapulae and rhomboid muscles, and nerve hydrodissection of the spinal accessory nerve and dorsal scapular nerve for a patient with upper back pain with neuropathic characteristics.
Creator: Daniel M Cushman, MD
Duration: 0:16
This video demonstrates needle electromyography on a patient with respiratory synkinesis, with a needle in the right biceps brachii muscle. The first section of the video shows a relaxed patient, with the appearance of motor units associated with the inhalation phase of breathing. Next, the electromyographer asks her to take a deep breath with subsequent activation of numerous atypical motor units, which is done three times. For the last section, the patient holds her breath, and the motor unit stops firing.
Creator: Yi-Chian Wang, Shaw-Gang Shyu, Chueh-Hung Wu, Tyng-Guey Wang
Duration: 1:52
This video showed the axial and sagittal ultrasound-guided injection to the cricopharyngeal muscle, and showed the videofluoroscopic swallowing study results before and after the injection.
Creator: Tze Chao Wee, Chueh-Hung Wu
Duration: 1:05
The video provides a brief background to the pa-tient’s presentation, management and follow up. This is accompanied by 2 clips showing the ultra-sound tracking of the affected posterior interosse-ous nerve and the sound side.
Creator: Ke-Vin Chang
Duration: 1:00
The video demonstrated tracking a swollen extensor carpi ulnaris tendon with a thickened retinaculum. An enlarged nerve segment with loss of fascicular echotexture was observed, and was impinged by the thickened retinaculum.