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“The athlete’s job is to stay consistent with rehab and to be hungry to get back on the field. I think our job as a sports medicine team is to make sure that they’re safe and that they can perform.” In this episode of BackTable MSK, guest host and sports medicine physician Dr. Larry Balle joins physical therapist/athletic trainer Andy Glidewell to discuss how “return to play” is defined and why it is often misunderstood among athletes, coaches, physicians, and rehab teams. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:25 - Return to Play from the Lens of Physical Therapy vs. Sports Medicine12:11 - Evidence-based vs. Anecdotal-based Practice for Return to Play21:18 - Is there an Appropriate Team Approach? 24:25 - Continuing Conservative Management vs. Surgical Intervention34:01 - Notes on a High-Profile Sports Medicine Case40:20 - The Influence of NIL on College Athletics42:51 - Obtaining Objective Metrics for Clearance52:38 - Influence of AI on Return to Play Algorithms 57:11 - Final Takeaways --- More about this episode They emphasize that return to play is a milestone-based rehabilitation phase requiring clear communication, collaboration, and risk management, rather than rigid timelines or just “vibes.” The conversation covers how evidence and objectivity have shaped protocols (notably ACL timelines), the role of prognostic indicators in operative vs. non-operative decisions, and practical use of functional strength and agility reassessment. They also address pressures of working with elite sport and NIL (Name, Image, Likeness) considerations. Furthermore, they expand on how AI may inform, but not replace, the humanistic and team-based components of decision making. --- Resources Dr. Larry Ballehttps://www.linkedin.com/in/larry-balle-ii/ Dr. Andy Glidewellhttps://uamshealth.com/provider/michael-a-glidewell/ The Journal of Orthopedic and Sports Physical Therapyhttps://www.jospt.org/ --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Beyond the basics: anatomy, technique, and clinical pearls for the evolving world of hip embolization. In this episode of BackTable MSK, we dive into the fine details of hip embolization. In Part II of this two-part series, Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, return with host Dr. Kavi Krishnasamy, to explore the nuances of hip embolization and reviewing real-world case studies. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:17 - Explanation of Hip Physical Exam Maneuvers 04:30 - Overview of Hip Embolization Technique with Anatomy10:10 - Case 1: Awake Superselective Angiography and Procedure Technique for GTPS Patient12:43 - Case 2: Patient Presents with Hip Pain, Increased Since L3 Compression Fracture18:15 - Mixing Imipenem20:40 - Overview of Hip Embolization Scientific Data32:52 - Closure Techniques and Final Thoughts --- More about this episode Together, they apply the foundational skills of physical exam and procedure technique, including detailed anatomy, procedural technique, and hip physical exam maneuvers.The discussion also covers the latest research on the use of temporary embolization agents. Looking for a way to mix your Imipenem? Tune in for a “how to” and other intricate insights. --- Resources Dr. Mateus Correahttps://www.researchgate.net/profile/Mateus-Correa-4 Dr. Joaquim Filhohttps://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ready to shake up hip pain management? In this episode of BackTable MSK, we unpack how embolization is opening a new frontier for patients caught between conservative care and surgery. Interventional radiologist Dr. Kavi Krishnasamy hosts Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, to discuss hip embolization for Greater Trochanteric Pain Syndrome (GTPS) and early hip Osteoarthritis (OA). The doctors highlight building multidisciplinary referrals, reimbursement, and the availability of embolic agents. They also address pre-procedure workup, including imaging and physical exam findings. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:37 - Guest Background in MSK Embolization 08:14 - Availability of Embolics and Preferences in Brazil 10:31 - Reimbursement and Access Hurdles13:55 - Hip Etiologies Treated by Embolization 16:54 - Imaging Workup and the Role of MRI24:23 - Offering Conservative Treatment Options Prior to Embolization 26:52 - Scoring Systems and Physical Exam34:44 - Procedure Access Strategy39:16 - When to Utilize Temporary vs. Permanent Embolics46:34 - Post-Procedure and Follow-Up Guidelines58:05 - Discussion of Current Evidence --- More about this episode At the time of the procedure, Drs. Correa and Filho explain why they prefer certain vascular access points and specify arterial targets, favoring temporary embolic agents due to potential risk of Avascular Necrosis (AVN) of the femoral head. Furthermore, the doctors detail awake procedures with intraprocedural palpation and blush/pain-based endpoints, post-embolization pain flare management, follow-up schedules, and re-treatment criteria; all with consideration for current published evidence. ---Resources Dr. Mateus Correahttps://www.researchgate.net/profile/Mateus-Correa-4 Dr. Joaquim Filhohttps://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Caught between conservative care and a large spine surgery, the MILD procedure offers potential as the in-between. On this episode of the BackTable MSK Podcast, Interventional Radiologist Dr. Dana Dunleavy welcomes pain specialist Dr. Denis Patterson to explore the evidence, technique, and evolving role of Minimally Invasive Lumbar Decompression (MILD) procedure for lumbar spinal stenosis with neurogenic claudication. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Strykerhttps://www.stryker.com/us/en/interventional-spine/products/mild-procedure.html --- Timestamps 00:00 - Introduction04:22 - What is the MILD procedure?09:55 - Comparing Discogenic Pain to Neurogenic Claudication 19:20 - MILD Procedure Technique 22:54 - Toolbox and Workflow36:59 - MILD Makes a Difference in the Pain Management Field41:53 - Objectifying Pain Measurements and Setting Patient Expectations46:26 - Driving Mutual Understanding in Surgical Cohorts 01:00:53 - Collaboration Over Competition01:05:32 - Final Takeaways --- More about this episode Dr. Patterson explains the pathophysiology and diagnostic process, highlighting key insights from patient history and MRI findings. The physicians review technique evolution from multiple paramedian incisions and epidurograms to streamlined single midline incision access, and cross lateral oblique (CLO) fluoroscopic safety landmarks. The discussion also references the MiDAS and Cleveland Clinic studies showing pain and functional improvement with a complication rate similar to epidural steroid injections, along with promising long-term outcomes and reduced need for surgical re-intervention. This episode also tackles practical considerations, including the impact of Category I CPT codes on reimbursement, challenges in radiology reporting, privileging politics, and pathways for physician training and proctoring. --- Resources Dr. Denis Pattersonhttps://www.linkedin.com/in/denis-patterson-50ba0485/ MiDAS I (Mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical studyhttps://pubmed.ncbi.nlm.nih.gov/20648206/ The durability of Minimally Invasive Lumbar Decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-uphttps://pubmed.ncbi.nlm.nih.gov/33942964/ Pacific Spine and Pain Societyhttps://pacificspineandpainsociety.com/ --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

The embolization playbook is expanding. The question is: are you ready to use it? In this episode of the BackTable MSK Podcast, host Dr. Ally Bahehi joins Dr. Mikin Patel and Dr. Osmad Ahmed from Joint and Vascular Institute in the greater Chicago area to discuss plantar fasciitis embolization; a newer MSK embolization technique, building from concepts and clinical pearls for genicular artery embolization (GAE). --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:18 - Ideal Patient for Plantar Fasciitis Embolization02:14 - Workup, Imaging Needs, and the Reality of Insurance Coverage 03:53 - Benefits And Expectations06:05 - Step By Step Procedure Walkthrough11:29 - Pain Relief and Follow-Up Timeline13:46 - GAE Case Setup14:54 - Debating Access Strategy 15:54 - Crash Course in Genicular Artery Anatomy19:08 - Minimalist GAE Toolkit Set-Up22:32 - Time to Inject! The Wrap Up --- Resources Dr. Mikin Patelhttps://jointvascular.com/team/mikin-v-patel-md-mba/ Dr. Osman Ahmedhttps://jointvascular.com/team/osman-ahmed-m-d-fcirse/

Every new device and technique comes with a learning curve, and in this BackTable MSK Brief we’re navigating pelvic curves. Host Dr. Kavi Krishnasamy joins Dr. Brandon Key to dissect pelvic and sacral fixation techniques. They discuss patient positioning and prep to needle-guidance software, with procedural pearls scattered throughout the conversation. Episode Outline 00:00 - Introduction 00:26 - Pelvic Positioning Strategy 04:00 - Need to Know: Needle Guidance 09:20 - Thermoablation in Pathologic Fracture Fixation 13:29 - The Photodynamic Nail by IlluminOss: An Overview 20:00 - Finding The Way with a Curved Trajectory 22:52 - Wrap Up Resources Dr. Brandon Key, MD https://www.linkedin.com/in/brandon-key-md-367a01310/ IlluminOss https://illuminoss.com/us

For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization. --- SYNPOSIS The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization. --- TIMESTAMPS 00:00 - Introduction 01:42 - Dr. Yan Epelboym’s Origin Story in MSK03:02 - Building Referral Networks06:50 - Details on Clinic Workflow 10:08 - The Run Down on Shoulder Embolization Treatment Targets22:09 - Current Insights on Shoulder OA Embolization27:56 - Shoulder Embolization Setup and Access Choice34:28 - Shoulder Embolization Strategy and Endpoints36:38 - Post-Procedure Pain Control and Activity Limitations42:26 - Shoulder Surgery Status-Post Embolization44:17 - Discussing Existing Research Data on Shoulder Embolization01:00:32 - Key Shoulder Arterial Anatomy and Variants01:04:27 - Shoulder OA Case Discussion01:09:08 - Final Thoughts --- RESOURCES Dr. Yan Epelboym, MD, MPHhttps://www.linkedin.com/in/yan-epelboym-4a84991b/ Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)https://clinicaltrials.gov/study/NCT06095050

In orthopedic IR, confidence comes from exposure. It’s all about getting those reps in. In this BackTable MSK Brief, host Kavi Krishnasamy interviews Dr. Brandon Key from the Medical College of Wisconsin about implementing bone stabilization and fixation in interventional radiology for pathologic and non-pathologic fractures. The doctors discuss key barriers which include limited training exposure and operational inefficiencies that discourage adoption. However, they highlight the evolving technology, vendor toolsets, and growing multidisciplinary collaboration that are mitigating these barriers. The discussion expands to cover trauma-related consults from orthopedic surgery, indications and evolving applications of the IlluminOss device, screw types and preferences, and the capabilities of the Flow-FX cement-delivery device. Episode Outline 00:00 - Introduction 00:57 - The Delay in Take-Off of Bony Fixation and Stabilization at the Trainee Level 03:10 - Meaningful Multidisciplinary Momentum 05:35 - Treatment of Pathologic Fractures in the Orthopedic IR Space 09:17 - Considerations for Trauma and Fragility Cases 16:09 - Patient Prep and Approach 18:05 - Final Thoughts Resources Dr. Brandon Key, MD https://www.linkedin.com/in/brandon-key-md-367a01310/ IlluminOss https://illuminoss.com/us Flow-FXhttps://flow-fx.net/products/

From anesthesia decisions to ablation strategy, what really separates a good outcome from a great one in bone tumor ablation? This BackTable MSK Brief features an enlightening conversation between host Kavi Krishnasamy and bone ablation pioneer Dr. Damian Dupuy. They cover anesthesia choices for different patient scenarios, optimal procedural techniques and agent selection for bone ablations, and the combination of local and systemic therapies for oligometastatic and oligo-progressive diseases. The doctors also tackle myths and realities around thermal and cryoablation, examining both clinical trial data and real-world experiences. Episode Outline 00:00 - Introduction 00:40 - Selecting General Anesthesia vs. MAC 03:30 - Approach to Multiple Bony Lesions in Metastatic Disease 07:27 - Ablation Confirmation and Techniques Utilized in Bone Ablation 09:00 - Research Insights Surrounding RFA in Bone 12:16 - Sclerotic vs. Lytic Lesions: Techniques and Considerations 14:47 - Skin Protection During Superficial Lesion Treatments 16:38 - Analyzing Clinical Trials: Motion and OPuS One 20:51 - Conclusion Resources Dr. Damian E. Dupuy, MD, FACR https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study https://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study https://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/

Bone tumor treatment: when do you burn it and when do you freeze it? In this BackTable MSK Brief, Dr. Damian Dupuy joins Host Dr. Kavi Krishnasamy to discuss the technical nuances of radiofrequency ablation (RFA) and cryoablation, patient selection criteria, procedural strategies, and the importance of setting appropriate patient expectations. Dr. Dupuy also shares insights on preventing complications like cryomyositis and myoglobinuria, underscoring the balance between aggressive treatment and patient safety. Episode Outline 00:00 - Introduction 00:40 - Bone Tumor Interface and Time Under Treatment 05:10 - Patient Selection and Treatment Considerations 07:57 - Approach to Large Bony Lesions 12:37 - Best Treatment Modality: Cryoablation vs. RFA 13:38 - Managing Collateral Damage 15:58 - Navigating Patient Expectations Resources Dr. Damian E. Dupuy, MD, FACR https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network study https://pubmed.ncbi.nlm.nih.gov/23657892/