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ABDOMINAL WALL ENDOMETRIOSIS: Lower rectus abdominis Intramuscular mass, immediately, deep to c-section scar. Young cross fitter came in to r/o muscle injury with non cyclic pain (which is a frequent presentation in spite of being ectopic endometrial tissue) #msk #ultrasound #sportsimaging

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JP Munoz • MSK

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13,760 Aufrufe • vor 9 Monaten •via X (Twitter)

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Abdominal wall pain: differential diagnosis A 28-year-old soccer player presented with right periumbilical pain of 2 months' duration. An MRI was performed, which showed no abnormalities in the abdominal wall. He was diagnosed with anterior cutaneous nerve entrapment syndrome (ACNES), and perineural injection was performed, with no improvement in symptoms. He came to the clinic for a second opinion, presenting with tenderness on palpation of the middle third of the rectus abdominis muscle, which increased with trunk resistance flexion. The pain decreased after this test was performed after muscle inhibition. An ultrasound assessment was completed, revealing no abnormalities in the discomfort, but evidence of increased thickness and decreased echogenicity of the tendon at its origin in the pubic ramus, associated with significant pain on sonopalpation, related to tendinosis. An evaluation was completed with a thoracic spine examination, revealing significant pain at the level of the spinous process of T8 (the rectus abdominis muscle is innervated by the T7-T12 thoracoabdominal nerves). It was decided to treat the patient with ultrasound-guided injections around the rectus abdominis tendon with 1 cc of triamcinolone and 1 cc of 2% lidocaine, and periradicular injections of the right T8 muscle with 2 cc of betamethasone and 1 cc of 2% lidocaine. The symptoms resolved immediately, and the patient did not reappear during the following two months of follow-up.
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Abdominal wall pain: differential diagnosis A 28-year-old soccer player presented with right periumbilical pain of 2 months' duration. An MRI was performed, which showed no abnormalities in the abdominal wall. He was diagnosed with anterior cutaneous nerve entrapment syndrome (ACNES), and perineural injection was performed, with no improvement in symptoms. He came to the clinic for a second opinion, presenting with tenderness on palpation of the middle third of the rectus abdominis muscle, which increased with trunk resistance flexion. The pain decreased after this test was performed after muscle inhibition. An ultrasound assessment was completed, revealing no abnormalities in the discomfort, but evidence of increased thickness and decreased echogenicity of the tendon at its origin in the pubic ramus, associated with significant pain on sonopalpation, related to tendinosis. An evaluation was completed with a thoracic spine examination, revealing significant pain at the level of the spinous process of T8 (the rectus abdominis muscle is innervated by the T7-T12 thoracoabdominal nerves). It was decided to treat the patient with ultrasound-guided injections around the rectus abdominis tendon with 1 cc of triamcinolone and 1 cc of 2% lidocaine, and periradicular injections of the right T8 muscle with 2 cc of betamethasone and 1 cc of 2% lidocaine. The symptoms resolved immediately, and the patient did not reappear during the following two months of follow-up.

sergio serrano belmar

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The usefulness of the fibrillar pattern and pennation angle in the ultrasound diagnosis of muscle injury A 17-year-old patient who, while braking while playing football, feels a sharp pain in the anterolateral region of the proximal third of the thigh that prevents him from continuing to play sports. Typically, the axial plane (the short axis of the muscle) is used to study fibrillar tears, with a high diagnostic sensitivity. However, on many occasions, it can be easier to scan through the long axis of the muscle to visualize the different muscle fascicles and the pennation angle in their entirety, being able to make the diagnosis by observing the interruption and loss of tension of the muscle fascicles associated with the loss of the normal pennation angle. In the present case, the normal fibrillar pattern is initially visualized in the medial region of the rectus femoris muscle until the presence of a fibrillar tear in the posterolateral myofascial junction of its proximal third, where there is a sudden interruption of the fibrillar pattern due to the presence of an intramuscular hematoma.
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The usefulness of the fibrillar pattern and pennation angle in the ultrasound diagnosis of muscle injury A 17-year-old patient who, while braking while playing football, feels a sharp pain in the anterolateral region of the proximal third of the thigh that prevents him from continuing to play sports. Typically, the axial plane (the short axis of the muscle) is used to study fibrillar tears, with a high diagnostic sensitivity. However, on many occasions, it can be easier to scan through the long axis of the muscle to visualize the different muscle fascicles and the pennation angle in their entirety, being able to make the diagnosis by observing the interruption and loss of tension of the muscle fascicles associated with the loss of the normal pennation angle. In the present case, the normal fibrillar pattern is initially visualized in the medial region of the rectus femoris muscle until the presence of a fibrillar tear in the posterolateral myofascial junction of its proximal third, where there is a sudden interruption of the fibrillar pattern due to the presence of an intramuscular hematoma.

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Consent ✅ Very interesting case!! 🤓🤓🤓 Young teenager - laparoscopic cholecystectomy months ago Persistent debilitating R upper quadrant pain around port scar site Burning, stabbing - provoked by minimal activity eg sitting up, bracing in car turning corners 4 weeks as in-patient in hospital, having further general surgical work up .... MRI, US, CT, bloods normal Off school Examination - +ive Carnett's sign, pain / inhibition on sit up, clearly abdo wall issue POCUS - can appreciate subtle port site hypoechoeic channel through rectus abdominus - this has injured the anterior cutaneous nerve at this level (T9 / T10 - see ACN schematic) Video - US guided nerve block / hydrodissection..... immediate pain relief 🥳 So at least the potential (harmful) hunt for a non MSK / gastroenterological cause can stop now Only one other case report of this in 2022 - but not a typical laparoscopic complication or tick box form. If the block fails to improve pain beyond short term, RF ablation might be helpful - then last resort surgical neurolysis.
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Consent ✅ Very interesting case!! 🤓🤓🤓 Young teenager - laparoscopic cholecystectomy months ago Persistent debilitating R upper quadrant pain around port scar site Burning, stabbing - provoked by minimal activity eg sitting up, bracing in car turning corners 4 weeks as in-patient in hospital, having further general surgical work up .... MRI, US, CT, bloods normal Off school Examination - +ive Carnett's sign, pain / inhibition on sit up, clearly abdo wall issue POCUS - can appreciate subtle port site hypoechoeic channel through rectus abdominus - this has injured the anterior cutaneous nerve at this level (T9 / T10 - see ACN schematic) Video - US guided nerve block / hydrodissection..... immediate pain relief 🥳 So at least the potential (harmful) hunt for a non MSK / gastroenterological cause can stop now Only one other case report of this in 2022 - but not a typical laparoscopic complication or tick box form. If the block fails to improve pain beyond short term, RF ablation might be helpful - then last resort surgical neurolysis.

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Consent✅ Another - possible - genicular nerve case Runner, bilateral lateral knee pain Treated as ITB overload; exhausted all non-surgical options so reasonably proceeded to targeted partial ITB release Unfortunately symptoms persisted but changed in nature - 'burning' now (L more than R), slightly more diffuse & symptoms with sitting, not just on exercise POCUS video - Scarred thickened ITB (typical post-surgical legacy) seen, with superolateral genicular NV bundle sat just deep to it Injection - hydrodissection of scar tissue around the NV bundle, freeing up the fascial plane systematically - hard work because of the density of the tissue Post procedure (volume up) - patient essentially pain free on the treadmill - R side (not injected) still painful
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Consent✅ Another - possible - genicular nerve case Runner, bilateral lateral knee pain Treated as ITB overload; exhausted all non-surgical options so reasonably proceeded to targeted partial ITB release Unfortunately symptoms persisted but changed in nature - 'burning' now (L more than R), slightly more diffuse & symptoms with sitting, not just on exercise POCUS video - Scarred thickened ITB (typical post-surgical legacy) seen, with superolateral genicular NV bundle sat just deep to it Injection - hydrodissection of scar tissue around the NV bundle, freeing up the fascial plane systematically - hard work because of the density of the tissue Post procedure (volume up) - patient essentially pain free on the treadmill - R side (not injected) still painful

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For those that don’t understand how bad the ICE mass deportation protests are getting in Phoenix, Arizona: Police are now being forced to use chemical agents and other weapons against protestors to defend themselves “If you do not disperse, you'll be subject to arrest or police action. Other police action could include the use of chemical agents or less of weapon. — Which may inflict pain or result in serious injury. Please leave this area immediately.” They are forced to release a chemical agent. This is getting violent, someone is paying for these huge protests
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dry needling: MRI findings Patient with pain in the long head of the biceps femoris muscle and a suspected fibrillar tear, for whom an MRI of the thigh was requested. The MRI shows a patchy increase in signal in the distal third of the long head of the biceps associated with hyperintense linear paths, which correlate with the history of dry needling performed three days before the radiological study. Dry needling is an invasive technique used in physiotherapy to eliminate muscle pain points (or trigger points), which can be generated due to overload. It is imperative not to do this treatment during the five days before performing an MRI because it can make the diagnosis of muscle injury difficult or impossible, mainly grade I. How many routes do you see in the video?
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dry needling: MRI findings Patient with pain in the long head of the biceps femoris muscle and a suspected fibrillar tear, for whom an MRI of the thigh was requested. The MRI shows a patchy increase in signal in the distal third of the long head of the biceps associated with hyperintense linear paths, which correlate with the history of dry needling performed three days before the radiological study. Dry needling is an invasive technique used in physiotherapy to eliminate muscle pain points (or trigger points), which can be generated due to overload. It is imperative not to do this treatment during the five days before performing an MRI because it can make the diagnosis of muscle injury difficult or impossible, mainly grade I. How many routes do you see in the video?

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🚨 Very Scary For the past two months, this 12-year-old girl had been suffering from pain in her right nostril along with repeated episodes of bleeding. There was no history of any injury. She used to go daily to fields and forest areas to graze animals. On examination, a greenish-brown moving mass was seen inside her nose, which turned out to be a leech. When water was poured into the nostril, the leech came out and was then removed using forceps.

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What the names “Odysseus” and “Achilles” mean is fascinating. It reveals the terrifying reality of what a Greek hero is. • Achilles can be read as ἄχος (grief) + λαός (fighting men) = grief of the fighting men. • We are told that Odysseus is given the name by his grandfather from ὀδύσσομαι (to hate) = Mr. Hatred. • The non-ionic pronunciation from which we get Ulysses sounds like οὐλή (scar) which is of course the defining physical feature by which Odysseus is identified. (These are all “folk” etymologies) The Greek hero is a man of pain and suffering. They cause enormous pain to their rivals: Achilles to Hector and Agamemnon; Odysseus to the Trojans, suitors, and cyclops. But they also cause enormous pain to their friends: Achilles to the Achaeans; Odysseus to his family and the Phaeacians. Lastly, they cause enormous pain to themselves: both lives are riddled with suffering. While both heroes are men of pain and suffering they are also clearly different. Wily Odysseus is a different archetype than godlike Achilles. So who is the greater hero? That’s what I try to answer in this video essay filmed in Ithaca.
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Yesterday, August 4, 2026, Naija Confra received reports that a former Aye (NBM) number 1 man (Kpoi) in Ogun State had cross-carpeted to Eiye (ACN). The report was circulated around many NBM cult platforms, with members calling for the young man to be targeted. During our investigation, we obtained a video showing the young man’s side of the story, in which he explained that he NEVER cross-carpeted. He stated that his non-cultist friend, whom he always helps, bought a new car and invited him to celebrate with him. At the gathering, he met Eiye members who used their phones to record the activities, and he could not stop them. The video was then circulated, making it appear as though he had cross-carpeted to Eiye, which is not true. The young man did not cross-carpet, and this update is for awareness and safety. Reject Violence.
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Yesterday, August 4, 2026, Naija Confra received reports that a former Aye (NBM) number 1 man (Kpoi) in Ogun State had cross-carpeted to Eiye (ACN). The report was circulated around many NBM cult platforms, with members calling for the young man to be targeted. During our investigation, we obtained a video showing the young man’s side of the story, in which he explained that he NEVER cross-carpeted. He stated that his non-cultist friend, whom he always helps, bought a new car and invited him to celebrate with him. At the gathering, he met Eiye members who used their phones to record the activities, and he could not stop them. The video was then circulated, making it appear as though he had cross-carpeted to Eiye, which is not true. The young man did not cross-carpet, and this update is for awareness and safety. Reject Violence.

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🚨 BREAKING UPDATE: John Thune is facing mass calls to keep the Senate IN SESSION, rather than RECESS starting this weekend, so a reconciliation package with the SAVE America Act can be rammed through JD Vance is waiting in the wings to break the tie! SENATORS IN SUPPORT OF NO VACATION: Sen. Mike Lee (R-UT) Sen. Rick Scott (R-FL) Sen. Tommy Tuberville (R-AL) Sen. Jim Banks (R-IN) Sen. Ashley Moody (R-FL) Sen. Darline Graham (R-SC) Sen. Bill Hagerty (R-TN) Sen. Katie Britt (R-AL) Sen. Todd Young (R-IN) Sen. Marsha Blackburn (R-TN) Sen. Eric Schmitt (R-MO) Sen. Dave McCormick (R-PA) Sen. Roger Marshall (R-KS) Sen. Jim Risch (R-ID) Sen. Ted Cruz (R-TX) Sen. Mike Crapo (R-ID) Sen. Jon Husted (R-OH) Sen. James Lankford (R-OK) Sen. Ted Budd (R-NC) HAGERTY: "What we're focused on right now is the reconciliation product...which only requires a majority vote, which we can deliver." "I'm ready to stay here to get this done in whatever form it requires!"
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🚨 BREAKING UPDATE: John Thune is facing mass calls to keep the Senate IN SESSION, rather than RECESS starting this weekend, so a reconciliation package with the SAVE America Act can be rammed through JD Vance is waiting in the wings to break the tie! SENATORS IN SUPPORT OF NO VACATION: Sen. Mike Lee (R-UT) Sen. Rick Scott (R-FL) Sen. Tommy Tuberville (R-AL) Sen. Jim Banks (R-IN) Sen. Ashley Moody (R-FL) Sen. Darline Graham (R-SC) Sen. Bill Hagerty (R-TN) Sen. Katie Britt (R-AL) Sen. Todd Young (R-IN) Sen. Marsha Blackburn (R-TN) Sen. Eric Schmitt (R-MO) Sen. Dave McCormick (R-PA) Sen. Roger Marshall (R-KS) Sen. Jim Risch (R-ID) Sen. Ted Cruz (R-TX) Sen. Mike Crapo (R-ID) Sen. Jon Husted (R-OH) Sen. James Lankford (R-OK) Sen. Ted Budd (R-NC) HAGERTY: "What we're focused on right now is the reconciliation product...which only requires a majority vote, which we can deliver." "I'm ready to stay here to get this done in whatever form it requires!"

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Diferential diagnosis of insertional plantar fasciitis: part one A patient with plantar pain that had been going on for months was diagnosed with fasciitis, with no response to physiotherapy treatment, two corticosteroid infiltrations and three PRP infiltrations. She reports intermittent plantar and medial plantar pain, sometimes being more intense early in the day. Minimal non-painful thickening at the origin of the plantar fascia is identified sonographically. On clinical examination and ultrasound, there was pain along the posterior tibial tendon, with a positive double heel-rise test, so ultrasound-guided infiltration was performed with 1 cc of triamcinolone and 1 cc of 2% lidocaine in its sheath, with partial resolution of the symptomatology. Lumbar exploration was performed, with pain due to compression of the S1 sacral foramina that correlated with the dermatome of the sensitive area at the level of the heel (dependent on the branch of the tibial nerve), so transforaminal infiltration was performed with 1 cc of triamcinolone and 1 cc of 2% lidocaine, with complete resolution of symptoms.
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Diferential diagnosis of insertional plantar fasciitis: part one A patient with plantar pain that had been going on for months was diagnosed with fasciitis, with no response to physiotherapy treatment, two corticosteroid infiltrations and three PRP infiltrations. She reports intermittent plantar and medial plantar pain, sometimes being more intense early in the day. Minimal non-painful thickening at the origin of the plantar fascia is identified sonographically. On clinical examination and ultrasound, there was pain along the posterior tibial tendon, with a positive double heel-rise test, so ultrasound-guided infiltration was performed with 1 cc of triamcinolone and 1 cc of 2% lidocaine in its sheath, with partial resolution of the symptomatology. Lumbar exploration was performed, with pain due to compression of the S1 sacral foramina that correlated with the dermatome of the sensitive area at the level of the heel (dependent on the branch of the tibial nerve), so transforaminal infiltration was performed with 1 cc of triamcinolone and 1 cc of 2% lidocaine, with complete resolution of symptoms.

sergio serrano belmar

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In 1993 CNN warned against pregnancy ultrasound and had the FDA admit it was aware of its dangers. Remarkably, the FDA raised the maximum allowable ultrasound dose by 8 times (despite data showing the old dose was too high) and all those dangers were forgotten. Ultrasound causes a dose dependent injury to the organs and cells that fetuses are particularly susceptible to (especially early in life when ultrasounds have no medical value). Those harms include: •Genetic damage, significant damage to cellular structures (e.g., mitochondria, microtubules and the nucleus). •Initiating programmed cell death. •In mice and monkeys, significantly impaired learning, memory, activity, and sociability. •Fetal death. •Hemorrhages. •A wide range of congenital malformations. The Chinese in turn conducted a series of studies showing the low doses of ultrasound created those injuries in the placenta, pituitary gland, eyes, immune system, kidneys, liver, ovaries, testicles (and sperm), and the brain’s neurons and glial cells. Additionally, in humans, ultrasound has also been linked to miscarriages, premature ovulation, male infertility, fetal growth restrictions, altered neurological function, developmental delays. Conversely, ultrasound has not been proven to improve pregnancy outcomes (rather it just leads to more frequent C-sections, prenatal testing, anxiety for the parents, abortions and neonatal distress) Rather, all it can do most of the time is (sometimes erroneously) tell parents to abort their baby or subject it to invasive (and harmful tests), all of which creates immense unnecessary anxiety and anguish for the parents. I complied the 200+ studies proving all of this in the article below.
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In 1993 CNN warned against pregnancy ultrasound and had the FDA admit it was aware of its dangers. Remarkably, the FDA raised the maximum allowable ultrasound dose by 8 times (despite data showing the old dose was too high) and all those dangers were forgotten. Ultrasound causes a dose dependent injury to the organs and cells that fetuses are particularly susceptible to (especially early in life when ultrasounds have no medical value). Those harms include: •Genetic damage, significant damage to cellular structures (e.g., mitochondria, microtubules and the nucleus). •Initiating programmed cell death. •In mice and monkeys, significantly impaired learning, memory, activity, and sociability. •Fetal death. •Hemorrhages. •A wide range of congenital malformations. The Chinese in turn conducted a series of studies showing the low doses of ultrasound created those injuries in the placenta, pituitary gland, eyes, immune system, kidneys, liver, ovaries, testicles (and sperm), and the brain’s neurons and glial cells. Additionally, in humans, ultrasound has also been linked to miscarriages, premature ovulation, male infertility, fetal growth restrictions, altered neurological function, developmental delays. Conversely, ultrasound has not been proven to improve pregnancy outcomes (rather it just leads to more frequent C-sections, prenatal testing, anxiety for the parents, abortions and neonatal distress) Rather, all it can do most of the time is (sometimes erroneously) tell parents to abort their baby or subject it to invasive (and harmful tests), all of which creates immense unnecessary anxiety and anguish for the parents. I complied the 200+ studies proving all of this in the article below.

A Midwestern Doctor

783,400 Aufrufe • vor 1 Jahr

You become injured. ⠀ ⠀ You’re placed in a cast, or sling. ⠀ ⠀ You are told to not train upper body, and just build the lower half, or vice versa. ⠀ ⠀ You don’t even bother training your non-injured, non-dominant (in most baseball, upper extremity related cases) side, because why would you need to? ⠀ ⠀ Here’s why you should absolutely train your non-injured side, even if your injured side is immobilized. ⠀ ⠀ Cross education (CE) occurs after unilateral training where performance of the untrained, contralateral (in this case injured) limb is enhanced.⠀ ⠀ Increased neural drive originating from the “untrained” motor cortex contributes to the cross education effect.⠀ ⠀ A few studies have shown that CE can preserve or spare strength and decrease atrophy on the untrained, injured limb. ⠀ ⠀ In most baseball related cases, injuries of the upper extremity most often tend to be on the dominant side. Chances are there is already some sort of imbalance in strength and or hypertrophy between sides. It is also likely that when rehabbing from that injury, we tend to attend less and be less detailed with the non-injured, non-dominant side. So the chances of there being an imbalance post-injury are likely. It’s the reason why players get hurt, rehab, come back, and in some cases end up injuring the contralateral side shortly thereafter. (Of course we see that more with lower extremity injuries.) ⠀ ⠀ In a study conducted by Justin W. Andrushko and co. They took 16 participants who were immobilized with a cast, and assigned them to a 4-week resistance training forearm program on the non-injured limb. Here’s what they found ⬇️ “The nondominant forearm of 16 participants was immobilized with a cast, and participants were randomly assigned to a resistance training (eccentric wrist flexion, 3 times/week) or control group for 4 weeks. Pre- and post testing involved wrist flexors and extensors eccentric, concentric and isometric maximal voluntary contractions (via dynamometer), muscle thickness (via ultrasound), and forearm muscle cross-sectional area (MCSA; via peripheral quantitative computed tomography). Only the training group showed strength preservation across all contractions in the wrist flexors of the immobilized limb (training: −2.4% vs. control: −21.6%; P = 0.04), and increased wrist flexors strength of the nonimmobilized limb (training: 30.8% vs. control: −7.4%; P = 0.04). Immobilized arm MCSA was preserved for the training group only (training: 1.3% vs. control: −2.3%; P = 0.01). Muscle thickness differed between groups for the immobilized (training: 2.8% vs. control: −3.2%; P = 0.01) and nonimmobilized wrist flexors (training: 7.1% vs. control: −3.7%; P = 0.02). Strength preservation was nonspecific to contraction type (P = 0.69, η2p = 0.03) yet specific to the trained flexors muscle. These findings suggest that eccentric training of the nonimmobilized limb can preserve size of the immobilized contralateral homologous muscle and strength across multiple contraction types.”
0:41

You become injured. ⠀ ⠀ You’re placed in a cast, or sling. ⠀ ⠀ You are told to not train upper body, and just build the lower half, or vice versa. ⠀ ⠀ You don’t even bother training your non-injured, non-dominant (in most baseball, upper extremity related cases) side, because why would you need to? ⠀ ⠀ Here’s why you should absolutely train your non-injured side, even if your injured side is immobilized. ⠀ ⠀ Cross education (CE) occurs after unilateral training where performance of the untrained, contralateral (in this case injured) limb is enhanced.⠀ ⠀ Increased neural drive originating from the “untrained” motor cortex contributes to the cross education effect.⠀ ⠀ A few studies have shown that CE can preserve or spare strength and decrease atrophy on the untrained, injured limb. ⠀ ⠀ In most baseball related cases, injuries of the upper extremity most often tend to be on the dominant side. Chances are there is already some sort of imbalance in strength and or hypertrophy between sides. It is also likely that when rehabbing from that injury, we tend to attend less and be less detailed with the non-injured, non-dominant side. So the chances of there being an imbalance post-injury are likely. It’s the reason why players get hurt, rehab, come back, and in some cases end up injuring the contralateral side shortly thereafter. (Of course we see that more with lower extremity injuries.) ⠀ ⠀ In a study conducted by Justin W. Andrushko and co. They took 16 participants who were immobilized with a cast, and assigned them to a 4-week resistance training forearm program on the non-injured limb. Here’s what they found ⬇️ “The nondominant forearm of 16 participants was immobilized with a cast, and participants were randomly assigned to a resistance training (eccentric wrist flexion, 3 times/week) or control group for 4 weeks. Pre- and post testing involved wrist flexors and extensors eccentric, concentric and isometric maximal voluntary contractions (via dynamometer), muscle thickness (via ultrasound), and forearm muscle cross-sectional area (MCSA; via peripheral quantitative computed tomography). Only the training group showed strength preservation across all contractions in the wrist flexors of the immobilized limb (training: −2.4% vs. control: −21.6%; P = 0.04), and increased wrist flexors strength of the nonimmobilized limb (training: 30.8% vs. control: −7.4%; P = 0.04). Immobilized arm MCSA was preserved for the training group only (training: 1.3% vs. control: −2.3%; P = 0.01). Muscle thickness differed between groups for the immobilized (training: 2.8% vs. control: −3.2%; P = 0.01) and nonimmobilized wrist flexors (training: 7.1% vs. control: −3.7%; P = 0.02). Strength preservation was nonspecific to contraction type (P = 0.69, η2p = 0.03) yet specific to the trained flexors muscle. These findings suggest that eccentric training of the nonimmobilized limb can preserve size of the immobilized contralateral homologous muscle and strength across multiple contraction types.”

Ryan Aguirre, CSCS

79,648 Aufrufe • vor 3 Jahren

Consent✅ "I’m at the Point of Breaking – Hang 10, take it thighs-an easy, I’m Hunting for a solution" Runner, surfer Massive ramp up in marathon training – rapid onset medial mid to lateral burning thigh pain (see pain map below) with low grade parasthesiae Exacerbated by deep knee flexion and running beyond 20 mins and a faster pace Struggled further on surfing holiday in prone on board and kneeling MRI excluded femoral bone stress injury and no adductor injury or knee intra-articular / ligamentous injury OE – Meniscal and ligamentous testing normal Lumbar spine and hip joint cleared POCUS video reel – Adductor magnus tendon & wider musculature normal Saphenous nerve swollen at mid Hunter’s canal point – almost same calibre as the adjacent femoral artery! (point of maximal tenderness with probe pressure - Tinel's positive) US guided hydrodissection (LS) – soft tissue planes around SN seen to open up effectively Post procedure – complete abolition of pain on treadmill running and deep squats for the first time in 8 months (excuse the language) Pearls - This area is diagnostic ‘No Man’s Land’ – ie, if there is no femur bony pathology, and in the absence of trauma, it can only really be neural ‘Adductor splint syndrome’ – a form of bone stress injury – is one of the key medial thigh pain differentials in runners Research links – ‘Surfer's neurapraxia - an uncommon surfing injury of the saphenous nerve’ ‘Adductor insertion avulsion syndrome (thigh splints): spectrum of MR imaging features’
2:19

Consent✅ "I’m at the Point of Breaking – Hang 10, take it thighs-an easy, I’m Hunting for a solution" Runner, surfer Massive ramp up in marathon training – rapid onset medial mid to lateral burning thigh pain (see pain map below) with low grade parasthesiae Exacerbated by deep knee flexion and running beyond 20 mins and a faster pace Struggled further on surfing holiday in prone on board and kneeling MRI excluded femoral bone stress injury and no adductor injury or knee intra-articular / ligamentous injury OE – Meniscal and ligamentous testing normal Lumbar spine and hip joint cleared POCUS video reel – Adductor magnus tendon & wider musculature normal Saphenous nerve swollen at mid Hunter’s canal point – almost same calibre as the adjacent femoral artery! (point of maximal tenderness with probe pressure - Tinel's positive) US guided hydrodissection (LS) – soft tissue planes around SN seen to open up effectively Post procedure – complete abolition of pain on treadmill running and deep squats for the first time in 8 months (excuse the language) Pearls - This area is diagnostic ‘No Man’s Land’ – ie, if there is no femur bony pathology, and in the absence of trauma, it can only really be neural ‘Adductor splint syndrome’ – a form of bone stress injury – is one of the key medial thigh pain differentials in runners Research links – ‘Surfer's neurapraxia - an uncommon surfing injury of the saphenous nerve’ ‘Adductor insertion avulsion syndrome (thigh splints): spectrum of MR imaging features’

James Noake

16,833 Aufrufe • vor 3 Monaten

The first time I saw this exercise, my reaction was: there’s NO way that’s safe. Eventually I came back to it and tried it. No pain. Deep pec stretch, perfectly targeted in the muscle belly. Tested with a few more guys - even tighter wound guys who have had shoulder issues in the past. No pain. Deep pec stretch. Looser arm spiral after a set. Out of an abundance of caution, I came up with some regressions. Incline the bench and start from your knees. This is an advanced movement, but it is a loaded stretch that trains strength through length. If your shoulders don’t feel better after a set, stop. However, I’ve come to prefer this over regular isometric pushups if the goal is to build end range strength or mobility in retraction/horizontal abduction. Have you tried this? Any negative experiences? Would love to hear your thoughts.
1:23

The first time I saw this exercise, my reaction was: there’s NO way that’s safe. Eventually I came back to it and tried it. No pain. Deep pec stretch, perfectly targeted in the muscle belly. Tested with a few more guys - even tighter wound guys who have had shoulder issues in the past. No pain. Deep pec stretch. Looser arm spiral after a set. Out of an abundance of caution, I came up with some regressions. Incline the bench and start from your knees. This is an advanced movement, but it is a loaded stretch that trains strength through length. If your shoulders don’t feel better after a set, stop. However, I’ve come to prefer this over regular isometric pushups if the goal is to build end range strength or mobility in retraction/horizontal abduction. Have you tried this? Any negative experiences? Would love to hear your thoughts.

Ben Brewster

568,630 Aufrufe • vor 8 Monaten

#WATCH | Ahmedabad: Gujarat Congress president Amit Chavda says, "... The Constitution of the country has given everyone the right to equality; whether it is the Prime Minister of the country or a common citizen of Gujarat, everyone has the right to one vote... A question is being raised in Gujarat about whether a person is casting just one vote or many. To verify this, we began the analysis in one constituency, which falls under the Union Minister C R Paatil. That area has 6 lakh 9 thousand voters, out of which, in the primary investigation, we checked 2 lakh 40 thousand voters. After checking, it is clear that 12.3% of the voters are fake... When the check is completed on that assembly, then there is every possibility of finding up to 75,000 fake voters... And this may be the reason why C R Paatil is winning with a record number of votes."
2:56

#WATCH | Ahmedabad: Gujarat Congress president Amit Chavda says, "... The Constitution of the country has given everyone the right to equality; whether it is the Prime Minister of the country or a common citizen of Gujarat, everyone has the right to one vote... A question is being raised in Gujarat about whether a person is casting just one vote or many. To verify this, we began the analysis in one constituency, which falls under the Union Minister C R Paatil. That area has 6 lakh 9 thousand voters, out of which, in the primary investigation, we checked 2 lakh 40 thousand voters. After checking, it is clear that 12.3% of the voters are fake... When the check is completed on that assembly, then there is every possibility of finding up to 75,000 fake voters... And this may be the reason why C R Paatil is winning with a record number of votes."

ANI

11,018 Aufrufe • vor 1 Jahr

One of the interesting findings from studies comparing social pain and physical pain is this: if you ask people directly which they would rather experience, most say social pain. Physical pain is extremely aversive. People dislike it intensely. When asked to imagine experiencing one or the other, they typically rate physical pain as more unpleasant than the social pain of embarrassing yourself on stage, being betrayed by a friend, or being dumped by a romantic partner. But an interesting study from about ten years ago approached the question differently. Instead of asking people to imagine pain, the researchers asked participants to recall real experiences. Some were asked to remember moments of physical pain—being in a serious car accident, falling out of a tree and breaking a bone, or some other injury. Others were asked to recall socially painful experiences—being broken up with, going through a divorce, being betrayed by a friend, or embarrassing themselves at an important work event. When recalling these events, people reported that the socially painful memories felt more painful than the physically painful ones. When I first read this study, I was a little skeptical. But then I thought back to the times in my own life when I experienced physical pain. The memory of it tends to be vague. If you’ve broken a bone, been punched, or stubbed your toe, it’s surprisingly difficult to recreate the sensation in your mind once the pain is gone. Social pain is different. It’s much easier to recall vividly. I can remember moments when I felt embarrassed, betrayed, or misled, and those memories can still bring back the emotional sting. Many of those experiences are easy to relive even years later.
2:16

One of the interesting findings from studies comparing social pain and physical pain is this: if you ask people directly which they would rather experience, most say social pain. Physical pain is extremely aversive. People dislike it intensely. When asked to imagine experiencing one or the other, they typically rate physical pain as more unpleasant than the social pain of embarrassing yourself on stage, being betrayed by a friend, or being dumped by a romantic partner. But an interesting study from about ten years ago approached the question differently. Instead of asking people to imagine pain, the researchers asked participants to recall real experiences. Some were asked to remember moments of physical pain—being in a serious car accident, falling out of a tree and breaking a bone, or some other injury. Others were asked to recall socially painful experiences—being broken up with, going through a divorce, being betrayed by a friend, or embarrassing themselves at an important work event. When recalling these events, people reported that the socially painful memories felt more painful than the physically painful ones. When I first read this study, I was a little skeptical. But then I thought back to the times in my own life when I experienced physical pain. The memory of it tends to be vague. If you’ve broken a bone, been punched, or stubbed your toe, it’s surprisingly difficult to recreate the sensation in your mind once the pain is gone. Social pain is different. It’s much easier to recall vividly. I can remember moments when I felt embarrassed, betrayed, or misled, and those memories can still bring back the emotional sting. Many of those experiences are easy to relive even years later.

Rob Henderson

15,947 Aufrufe • vor 6 Monaten