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A training day in London

A training day in London……

A couple of weeks ago I went up to London to attend an ultrasound workshop. It was at Canada Water, not too far from The Shard, an amazing building! The course was run by The British Medical Ultrasound Society and was about Point Of Care UltraSound (POCUS), which is where ultrasound is performed by the clinician seeing the patient, rather than by a sonographer somewhere else in the building. Although this type of course is aimed primarily at hospital doctors, and they made up most of the audience, there was a GP there, as well as me, the only chiropractor/sonographer. My use of ultrasound is POCUS, of course, because I am the clinician, as well as being the sonographer, when I use abdominal ultrasound here in the clinic to help work out what is causing a patient’s back pain.

The first presentation was about the FAST examination (Focused Assessment with Sonography for Trauma), used in A+E departments, mainly to look for free fluid (bleeding) in patients who have had trauma. Five views are taken, looking for fluid. In this example, you can see blood in the peritoneum. Interestingly, a bleed will often form sharp triangles, which helps to differentiate it from a cyst, which doesn’t. I don’t use the FAST protocol in my patient assessment, but it was a good reminder about some of the practical aspects of an abdominal ultrasound examination (which is what I do every day).

The next presentation was about abdominal aortic aneurysms (AAAs), where there is a bulge in the main artery carrying blood to the lower body. These are most common in older men who smoke, or have smoked in the past. We are looking for an increase in the internal diameter of the artery, above 3cm, as they can rupture, with fatal results. AAAs can cause back pain, so this is certainly of interest to clinicians like chiropractors.

We then had a presentation and a practical session about the use of ultrasound scanning to detect deep venous thrombus (DVT). Veins are normally easily squashed by pressure, so the aim with ultrasound scanning is to see if the vein can be squashed. If it can’t be squashed, then there may be a DVT. I haven’t done DVT scanning in the past, and it obviously takes quite a bit of practice to develop the confidence in your interpretation to use it clinically. I can see the merits of being able to do this and being able to differentiate a DVT from a muscle tear in the calf, which is often difficult to do. This area is something that I need to do more training in and get a lot more practice!

Next up was vascular access scanning, where ultrasound is used to guide the insertion of a canula into a vein for drug administration.  Not something that I will be doing clinically, but interesting to learn about, and to practice with the help of some models. I found it quite difficult, so hats off to those clinicians doing this with ease in hospital!

We then moved on to ultrasound of the lung, looking at a variety of things for which ultrasound is helpful, including pneumothorax. Normally you should see the pleura slide over each other like in this video. In this case there is shimmering of the pleura, and comet tails, so this excludes a pneumothorax . There was lots more, of course, some of it relating to the use of ultrasound in assessing the lungs of patients who have Covid-19. Not something that I am planning on doing!

The last section was echocardiology: using ultrasound to image the chambers of the heart. Although this was really interesting, it’s not something that I shall be using in practice. It’s a challenging subject not least because most of the images of the heart are from underneath, so I found working out what was what extremely difficult!

Although, like all seminars and workshops, much of what we were covering was not applicable to me, it made me think, and also made be reflect on what areas I should do more CPD in the future. I think being able to do DVT scanning proficiently is my next aim. I was pretty exhausted by the end of the day, when I had to get the underground back across London and then catch the train home, but it was worth it! Thanks to BMUS for a great training day.

#BMUS, #ultrasound, #POCUS, #FASTscan, #AAAscan, #DVT, #lungultrasound, #echocardiography

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Lim, Y.Z., et al., People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother, 2019. 65(3): p. 124-135.
Meade, T.W., et al., Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ, 1990. 300(6737): p. 1431-7.
Koes, B.W., et al., Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine (Phila Pa 1976), 2001. 26(22): p. 2504-13; discussion 2513-4.
Chou, R., et al., Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med, 2017. 166(7): p. 493-505.
Pengel, L.H., et al., Acute low back pain: systematic review of its prognosis. BMJ, 2003. 327(7410): p. 323.
Croft, P.R., et al., Outcome of low back pain in general practice: a prospective study. BMJ, 1998. 316(7141): p. 1356-9.
Santilli, V., E. Beghi, and S. Finucci, Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J, 2006. 6(2): p. 131-7.
Leemann, S., et al., Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: a prospective observational cohort study with one-year follow-up. J Manipulative Physiol Ther, 2014. 37(3): p. 155-63
Morris, C.E., Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation. J Manipulative Physiol Ther, 1999. 22(1): p. 38-44.
Bergmann, T.F. and B.V. Jongeward, Manipulative therapy in lower back pain with leg pain and neurological deficit. J Manipulative Physiol Ther, 1998. 21(4): p. 288-94.
Runge, N., A. Aina, and S. May, The benefits of adding manual therapy to exercise therapy for improving pain and function in patients with knee or hip osteoarthritis - a systematic review with meta-analysis. J Orthop Sports Phys Ther, 2022: p. 1-36.
Anwer, S., et al., Effects of orthopaedic manual therapy in knee osteoarthritis: a systematic review and meta-analysis.Physiotherapy, 2018. 104(3): p. 264-276.
Zhu, L., X. Wei, and S. Wang, Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2016. 30(2): p. 145-55.
Wang, Z., et al., Systematic Review and Network Meta-analysis of Acupuncture Combined with Massage in Treating Knee Osteoarthritis. Biomed Res Int, 2022. 2022: p. 4048550.
Tian, H., et al., Acupuncture for Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials with Meta-Analyses and Trial Sequential Analyses. Biomed Res Int, 2022. 2022: p. 6561633.
Chen, J., et al., Acupuncture for the Treatment of Knee Osteoarthritis: An Overview of Systematic Reviews. Int J Gen Med, 2021. 14: p. 8481-8494.
Araya-Quintanilla, F., I. Cuyúl-Vásquez, and H. Gutiérrez-Espinoza, Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews. J Bodyw Mov Ther, 2022. 29: p. 117-126.
Katz, J.N., et al., Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA, 2022. 327(17): p. 1688-1699.
Bronfort, G., et al., Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther, 2001. 24(7): p. 457-66.
Vernon, H.T., The effectiveness of chiropractic manipulation in the treatment of headache: an exploration in the literature. J Manipulative Physiol Ther, 1995. 18(9): p. 611-17.
Nilsson, N., H.W. Christensen, and J. Hartvigsen, The effect of spinal manipulation in the treatment of cervicogenic headache.J Manipulative Physiol Ther, 1997. 20(5): p. 326-30.

Boline, P.D., et al., Spinal manipulation vs. medication for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther, 1995. 18(3): p. 148-54.

Bryans, R., et al., Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther, 2011. 34(5): p. 274-89.
Varatharajan, S., et al., Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J, 2016. 25(7): p. 1971-99.
Côté, P., et al., Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. Eur J Pain, 2019. 23(6): p. 1051-1070.
Chu, E.C.P. and M. Ng, Long-term relief from tension-type headache and major depression following chiropractic treatment. J Family Med Prim Care, 2018. 7(3): p. 629-631.
West, J. and R.B. Phillips, Chiropractic management of a patient with persistent headache. J Chiropr Med, 2013. 12(4): p. 281-7.
Haas, M., et al., Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. J Manipulative Physiol Ther, 2004. 27(9): p. 547-53.
Pribicevic, M. and H. Pollard, Rotator cuff impingement. J Manipulative Physiol Ther, 2004. 27(9): p. 580-90.
Pribicevic, M., H. Pollard, and R. Bonello, An epidemiologic survey of shoulder pain in chiropractic practice in australia. J Manipulative Physiol Ther, 2009. 32(2): p. 107-17.
Liu, M., et al., Effects of massage and acupuncture on the range of motion and daily living ability of patients with frozen shoulder complicated with cervical spondylosis. Am J Transl Res, 2021. 13(4): p. 2804-2812.
Kim, Y.J., Acupuncture management for the acute frozen shoulder: A case report. Clin Case Rep, 2021. 9(11): p. e05055.
Ben-Arie, E., et al., The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med, 2020. 2020: p. 9790470.
Rueda Garrido, J.C., J. Vas, and D.R. Lopez, Acupuncture treatment of shoulder impingement syndrome: A randomized controlled trial. Complement Ther Med, 2016. 25: p. 92-7.
Pribicevic, M. and H. Pollard, A multi-modal treatment approach for the shoulder: a 4 patient case series. Chiropr Osteopat, 2005. 13: p. 20.
Russell, S., et al., A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder. J Shoulder Elbow Surg, 2014. 23(4): p. 500-7.
Brantingham, J.W., et al., Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. J Manipulative Physiol Ther, 2011. 34(5): p. 314-46.

Pribicevic, M., et al., A systematic review of manipulative therapy for the treatment of shoulder pain. J Manipulative Physiol Ther, 2010. 33(9): p. 679-89.

Page, M.J., et al., Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev, 2016(6): p. CD012224.
Page, M.J., et al., Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev, 2014(8): p. CD011275.
de Sire, A., et al., Non-Surgical and Rehabilitative Interventions in Patients with Frozen Shoulder: Umbrella Review of Systematic Reviews. J Pain Res, 2022. 15: p. 2449-2464.
Murray, C.J., et al., The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA, 2013. 310(6): p. 591-608.
Croft, P.R., et al., Risk factors for neck pain: a longitudinal study in the general population. Pain, 2001. 93(3): p. 317-325.
Nilsen, T.I., A. Holtermann, and P.J. Mork, Physical exercise, body mass index, and risk of chronic pain in the low back and neck/shoulders: longitudinal data from the Nord-Trondelag Health Study. Am J Epidemiol, 2011. 174(3): p. 267-73.
Kääriä, S., et al., Risk factors of chronic neck pain: a prospective study among middle-aged employees. Eur J Pain, 2012. 16(6): p. 911-20.
Linton, S.J., A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976), 2000. 25(9): p. 1148-56.
Côté, P., et al., The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther, 2009. 32(2 Suppl): p. S70-86.
Bryans, R., et al., Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther, 2014. 37(1): p. 42-63.
Zhu, L., X. Wei, and S. Wang, Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2016. 30(2): p. 145-55.
Gross, A., et al., Manipulation or mobilisation for neck pain: a Cochrane Review. Man Ther, 2010. 15(4): p. 315-33.
Cohen, S.P., Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc, 2015. 90(2): p. 284-99.
Peterson, C., J. Bolton, and B.K. Humphreys, Predictors of outcome in neck pain patients undergoing chiropractic care: comparison of acute and chronic patients. Chiropr Man Therap, 2012. 20(1): p. 27.