Dr. Sharon Kolasinski is a professor of clinical medicine at the University of Pennsylvania and chief of the Division of Rheumatology at Penn Presbyterian Medical Center.

Part 1

Her objectives in the presentation are to help listeners by learning about evidence-based treatment for patients with osteoarthritis (OA), to understand the process by which guidelines are developed that might help us figure out our evidence-based approach, to review the recommended treatments for OA, and to review some treatments that are not recommended for OA. Her basic evidence-based reference is a University of Pennsylvania guideline that was published in 2020. Numerous other guidelines are available, which she described. She discussed her work with a case involving a 55-year-old male patient. He arrived for routine follow-up care for immunosuppressive medication monitoring. He described pains that he was experiencing and was diagnosed with OA. She indicated the impacts OA has on patients. Clinicians find it a daunting challenge to provide satisfactory treatment. For example, for some clinicians, the guidelines do not appear to be clear and provide a roadmap. Also, they do not always believe in the recommendations contained in the guidelines. In this presentation, she wants to see if she can change some minds about guidelines. She provided an example based on investigations conducted at her institution. The outcome was a series of recommendations that she described.

Part 2

Dr. Kolasinski began Part 2 of her presentation by continuing to focus on the importance of having patients with OA engage in physical activity. She stated that “they are worn out and the implication is that a doctor is needed to fix them.” Perhaps a perspective should be taken of a more participatory discourse where we encourage physical therapy and emphasize that physical exercise is safe when you have arthritis and focus on what the patient can do, empowering them to exercise. A starting point is to give patients a physical therapy prescription. She discussed the extent to which physical therapy is useful, along with indicating how much and how frequently exercise is beneficial (e.g., for 20 minutes, three times a week). Losing weight is an effective way of reducing symptoms. Food choices can affect OA symptoms. Diet and exercise used together can produce effective results. References were made to several studies that involve the status of steroid injections on improving patient health status. Acupuncture also was mentioned. She indicated conditional recommendations on the use of pharmacological interventions. She concluded by describing how to treat the 55-year-old patient she mentioned in Part 1 of her presentation.

Dr. Sharon Kolasinski is a professor of clinical medicine at the University of Pennsylvania and chief of the Division of Rheumatology at Penn Presbyterian Medical Center.

Part 1

Her objectives in the presentation are to help listeners by learning about evidence-based treatment for patients with osteoarthritis (OA), to understand the process by which guidelines are developed that might help us figure out our evidence-based approach, to review the recommended treatments for OA, and to review some treatments that are not recommended for OA. Her basic evidence-based reference is a University of Pennsylvania guideline that was published in 2020. Numerous other guidelines are available, which she described. She discussed her work with a case involving a 55-year-old male patient. He arrived for routine follow-up care for immunosuppressive medication monitoring. He described pains that he was experiencing and was diagnosed with OA. She indicated the impacts OA has on patients. Clinicians find it a daunting challenge to provide satisfactory treatment. For example, for some clinicians, the guidelines do not appear to be clear and provide a roadmap. Also, they do not always believe in the recommendations contained in the guidelines. In this presentation, she wants to see if she can change some minds about guidelines. She provided an example based on investigations conducted at her institution. The outcome was a series of recommendations that she described.

Part 2

Dr. Kolasinski began Part 2 of her presentation by continuing to focus on the importance of having patients with OA engage in physical activity. She stated that “they are worn out and the implication is that a doctor is needed to fix them.” Perhaps a perspective should be taken of a more participatory discourse where we encourage physical therapy and emphasize that physical exercise is safe when you have arthritis and focus on what the patient can do, empowering them to exercise. A starting point is to give patients a physical therapy prescription. She discussed the extent to which physical therapy is useful, along with indicating how much and how frequently exercise is beneficial (e.g., for 20 minutes, three times a week). Losing weight is an effective way of reducing symptoms. Food choices can affect OA symptoms. Diet and exercise used together can produce effective results. References were made to several studies that involve the status of steroid injections on improving patient health status. Acupuncture also was mentioned. She indicated conditional recommendations on the use of pharmacological interventions. She concluded by describing how to treat the 55-year-old patient she mentioned in Part 1 of her presentation.

Dr. Natalie Azar is an Associate Clinical Professor of Medicine & Rheumatology at NYU Langone Health. Certified by the American Board of Internal Medicine, she is a designated long Covid provider in rheumatology. Her practice locations are at the Langone orthopedic center and Washington Square, and she has been in private practice since 2001. A graduate of Wellesley College, Dr. Azar’s medical degree is from Cornell University Medical College. She completed her internship, residency, and fellowship at New York University. Her fellowship in rheumatology was at the Hospital For Joint Diseases. She has been a medical contributor to NBC News since 2014.

Part 1

The discussion in Part 1 included the following items: clinical definition of Long-COVID; predictability of developing Long-COVID; whether patients with existing rheumatic disease are more susceptible to developing Long-COVID; whether COVID-19 could trigger rheumatic disease; differences and similarities between Long-COVID and rheumatic disease; whether Long-COVID can occur following mild acute illness; risk factors associated with developing Long-COVID; presence of fatigue as a risk factor for developing Long-COVID; and major symptoms of Long-COVID.

Part 2

The discussion in Part 2 included the following items: organ systems and tissues most affected by Long-COVID; variations in symptoms and disease severity among patients; diagnostic and prognostic biomarkers for Long-COVID; protective effects of vaccine; episodic aspects of Long-COVID; use of medications and non-pharmaceutical treatment interventions; and personal and NYU involvement in conducting Long-COVID studies.

Dr. Natalie Azar is an Associate Clinical Professor of Medicine & Rheumatology at NYU Langone Health. Certified by the American Board of Internal Medicine, she is a designated long Covid provider in rheumatology. Her practice locations are at the Langone orthopedic center and Washington Square, and she has been in private practice since 2001. A graduate of Wellesley College, Dr. Azar’s medical degree is from Cornell University Medical College. She completed her internship, residency, and fellowship at New York University. Her fellowship in rheumatology was at the Hospital For Joint Diseases. She has been a medical contributor to NBC News since 2014.

Part 1

The discussion in Part 1 included the following items: clinical definition of Long-COVID; predictability of developing Long-COVID; whether patients with existing rheumatic disease are more susceptible to developing Long-COVID; whether COVID-19 could trigger rheumatic disease; differences and similarities between Long-COVID and rheumatic disease; whether Long-COVID can occur following mild acute illness; risk factors associated with developing Long-COVID; presence of fatigue as a risk factor for developing Long-COVID; and major symptoms of Long-COVID.

Part 2

The discussion in Part 2 included the following items: organ systems and tissues most affected by Long-COVID; variations in symptoms and disease severity among patients; diagnostic and prognostic biomarkers for Long-COVID; protective effects of vaccine; episodic aspects of Long-COVID; use of medications and non-pharmaceutical treatment interventions; and personal and NYU involvement in conducting Long-COVID studies.

Dr. Jacques Hacquebord is  Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery. 

The discussion in Part 2 included the following items: other types of clinicians who provide treatment for patients who need hand surgery; influence of artificial intelligence (AI) on hand surgery; complications that could arise during hand surgery and how to mitigate them; management of post-operative pain; dealing with pre-operative anxiety experienced by patients; quality of patient information on the Internet about hand health problems; advice on how to prevent health problems regarding the hands; personal lessons learned that have implications for improving patient care; and research involvement at NYU Langone Health.

Dr. Jacques Hacquebord is  Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery. 

The discussion in Part 1 included the following items: reason for deciding to practice in hand surgery; common health problems that result in patients undergoing hand surgery, influence of gender on the onset of health problems, kinds of health problems children experience, patient expectations of what will result from hand surgery, use of wide-awake local anesthesia no tourniquet surgery (WALANT), and patients’ level of cooperation in achieving positive surgical outcomes.

A special two-part Grand Rounds presentation by Dr. Carlo Pardo, who is a clinical neurologist/pathologist and professor of neurology and pathology at the Johns Hopkins School of Medicine.

Part One

He began by stating that the main objective of this presentation is understanding the concept of myelopathies versus myelitis. He wants to present a diagnostic approach for the evaluation of a patient with an acute case of myelopathy and vascular myelopathy, and review the current concepts of vascular myelopathies, something that probably will be encountered very often in rehabilitation clinical practice. It is truly important that after this lecture to stop using the term myelitis and instead use a more precise etiological diagnosis of myelopathy. He disclosed where his research funding comes from. He presented a historical concept of myelitis and myelopathies. In the past several years, the major revolution in neurology has been the discovery of many biomarkers that are identified myelopathies. Etiological diagnosis should dominate the evaluation of patients with acute myelopathies because once we identify the etiological factor, we are able to help those patients in a better way. A lack of proper characterization may lead to mistreatment. A major difficulty in assessment of non-inflammatory myelopathy is at this moment, we do not have clear criteria to diagnose some of them. So keep in mind that the temporal assessment of the lesion by MRI is also important and you need to think about the timing of the MRI when you are preparing to give an interpretation to decide what is a potential etiological diagnosis.

Part Two

Getting the clinical information, the temporal profile of the patient, along with MRI findings and spinal fluid analysis is important during the analysis of patients presenting with myelopathic syndromes. MRI is one important tool and a very good way to establish the magnitude and localization of spinal cord lesions. One thing he likes to emphasize also is that the presence of myelopathies are not following the classical territories that we know. One thing that is important is that in addition to the blood supply is the blood drainage. The blood drainage of the spinal cord once again is very complex and there is a good and complex pattern of drainage at every segment of the spinal cord. He emphasized for individuals working in rehabilitation that there are other areas of the blood supply that may be affected. Some examples were provided of what he meant. He discussed experiences in their analysis of some cases at his institution where they analyzed 125 patients, attempting to classify the topographic distribution of the lesion.

A special two-part Grand Rounds presentation by Dr. Carlo Pardo, who is a clinical neurologist/pathologist and professor of neurology and pathology at the Johns Hopkins School of Medicine.

Part One

He began by stating that the main objective of this presentation is understanding the concept of myelopathies versus myelitis. He wants to present a diagnostic approach for the evaluation of a patient with an acute case of myelopathy and vascular myelopathy, and review the current concepts of vascular myelopathies, something that probably will be encountered very often in rehabilitation clinical practice. It is truly important that after this lecture to stop using the term myelitis and instead use a more precise etiological diagnosis of myelopathy. He disclosed where his research funding comes from. He presented a historical concept of myelitis and myelopathies. In the past several years, the major revolution in neurology has been the discovery of many biomarkers that are identified myelopathies. Etiological diagnosis should dominate the evaluation of patients with acute myelopathies because once we identify the etiological factor, we are able to help those patients in a better way. A lack of proper characterization may lead to mistreatment. A major difficulty in assessment of non-inflammatory myelopathy is at this moment, we do not have clear criteria to diagnose some of them. So keep in mind that the temporal assessment of the lesion by MRI is also important and you need to think about the timing of the MRI when you are preparing to give an interpretation to decide what is a potential etiological diagnosis.

Part Two

Getting the clinical information, the temporal profile of the patient, along with MRI findings and spinal fluid analysis is important during the analysis of patients presenting with myelopathic syndromes. MRI is one important tool and a very good way to establish the magnitude and localization of spinal cord lesions. One thing he likes to emphasize also is that the presence of myelopathies are not following the classical territories that we know. One thing that is important is that in addition to the blood supply is the blood drainage. The blood drainage of the spinal cord once again is very complex and there is a good and complex pattern of drainage at every segment of the spinal cord. He emphasized for individuals working in rehabilitation that there are other areas of the blood supply that may be affected. Some examples were provided of what he meant. He discussed experiences in their analysis of some cases at his institution where they analyzed 125 patients, attempting to classify the topographic distribution of the lesion.

In this episode, the two discuss how and when they began to develop an interest in performing arts medicine; health screening of performers prior to participation in these activities; failure to admit the existence of a health problem because of a fear of being replaced by a healthier performer; types of clinicians involved in treating performing artists; and approaches to preventing health problems in performing artists.

Dr. Tracy McKay is a Clinical Assistant Professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine.  She specializes in Integrative Sports and Spine Medicine with a special interest in Performing Arts Medicine. Dr. McKay is Chairperson of the Performing Arts Medicine Community of the American Academy of Physical Medicine and Rehabilitation and served as consulting medical director for the Broadway show, Here Lies Love. She is a staff physician at the Harkness Center for Dance Injuries and provides care to professional dance companies that include Complexions, Alvin Ailey, Ballet Hispanico, and AIM. 

Dr. Rosa Pasculli is a non-operative Sports Medicine physician at Emory Orthopedics at Grady Health System in Atlanta. Her primary clinical area of interest is performing arts medicine. She serves as a consulting physician for the Atlanta Ballet, the Georgia Ballet, and she is a faculty member of the Female Athlete Program. She also serves as a team physician for Emory University, the College Park Skyhawks, and several Atlanta high schools. Dr. Pasculli completed medical school at New York University School of Medicine and her residency was in Physical Medicine and Rehabilitation at NYU. She also had a fellowship in Primary Care Sports Medicine at Emory University.

We should begin with every patient by validating that their pain is real. He discussed the role played by cognitive behavioral therapy (CBT). It is referenced most often because it has the best evidence, but we do not really know how to break that down for patients. He described three basic stages. It is important to recognize that CBT is not the best and only treatment. Exercise is important in a lot of musculoskeletal conditions, but it should be tailored to benefit that window between benefit and symptom aggravation. Next, is the question of what must be done with all the information he has provided in this presentation thus far. There seems to be evidence of some advantage to participating in athletics or being fit. Also, not everyone who is fit is having a good time and not everyone with a chronic condition can jump into fitness in the right way. So, we need to figure out how to meld that. Patients come to us because they are suffering. We need a team approach to close the performance gap they experience. A psychological battle must be dealt with at the same time as physical problems. He described strategies he would use. Find out what exercise they do now and for how many minutes, and their amount of sleep. Determine what they enjoyed doing in the past. It is important to focus on one of their problems and aim to achieve success in treating it. He described some available resources that are useful.

A Question & Answer period followed.

PART 1

Dr. Vasudevan began by discussing how pain is experienced by athletes and non-athletes, how to identify components of multidisciplinary care for both those groups, and incorporate some reasonable strategies that might help with exercise prescriptions and lifestyle modifications for those with chronic pain. He provided some definitions for various terms, such as pain medicine, sports medicine, and pain. The latter is in the brain, which is the summation of all inputs. As physiatrists, we look at what the pain is keeping you from doing what you want to perform. He addressed the question of whether there are gender differences in the perception of pain. The short answer is no. Strength and endurance matter more. Endurance athletes can tolerate pain better. He discussed some consequences of the overtraining syndrome. If an athlete cannot perform at a desired level, there is a higher mental risk. Insufficient sleep is a risk factor. A pertinent concern is how to improve mental health in athletes. He indicated what they do at Penn to address this matter. Non-pharmacological interventions are preferred for treating injuries, e.g., massage modalities. The use of topical medications can be effective from a systemic perspective. The discussion then switched to chronic pain.