Case Study: Hamstring and SI Joint Dysfunction in Female Runner

Our Patient Our patient is a 52 year-old female runner who came to us after unsuccessful treatment elsewhere, complaining of mild low back pain shooting down her right leg. She explained that she had never had low back pain before, and that her locus of pain was slightly lower than her lumbar spine and closer […]

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March 13, 2024

Case Study: Runner’s Pain

Our Patient Our patient is a 33 year-old female runner complaining of hamstring and calf tightness, and posterior knee pain in both legs. The pain began in 2015, but she continued to run. The Challenge The patient had seen numerous running physical therapists and had undergone multiple gait analyses without any results. Five years prior […]

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February 29, 2024

Case Study: Lateral Epicondylitis

Our Patient Our patient is a 56 year-old male jeweler who came to us with lateral elbow pain. The patient is a very athletic tennis player who works out at the gym on a regular basis. He stated that his pain initially started at the front of his elbow and eventually moved toward his lateral […]

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February 29, 2024

Case Study: Femoroacetabular Impingement

Our Patient Our patient is a 29 year-old female, a professional fencer since the age of 11, who came to us with right-sided hip pain. She denied any past trauma, and at the time of her visit she had just recovered from COVID. She had been diagnosed with femoroacetabular impingement (FAI), and had undergone 4 […]

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February 28, 2024

Case Study: Misdiagnosis of Rib Cage Pain

Our Patient Our patient is a 19 year-old male suffering from 3 years of sternal and lower frontal rib cage pain. The patient was a bodybuilder whose weight training regimen included chest presses, pushups, dips and other exercises that recruited muscles in the pectoral region. Various attempts to treat him had been unsuccessful, and his […]

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February 6, 2024

Case Study: Misdiagnosed Low Back Pain

Our Patient Our patient is a 33 year-old female who had been suffering from low back pain for 18 years. Three years prior to visiting our clinic, she had developed severe left-sided sciatica. An MRI revealed a spinal anomaly and the patient underwent surgery for a multi-segmental spinal fusion. While the surgery initially relieved her […]

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February 6, 2024

Case Study: Postpartum Back Pain

Our Patient Our 41 year-old female patient complained of moderate to severe low back pain. She had gone through five pregnancies – two vaginal and three by C-section. Her back pain commenced about 3 months after abdominoplasty (“tummy tuck”) surgery to correct a 6 cm diastasis recti. The surgery took place 7 months prior to […]

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January 11, 2024

Case Study: Demystifying Persistent Ankle Pain

Our Patient Our patient is a 44 year-old female complaining of ankle pain. She had sprained the ankle two years prior and had been successfully treated with physical therapy. The Challenge Eight months after her initial treatment, the patient’s ankle pain returned, somewhat distal to the original site of trauma. She reported worse pain and […]

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December 21, 2023

Case Study: Patient with Elbow Pain Self-Misdiagnoses

Our Patient Our patient is a 57 year-old barber and recreational bodybuilder complaining of “tennis elbow” that would not go away. The pain worsened while lifting weights at the gym, and he reported pain and stiffness after waking up in the morning. He had previously had physical therapy, and an orthopedist had blindly injected a […]

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December 20, 2023

Case Study: Resolving Chronic Sit Bone Pain in a Female Runner

Our Patient Our patient is a 45 year-old female runner complaining of left sit bone pain when running and sitting. She has a history of proximal hamstring tendinopathy, and had been treated with plasma injections about 5 years prior, along with physical therapy. Her pain was initially resolved by the injections, and she continued to […]

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December 13, 2023

Case Study: Ultrasound Reveals Sciatic Neuropathy and Life-Threatening Peripheral Vascular Disease

Our Patient Our patient is a 62-year-old female complaining of leg pain, calf and foot muscle weakness, and sensations of numbness in her lower extremities. Our Diagnostic Approach Our initial clinical exam indicated neuropathy, which we confirmed with multiple EMG tests. We followed up with an examination by high-resolution diagnostic ultrasonography. Our ultrasound exam of […]

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December 8, 2023

Case Study: Pelvic Pain Demystified in Female Patient

Our Patient A 33-year-old female came to us complaining of persistent left groin pain and painful intercourse. She had been seeing a physical therapist for hip pain that extended to her groin and pelvis. The Challenge In addition to physical therapy, the patient was treated with manual internal pelvic floor massage. When her condition did […]

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November 17, 2023

Case Study: Male Pelvic Pain and Erectile Dysfunction

Our Patient A male cyclist came to us with erectile dysfunction and pelvic pain. He was being treated elsewhere with manual therapy, with no signs of improvement. The Challenge The therapist who had been treating the patient was using internal manual therapy to address tight pelvic floor muscles, when in fact the muscle tension was […]

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November 16, 2023

Case Study: Knee Pain Caused by Nerve Entrapment

Our Patient Our patient was a 65 year-old male complaining of medial knee pain, with a history of low back pain. He had previously undergone a lumbar discectomy where a degenerative disc had been removed at L4-L5. He suffered from mild arthritis in both knees, and had an old medial meniscus tear. The patient had […]

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November 1, 2023

Case Study: Occupational Hip and Low Back Pain

Our Patient Our patient was a 55 year-old male employee of the Metropolitan Transportation Authority (MTA). The patient’s job required heavy manual labor. He came to us complaining of hip and low back pain. The Challenge The patient’s job did not allow ample recovery time for standard physical therapy and injury rehabilitation to provide significant […]

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October 19, 2023

Case Study: Patient with Back Pain, Scoliosis and External Foot and Hip Rotation Successfully Treated

Our Patient Our patient was a 22 year-old male presenting with low back pain, scoliosis, and external hip and foot rotation. The Challenge The patient had previously sought orthopedic consultations and underwent MRI. The suspected diagnosis was ischio-femoral impingement, a condition associated with hamstring syndrome, to which his external hip and foot rotation were attributed. […]

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October 19, 2023

Case Study: Patient with Facial Pain and Complex Neurological Dysfunction Successfully Treated with Alternative Therapies

Our Patient Our patient, a 28 year-old male, had been suffering for over two years with unexplained facial and upper body pain. He had seen two separate neurologists and undergone MRIs of his brain and cervical spine, with no concrete diagnosis. The patient’s symptoms included: Pains in the face, anterior neck, chest and rib cage […]

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October 18, 2023

Case Study: Peroneal Nerve Entrapment

Our Patient Our female patient came to us after unsuccessful treatment at another clinic. She presented with painful hip snapping, leg paresthesia (tingling/numbness), low back pain, sacroiliac(SI) joint pain, and gluteal pain. She had previously been treated with epidural steroid injections, piriformis steroid injections, and hip steroid injection, without long-term results. The Challenge Navigating the […]

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October 6, 2023

Case Study: Neck and Scapular Pain with Disc Bulges

Our Patient Our patient presented with persistent neck and interscapular pain lasting more than five years, with a history of overhead sports and a prior car accident. The patient had been unsuccessfully treated elsewhere. The Challenge Pain had begun prior to the patient’s car accident. The patient had received a brachial plexus hydrodissection, which failed […]

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October 6, 2023

Case Study: Steroid Injection-Induced Pain and Muscle Atrophy

Our Patient Our patient is a 58 year-old female with complaints of persistent pain in the sacroiliac joint, with radiating pain and paresthesia to the buttock and trochanter. She had previously received unsuccessful steroid injections for her symptoms at another clinic. The Challenge The patient had been previously diagnosed with a deviated coccyx and a […]

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October 6, 2023

Case Study: Ultrasound Guided Dry Needling for Scoliosis-Related Pain and Mobility

Our Patient Our patient is a 30 year-old male who had been diagnosed with Ehlers-Danlos syndrome – a condition characterized by joint hypermobility. The patient’s medical history included frequent fractures and chronic pain in the lower back and buttock regions. The persistent pain was significantly impacting the patient’s daily activities and overall well-being. The patient […]

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October 6, 2023

Case Study: Ultrasound Guided Dry Needling for Chemotherapy-Induced Pain and Numbness

Our Patient Our patient is a 43 year-old female suffering from hand numbness and impingement of the right shoulder consequent to chemotherapy treatment for thymoma. The patient had previously sought medical attention at another clinic where her condition had been misdiagnosed, resulting in unsuccessful, costly and time-consuming treatment. Our Diagnosis Our multidisciplinary team leveraged advanced […]

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October 6, 2023

Case Study: Ultrasound Guided Dry Needling for Vertigo Treatment in Patient with Skull Trauma

Our Patient Our patient is a 30 year-old male with head trauma, suffering from persistent vertigo and neck pain. Prior attempts to resolve his condition had been unsuccessful, primarily due to misdiagnosis and ineffective treatments. Apparently the musculoskeletal component of vertigo had been overlooked.   Our Diagnosis Immediately recognizing the potential link between the patient’s […]

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October 6, 2023

Case Study: Neck and Shoulder Pain Diagnosis and Treatment with Ultrasound-Guided Dry Needling

Our Patient Our patient was a 46 year-old male complaining of pain in his left shoulder and neck. During the clinical exam, it was revealed that two days prior, he had received an allergy injection in his left arm for asthma. Initial Diagnosis The initial diagnosis identified myofascial trigger points in the left rotator cuff […]

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October 6, 2023

Case Study: Ultrasound-Guided Dry Needling Eliminates Joint Fluid, Corrects Posture and Alleviates Mechanical Overload

Our Patient Our patient was a 40-year-old female with bilateral knee hydrarthrosis (fluid accumulation) and shoulder impingement, who was suspected to have arthritis. Ultrasound imaging revealed no significant structural abnormalities in the knees. However, fluid accumulation was evident, particularly in the left knee. Accumulation of fluid detected in both knees. In addition to excess knee […]

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October 6, 2023

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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