Best Clinical Practices in Chronic Shoulder Pain – Evidence of Newer Non-surgical Treatments

Nimish Mittal, Assistant Professor, Department of Medicine - Division of Physical Medicine and Rehabilitation, University of Toronto

Chronic shoulder pain is a common complaint, and the most common causes include rotator cuff injuries, frozen shoulder and shoulder arthritis. There is a lack of clear guidelines for best clinical practices in the treatment of chronic shoulder pain. This session will provide an update on the evidence for newer interventional procedures in rotator cuff injuries, frozen shoulder and shoulder arthritis. The audience will be updated on the practical use of ultrasound-guided shoulder pain interventions in the clinical setting, including information on patient selection and procedural techniques. The session will be of value to physiatrists, sports physicians, rheumatologists, orthopaedic surgeons, family physicians, medical students, and residents.

At the end of the session, participants will be able to:

  • Recognize sonographic anatomy of shoulder relevant to shoulder injections
  • Identify the current evidence for office based ultrasound guided procedures in treatment of chronic shoulder pain
  • Describe the techniques of radiofrequency neurotomy for shoulder pain in glenohumeral arthritis

Managing Post-Stroke Spasticity

Chris Boulias, Assistant Professor, Consultant Physiatrist, West Park Healthcare Centre

Spasticity is a functionally limiting disorder that may occur after stroke or brain injury. Post-stroke spasticity (PSS) in combination with other clinical signs and symptoms of the upper motor neuron syndrome such as weakness and lack of coordination, if left untreated, may result in costly complications. PSS management should be guided by improvement in function, decrease in burden of care and prevention of complications rather than a decrease in hypertonicity and improvement in the range of motion of a particular joint. In tandem with neurorehabilitation, chemodenervation with botulinum toxins is the first line treatment for focal spasticity, which is commonly observed post stroke. In this presentation I will touch on the assessment of PSS and I will discuss the pharmacological and non-pharmacological treatment options that are currently available. I will also cover the challenges in the treatment of PSS in patients receiving anticoagulants. The session will be of value to physiatrists, resident and medical students.

At the end of the session, participants will be able to:

  • Recognize the importance of goal setting in the assessment of post-stroke spasticity
  • Summarize the pharmacological and non-pharmacological treatments of post stroke spasticity
  • Discuss the challenges in the treatment of the anticoagulated patient with spasticity

Neuromodulation - current applications and a glimpse into the future

Suneil K Kalia MD PhD FRCSC

Current neuromodulation approaches which include deep brain stimulation (DBS) and spinal cord stimulation (SCS) are proven therapies with a substantial positive impact for well selected patients. This presentation will highlight current applications of DBS and SCS as well as provide a glimpse into the near future of this rapidly expanding field

The session will be of value to: Physiatrists, Medical Students, Residents

At the end of the session, participants will be able to:

  • List current modalities and options for neuromodulation
  • Summarize current clinical indications for neuromodulation
  • Discuss future applications of neuromodulation

Optimizing the Management of Spasticity in Spinal Cord Disorders

Anthony S. Burns, Associate Professor, Division of Physical Medicine & Rehabilitation, Dept. of Medicine, University of Toronto

The management of spasticity in spinal cord disorders will be reviewed. Specific topics will include (1) the definitions of spasticity and disabling spasticity; (2) the nature of spasticity in spinal cord disorders, as well as its impact on affected individuals; (3) outcome measures for assessing spasticity; and (4) the comparative advantages and disadvantages of treatment strategies (physical modalities, oral medications, injections for focal spasticity, intrathecal drug delivery for generalized spasticity). At the conclusion, participants will be able to select and optimize treatment strategies for individuals impacted by spasticity in spinal cord disorders.

At the end of the session, participants will be able to:

  • Define spasticity & disabling spasticity
  • List outcome measures for assessing spasticity
  • Compare the advantages & disadvantages of treatment options
  • Optimize treatment strategies following clinical assessment

Post Traumatic Headaches

Marek Jan Gawel, Associate Professor Medicine (Neurology), University of Toronto

Head trauma not uncommonly leads to the development of a variety of headache syndromes. These usually conform to recognizable headache phenotypes. Each of these requires a specific treatment strategy. The pathophysiology and treatment of the headaches will be discussed.

At the end of the session, participants will be able to:

  • Distinguish between different phenotypes of headache following head trauma
  • Treat post traumatic headaches disorders symptomatically and prophylactically
  • Contribute to multidiciplinary management of post traumatic headache

Treating Complex Regional Pain Syndrome

Paul S. Tumber, Assistant Professor of Anesthesiology, Toronto Western Hospital

This lecture will review the common treatments available for Complex Regional Pain Syndrome. The different types of treatment can be categorized into pharmacologic, psychologic, physical therapy modalities and procedural (interventional) medicine. The session will be of value to Physiatrists and Residents, physicians that treat patients with Complex Regional Pain Syndrome.

At the end of the session, participants will be able to:

  • Discuss various options for treatment of CRPS
  • List the pharmacologic agents used to treat CRPS
  • Explain the role of interventional pain medicine for CRPS

Treating the Patient with Persistent Neck Pain

Michael Gofeld, Medical Director, Unika Medical Centre

At the end of the session, participants will be able to:

  • List common etiologies of chronic neck pain
  • Differentiate between traumatic and degenerative patterns
  • Describe approaches in managing chronic neck pain

Updates in Stroke Rehabilitation

Simran Singh Basi, Assistant Clinical Professor and Associate Program Director, McMaster University

This presentation will review the latest evidence-based treatments of post-stroke motor recovery, depression and aphasia. The session will be of value to Physiatrists, residents, medical students, occupational therapists, physiotherapists, speech language pathologists and pharmacists.

At the end of the session, participants will be able to:

  • Describe post-stroke motor recovery treatment options.
  • Review post-stroke depression management.
  • Discuss post-stroke aphasia treatment options.

Vertebroplasty: Evolving Role in the Management of Spinal Fractures

Elizabeth David, Interventional Radiologist, Sunnybrook Health Sciences Center

Vertebral augmentation has been a slowly evolving treatment that has undergone various stages from initial skepticism to eventual acceptance in well defined indications. This presentation is designed to explain the unique role this intervention has in managing spinal fractures in suitable patients. I hope to go through the evaluation process, inclusion and exclusion criteria in determining if this procedure is suitable for a patient suffering from a spinal fracture and ongoing mechanical pain. I hope to explain how we decide whether a percutaneous or surgical approach is required and what follow up is required. I also hope to go over potential complications and management options of such complications. The session would be valuable to trainees and Physiatrists.

At the end of the session, participants will be able to:

  • Explain the evolving rold of vertebroplasty in the management of spinal fractures
  • Explain techniques that differentiate vertebroplasty from kyphoplasty
  • Discuss recent trial results
  • Discuss role of vertebroplasty in trauma and in the treatment of pathological fractures