BackTable MSK

“The athlete’s job is to stay consistent with rehab and to be hungry to get back on the field. I think our job as a sports medicine team is to make sure that they’re safe and that they can perform.” In this episode of BackTable MSK, guest host and sports medicine physician Dr. Larry Balle joins physical therapist/athletic trainer Andy Glidewell to discuss how “return to play” is defined and why it is often misunderstood among athletes, coaches, physicians, and rehab teams. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:25 - Return to Play from the Lens of Physical Therapy vs. Sports Medicine12:11 - Evidence-based vs. Anecdotal-based Practice for Return to Play21:18 - Is there an Appropriate Team Approach? 24:25 - Continuing Conservative Management vs. Surgical Intervention34:01 - Notes on a High-Profile Sports Medicine Case40:20 - The Influence of NIL on College Athletics42:51 - Obtaining Objective Metrics for Clearance52:38 - Influence of AI on Return to Play Algorithms 57:11 - Final Takeaways --- More about this episode They emphasize that return to play is a milestone-based rehabilitation phase requiring clear communication, collaboration, and risk management, rather than rigid timelines or just “vibes.” The conversation covers how evidence and objectivity have shaped protocols (notably ACL timelines), the role of prognostic indicators in operative vs. non-operative decisions, and practical use of functional strength and agility reassessment. They also address pressures of working with elite sport and NIL (Name, Image, Likeness) considerations. Furthermore, they expand on how AI may inform, but not replace, the humanistic and team-based components of decision making. --- Resources Dr. Larry Ballehttps://www.linkedin.com/in/larry-balle-ii/ Dr. Andy Glidewellhttps://uamshealth.com/provider/michael-a-glidewell/ The Journal of Orthopedic and Sports Physical Therapyhttps://www.jospt.org/ --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ready to shake up hip pain management? In this episode of BackTable MSK, we unpack how embolization is opening a new frontier for patients caught between conservative care and surgery. Interventional radiologist Dr. Kavi Krishnasamy hosts Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, to discuss hip embolization for Greater Trochanteric Pain Syndrome (GTPS) and early hip Osteoarthritis (OA). The doctors highlight building multidisciplinary referrals, reimbursement, and the availability of embolic agents. They also address pre-procedure workup, including imaging and physical exam findings. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:37 - Guest Background in MSK Embolization 08:14 - Availability of Embolics and Preferences in Brazil 10:31 - Reimbursement and Access Hurdles13:55 - Hip Etiologies Treated by Embolization 16:54 - Imaging Workup and the Role of MRI24:23 - Offering Conservative Treatment Options Prior to Embolization 26:52 - Scoring Systems and Physical Exam34:44 - Procedure Access Strategy39:16 - When to Utilize Temporary vs. Permanent Embolics46:34 - Post-Procedure and Follow-Up Guidelines58:05 - Discussion of Current Evidence --- More about this episode At the time of the procedure, Drs. Correa and Filho explain why they prefer certain vascular access points and specify arterial targets, favoring temporary embolic agents due to potential risk of Avascular Necrosis (AVN) of the femoral head. Furthermore, the doctors detail awake procedures with intraprocedural palpation and blush/pain-based endpoints, post-embolization pain flare management, follow-up schedules, and re-treatment criteria; all with consideration for current published evidence. ---Resources Dr. Mateus Correahttps://www.researchgate.net/profile/Mateus-Correa-4 Dr. Joaquim Filhohttps://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

The embolization playbook is expanding. The question is: are you ready to use it? In this episode of the BackTable MSK Podcast, host Dr. Ally Bahehi joins Dr. Mikin Patel and Dr. Osmad Ahmed from Joint and Vascular Institute in the greater Chicago area to discuss plantar fasciitis embolization; a newer MSK embolization technique, building from concepts and clinical pearls for genicular artery embolization (GAE). --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:18 - Ideal Patient for Plantar Fasciitis Embolization02:14 - Workup, Imaging Needs, and the Reality of Insurance Coverage 03:53 - Benefits And Expectations06:05 - Step By Step Procedure Walkthrough11:29 - Pain Relief and Follow-Up Timeline13:46 - GAE Case Setup14:54 - Debating Access Strategy 15:54 - Crash Course in Genicular Artery Anatomy19:08 - Minimalist GAE Toolkit Set-Up22:32 - Time to Inject! The Wrap Up --- Resources Dr. Mikin Patelhttps://jointvascular.com/team/mikin-v-patel-md-mba/ Dr. Osman Ahmedhttps://jointvascular.com/team/osman-ahmed-m-d-fcirse/

For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization. --- SYNPOSIS The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization. --- TIMESTAMPS 00:00 - Introduction 01:42 - Dr. Yan Epelboym’s Origin Story in MSK03:02 - Building Referral Networks06:50 - Details on Clinic Workflow 10:08 - The Run Down on Shoulder Embolization Treatment Targets22:09 - Current Insights on Shoulder OA Embolization27:56 - Shoulder Embolization Setup and Access Choice34:28 - Shoulder Embolization Strategy and Endpoints36:38 - Post-Procedure Pain Control and Activity Limitations42:26 - Shoulder Surgery Status-Post Embolization44:17 - Discussing Existing Research Data on Shoulder Embolization01:00:32 - Key Shoulder Arterial Anatomy and Variants01:04:27 - Shoulder OA Case Discussion01:09:08 - Final Thoughts --- RESOURCES Dr. Yan Epelboym, MD, MPHhttps://www.linkedin.com/in/yan-epelboym-4a84991b/ Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)https://clinicaltrials.gov/study/NCT06095050

From anesthesia decisions to ablation strategy, what really separates a good outcome from a great one in bone tumor ablation? This BackTable MSK Brief features an enlightening conversation between host Kavi Krishnasamy and bone ablation pioneer Dr. Damian Dupuy. They cover anesthesia choices for different patient scenarios, optimal procedural techniques and agent selection for bone ablations, and the combination of local and systemic therapies for oligometastatic and oligo-progressive diseases. The doctors also tackle myths and realities around thermal and cryoablation, examining both clinical trial data and real-world experiences. Episode Outline 00:00 - Introduction 00:40 - Selecting General Anesthesia vs. MAC 03:30 - Approach to Multiple Bony Lesions in Metastatic Disease 07:27 - Ablation Confirmation and Techniques Utilized in Bone Ablation 09:00 - Research Insights Surrounding RFA in Bone 12:16 - Sclerotic vs. Lytic Lesions: Techniques and Considerations 14:47 - Skin Protection During Superficial Lesion Treatments 16:38 - Analyzing Clinical Trials: Motion and OPuS One 20:51 - Conclusion Resources Dr. Damian E. Dupuy, MD, FACR https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study https://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study https://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/

Can genicular artery embolization (GAE) relieve chronic knee pain after total knee arthroplasty (TKA)? In this episode of BackTable MSK, Argentinian interventional radiologist Dr. Rene Viso joins host Dr. Kavi Krishnasamy to discuss the status of GAE in South America, patient selection criteria, procedural techniques, and the challenges of treating post-TKA patients with GAE. --- SYNPOSIS Dr. Viso also highlights the importance of multidisciplinary collaboration and adjunctive therapies like genicular nerve blocks to improve patient outcomes. The episode concludes with a discussion on Dr. Viso's recent research and case studies, emphasizing the potential and complexities of GAE in managing chronic knee pain. --- TIMESTAMPS 00:00 - Introduction02:02 - GAE in South America03:57 - Patient Selection for GAE13:18 - Procedure Techniques and Device Choices23:54 - Challenges and Tips for TKA Patients Undergoing GAE27:17 - Patient Follow-Up After Intervention29:41 - Handling Treatment Failures32:57 - Adjunctive Therapies for Post-TKA Patients with GAE34:46 - Research Update: Dr. Viso’s Recent Publication on GAE in Post-TKA Patients 39:44 - Case Studies and Discussion50:19 - Future Directions and Final Thoughts --- RESOURCES Dr. Rene Visohttps://www.linkedin.com/in/rene-viso-11a245132/ Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experiencehttps://pubmed.ncbi.nlm.nih.gov/41320119/

Frozen shoulder is characterized by progressive motion loss, distinct disease stages, and new treatment opportunities; raising important questions about timing, patient selection, and new interventional strategies. In this episode of the BackTable MSK Podcast, guest host Osman Ahmed welcomes orthopedic surgeon and upper extremity specialist Dr. Sameer Nagda to discuss the intricacies of adhesive capsulitis of the shoulder (“frozen shoulder”). --- SYNPOSIS Dr. Nagda shares his expertise on diagnosing and treating frozen shoulder, including the evaluation process, treatment options, and the role of early intervention. He emphasizes the importance of recognizing the stages of frozen shoulder and the potential benefits of embolization, particularly in the inflammatory stage. Dr. Nagda also shares his journey into shoulder specialization and his collaborative efforts with IR specialists to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 04:29 - The Run Down: What is Frozen Shoulder?08:37 - Approaching the Diagnosis of Frozen Shoulder13:51 - Treatment Paradigms 22:48 - Comparing Traditional Treatments vs. Embolization26:39 - An Orthopedic Surgeon’s Perspective on Embolization for Frozen Shoulder35:36 - Surgical Options and When to Consider Them 37:55 - Final Thoughts --- RESOURCES Dr. Sameer Nagda, MDhttps://www.sameernagdamd.com/sameer-nagda-md-sports-medicine-specialist-arlington-va.html Adhesive Capsulitis of the Shoulderhttps://journals.lww.com/jaaos/abstract/2011/09000/adhesive_capsulitis_of_the_shoulder.4.aspx Treatment of Adhesive Capsulitis of the Shoulderhttps://journals.lww.com/jaaos/abstract/2019/06150/treatment_of_adhesive_capsulitis_of_the_shoulder.3.aspx

How to stay cool when a thermal ablation case gets complicated? Your toolbox can make all the difference. In this episode of the BackTable MSK Podcast, Dr. Alan Sag returns with host Dr. Jacob Fleming to continue the discussion on thermal protection in musculoskeletal ablation procedures. Part 2 focuses on real-world cases to provide practical insights and illustrate decision-making in complex thermal ablation cases. --- SYNPOSIS Dr. Sag and Dr. Fleming discuss thermoprotection strategies in real-world cases, such as radiofrequency ablation (RFA) of inoperable rectal cancer and sacral metastases near nerve roots. They also discuss the importance of interdisciplinary collaboration, emerging technologies in the field, and the role of intraoperative neuromonitoring. --- TIMESTAMPS 00:00 - Introduction00:55 - Ganglion Impar and Pelvic Pain Strategies09:08 - The Active Thaw Phenomenon18:20 - Nerve Protection During Ablations23:16 - Motor and Sensory Neuromonitoring34:06 - Temperature Management in Ablative Procedures40:28 - Dosing Strategies for Gabapentin and Lyrica in Nerve Injuries42:33 - Future Directions --- RESOURCES Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238 Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/

Ablate before you radiate. Success with bone tumor ablation may have as much to do with your procedure technique as it does with your ability to collaborate. In this episode of BackTable MSK, interventional oncologist Dr. Damian Dupuy shares his approach to bone tumor ablation with host Dr. Kavi Krishnasamy, and offers practical advice on how to partner with your cancer care team to make ablation a viable treatment option. --- This podcast is supported by: Medtronic Osteocool https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html --- SYNPOSIS The doctors review the history of bone ablation techniques, including radiofrequency and cryoablation modalities. They discuss the significance of targeting the bone-tumor interface for pain palliation and highlight several case studies to illustrate various techniques and successful outcomes. The conversation also touches upon the synergistic benefits of combining ablation with radiation therapy and emphasizes the importance of multidisciplinary collaboration in treating cancer patients. --- TIMESTAMPS 00:00 - Introduction02:07 - Dr. Dupuy’s Start in Bone Ablation06:29 - Cryo vs. Microwave Therapies08:25 - Dr. Dupuy’s Clinical Trial and Research Involvement 12:49 - Patient Selection and Treatment Strategies25:54 - Sedation and Anesthesia Practices in Bone Ablation28:46 - Treatment Approach: Oligometastases vs. Progressive Disease36:22 - Microwave Ablation in Bone: Future Prospects37:30 - Techniques for Treating Sclerotic and Lytic Lesions40:01 - Skin Protection Methods in Superficial Lesion Treatments41:49 - Reviewing Recent Clinical Trials: MOTION, OPuS One, and More52:35 - Case Studies: Achieving Effective Ablation Techniques01:08:08 - Final Thoughts and Recommendations --- RESOURCES Dr. Damian E. Dupuy, MD, FACRhttps://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network studyhttps://pubmed.ncbi.nlm.nih.gov/23657892/ Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/ A Multi-Center Observational Trial of Symptomatic, High-Risk Bone Metastases Treated with Percutaneous Ablation and Palliative Radiation Therapy (TRIBUTE)https://clinicaltrials.gov/study/NCT06859801

Living in the best of both worlds: balancing pain management and quality of life. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss multidisciplinary approaches to treating spinal tumors with a particular focus on pain management. They explore the complexities of defining and treating pain related to spinal tumors, differentiating between mechanical instability, tumor burden, and neuropathic pain. The conversation delves into the roles of various treatments including opioids, radiation, nerve blocks, cryoablation, and surgical interventions. They highlight the evolving landscape of spine oncology, emphasizing the need for holistic approaches and the promising future of integrating advanced technologies for better patient outcomes. Episode Outline 00:00 - Introduction 00:53 - Approach to Pain Management in Spine Oncology 02:54 - Multimodal Analgesia 04:25 - What is a Safe Radiation Dose that Spares Spinal Nerves? 07:59 - The Balance Between Quality of Life and Pain Management 09:58 - Final Remarks Resources Dr. Mark Amsbaugh, MD https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ Dr. Ran Lador, MD https://med.uth.edu/ortho/2022/11/02/ran-lador-md/ Dr. Alexa Levey, MD https://medicine.yale.edu/profile/alexa-levey/

“There is always constant review and constant learning”. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss comprehensive treatment strategies for spinal tumors, highlighting the critical interplay between surgical and radiation oncology. The doctors explain the complex planning required based on tumor characteristics, including surgical options like en bloc resection and minimally invasive techniques, as well as the advancements in radiation therapy. The conversation emphasizes the importance of collaboration across disciplines to optimize patient outcomes, improve quality of life, and adapt to new medical advancements. Episode Outline 00:00 - Introduction 00:21 - Collaboration Between Surgeons and Interventionalists 05:42 - Intertwined Approach of Radiation and Surgical Treatment 07:37 - Advancements in Radiation Techniques 14:15 - Advancements in Surgical Approach 16:20 - Final Thoughts Resources Dr. Mark Amsbaugh, MD https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ Dr. Ran Lador, MD https://med.uth.edu/ortho/2022/11/02/ran-lador-md/ Dr. Alexa Levey, MD https://medicine.yale.edu/profile/alexa-levey/

Are you considering expanding your IR practice into pain management services? Get the download from someone who’s done it already. In this episode of BackTable MSK, Dr. Sean Maratto from Philadelphia's Jefferson Health Network is joined by guest Dr. Junjian Huang from Emory University School of Medicine to discuss the intricacies of building a pain management practice within the interventional radiology space. ---This podcast is supported by an educational grant from Medtronic.---SYNPOSISDr. Huang shares his career journey, highlighting his shift towards pain palliation. The conversation covers a range of topics including procedural insights, patient management strategies, navigating institutional politics, and future trends in orthopedic IR. Dr. Huang emphasizes the importance of balancing patient care with building robust referral networks, and shares valuable advice for budding interventional radiologists.---TIMESTAMPS00:00 - Introduction02:20 - What’s Your Why? Why Pain Intervention? 12:52 - Building a Complex Pain Management Practice24:47 - Marketing a Service Line30:57 - Patient Impact from Pain Management Services39:53 - Recommendations and Indications for Cryoneurolysis and BVNA 45:36 - Post-Procedure Follow-up and Psychosomatic Pain Guidance52:35 - Insight to the Future of Interventional Pain and Final Thoughts---RESOURCESDr. Junjian Huang, MDhttps://med.emory.edu/directory/profile/?u=JHUAN22 Dr. Sean Maratto, MDhttps://www.jeffersonhealth.org/find-a-doctor/m/maratto-sean-a

From patient selection to procedure technique–learn the key insights that shape a successful kyphoplasty and spine ablation practice. In this episode of the BackTable MSK Podcast, host Dr. Michael Barraza welcomes back Dr. Asad Baig, an Interventional Radiologist and director of the Interventional Spine Center at Columbia University. They discuss the latest developments at Columbia, focusing on exciting expansions in the interventional radiology and spine realms. The primary focus of their conversation is on advanced techniques in spine ablation and kyphoplasty, and the ideal patient profile for these treatments.---This podcast is supported by:Medtronic OsteoCoolhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html---SYNPOSISDr. Baig begins the episode by explaining the importance of collaborating with radiation oncologists and spine surgeons to optimize patient outcomes and emphasizes considerations, such as bone quality, prior to a spinal ablation. The episode also features Dr. Baig’s approach to treating sclerotic versus lytic lesions with his insights on navigating complex cases involving post-radiation fractures and internal fixation complications. This first episode of a two-part series emphasizes a multi-disciplinary approach and the need for precise imaging and patient communication when treating patients with spinal ablation.---TIMESTAMPS00:00 - Introduction 01:31 - Evaluating Patients Prior to Spine Ablation 09:02 - Who is the Ideal Candidate for Ablation Kyphoplasty?14:24 - Approaching Lesions Within the Vertebral Body21:26 - When is it Appropriate to Use Balloons After an OsteoCool Ablation?27:58 - Approach to Patients with Significant Vertebral Height Loss35:33 - Challenging Cases with Kyphoplasty39:02 - Sclerotic versus Lytic Lesions---RESOURCESDr. Asad Baig, MDhttps://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street OsteoCool RF Ablation System by Medtronic https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html