Max H. Epstein, MD
@MaxEpsteinMD
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Spine and Pain Medicine Physician w/ an interest in Orthobiologics and Neuromodulation | Type 1 Diabetic |
Salt Lake City, UT
Joined April 2019
My first Basivertebral Nerve Ablation (Intracept) for vertebrogenic low back pain at Intermountain
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Furnishing a new office work space. What have been the essentials or some fun additions to your work space? . Standing desk is first order of business!. @JayKarriMD @JSinghMD @AbdullahNewaj @Ryan_S_DSouzaMD
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Incoming and graduating Fellows, join me with @IPSISMed tomorrow night, Tuesday 6/11, 8:30p ET. Registration:
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Intraarticular SI Joint injections are the most difficult spine injection. Convince me otherwise!.
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Just registered for @IPSISMed International Pain & Spine Intervention Society 2024 Annual Meeting, September 11-14, 2024 in Boston, MA. Nice little “staycation” ahead….
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@CraigDiTommaso as you have likely read every article in the rehabilitation space over the past 15 years, anything ringing a bell?.
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No matter how hard I look, I can’t seem to find a non-surgical review on treatment for adults with Adolescent Idiopathic Scoliosis (AIS). Do I not know how to properly use MeSH terms, or does this review just not exist?. @AAPMR @NASSspine @JayKarriMD.
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RT @JeffreyPengMD: Everyone thinks their tendons hurt because of inflammation. But they’re all wrong. Here’s the truth. A lot of painful co….
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During fellowship at @UofUtahPain, inspired by the beauty of the mountains, I picked up running as a hobby. This Sunday I will run in the New York City Marathon for St. Jude’s Children’s Hospital!. Follow me on Sunday and consider donating to the wonderful people of @StJude
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Is this plan perfect? No. But, we now have:.1) A diagnosis of pain generators.2) A window of time to progress with PT- likely only about 3wk- but that just may be enough to get her over the hump .3) Availability for future steroid injection if needed without over exposure.
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Step 3: right GT bursa injection with Toradol (ketorolac) and local for diagnostic and temporary therapeutic benefit. - patient with immediate improvement in lateral leg pains post injection .- now able to tolerate PT. 4/n.
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Imaging with L4-L5 listhesis causing severe spinal and foramina stenosis. Step 1: L5-S1 IL ESI. -greatly improved neurogenic clarification, but did not help lateral leg pains. -unable to progress in PT . Step 2: inject GT bursa? Right L5 TFESI? .Expose to steroids again?. 3/n.
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Ex: 86yo F with sx of neurogenic claudication, and right lateral hip pain radiating down to lateral knee with getting out of chair and walking. Physical exam with pain on palpating of GT bursa, pain on resisted hip abduction. 2/n.
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Have been increasing my use of intra-articular and/or bursa Toradol (ketorolac), particularly when diagnosis is not clear or multiple pain generators . 1/n.
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@ZackMcCormickMD If both groups have similar immediate pain relief (32% and 21% respectively) is there any role for LA in a cervical interlaminar epidural steroid injection at all?.
pubmed.ncbi.nlm.nih.gov
ClinicalTrials.gov (NCT03127137); December 26, 2017.
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@ZackMcCormickMD 2mL of 1% lidocaine vs. 2mL of saline as dilutent for a 4mL CILESI injectate results in no sig. difference in pain reduction 20min after injection.
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Diagnostic value was my #1 reason for consider LA in my interlaminar injection, however, @ZackMcCormickMD et al suggest otherwise.
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Why would I want LA in my injection? Some thoughts include:.1) Diagnostic value in the immediate post-procedure period.2) Patient buy in/satisfaction.3) Improved efficacy??.
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