Consent✅ - this is a beauty 🤓
Elite runner
Crampy, aching lateral knee pain - onset at around 20-30 mins
Seen multiple clinicians - had numerous injections including ITB plus extensive rehabilitation - refractory
Almost 'claudicant' in nature - settles quickly on cessation of exercise - spreads both proximal & distal to lateral joint line
No spinal symptoms & LSp assessment clear
No lateral compartment pathology eg meniscal tear
Had popliteus tendinopathy on US, but minimal response to my initial diagnostic injection
POCUS video -
The inferolateral genicular neurovascular bundle ('pepper pot' structure) is seen compressed under the distal ITB on active knee flexion : terminal extension
Patient localises pain in this area with probe pressure
Injection - hydrodissection (CSI, LA) - fluid seen separating plane just superficial to NV bundle
100% pain relief on extended treadmill test beyond 45 mins 👍
I wonder how many recalcitrant 'ITB' cases are actually neurovascular in aetiology? 🧐
Plan - considering angiography, MR neurography & possible distal ITB release at Gerdy's tubercle if not responsive to injection
Nine months ago I embarked on my very first taught, in person CPD course. Four years in the making. Its been tough but highly enjoyable.
Mastering Lumbar Radiculopathy.
All of my knowledge from the spinal clinic, underpinned by science with a lack of fluff.
I have now delivered five of them. Four in-person courses and a very successful six part, six week online version. I also developed a professional website and managed to complete my ACP Masters.🎓
It is maybe not the most well known CPD course but i think the content speaks for itself and I have now properly finalised all of my artwork for the vascular, hip and myelopathy sections of Day 2 💪
Thank you to those who have supported and collaborated with me in 2025.
I will soon announce a 2026 London Date 🤟
https://t.co/tjPkiWsQ6Q
@PrimaryCareMSK@rob_chiro@martinthomas11@clinicalphysio@ClementsCharl96@physiojack@Martin_Nekkolai@BillingMartin@Irish_Physio
For the people at the back -
1. Distance runner with ramp in load +/- REDS risk factors
2. Positive hop test
3. Positive FADDIR
4. Weak / painful on iliopsoas testing
This is 99.9% likely to be a neck of femur stress injury
IT ISN'T A TIGHT HIP FLEXOR
What is the State of Play for Degenerative Cervical Myelopathy in Australasia? 🇳🇿🇦🇺🌏
🔓Check out our latest paper published in the @GlobalSpineJ
https://t.co/j7Cw7DUmSU
@AOSpine
Looking forward to delivering this session on all things Stenosis & PADs. Thanks as always for the invite @martinthomas11 last few 🎟️
https://t.co/jfqBu9VLO8