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From WikiMSK
WELCOME TO WIKIMSK
The New Zealand Musculoskeletal Medicine Wiki
Nau mai, haere mai! This website is a learning resource that is primarily designed for Musculoskeletal Medicine training in New Zealand. It also aims to be useful for GPs, other doctors, and medical students. It is not written for patients but they are welcome to read the articles. Click on a body region on the skeleton or a portal below to get started.
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Featured Wiki Article for 1 July 2025
Gait
Humans possess two primary gaits: walking and running. This article focuses on the walking gait, a complex, coordinated action requiring the seamless integration of sensory and motor functions throughout the neuromuscular and skeletal systems. A gait disturbance is defined as any deviation from a smooth, symmetrical, and efficient walking pattern. Such disturbances can affect the synchrony, fluency, and symmetry of movement. Identifying a gait disturbance is often a crucial step in diagnosing underlying pathologies, which can occur at any level of the neuraxis (central and peripheral nervous system) or within the musculoskeletal system itself. - Read More
New and Updated Articles
- Tendinopathy
- Thoracic Outlet Syndrome
- Hip Joint Injection
- Lumbar Transforaminal Epidural Steroid Injection
- Myositis
- Classifying Pain
- Central Neuropathic Pain
- Peripheral Neuropathic Pain
- Pain Oriented Sensory Testing
- Patient Reported Outcome Measures
- Placebo
- Myofascial Chains
- Internal Disc Disruption
- Palmitoylethanolamide
- Scapular Winging
- Facioscapulohumeral Dystrophy
- Diabetic Neuropathy
- Atlantoaxial Rotatory Displacement
- Spondylolisthesis
- Basivertebral Nerve Ablation
Featured Open Access Journal Article for 1 July 2025
Managing radicular pain in patients with normal MRIs: Challenges and insights?
David A. Provenzano, Julie Pilitsis, Christine Hunt. Interventional Pain Medicine. June 2025
ABSTRACT - This article discusses the management of lumbar radicular pain in patients with normal or near-normal MRIs. They note that while epidural steroid injections are common for radicular pain with clear MRI abnormalities, their effectiveness is questionable when such findings are absent. The authors highlight a Cohen et al. study, which found that ESIs offered limited benefits for patients with normal imaging, showing that a higher percentage of patients with abnormal imaging experienced positive outcomes at four weeks. The commentary suggests that for patients with radicular pain but normal MRIs, physicians should be discerning, as the likelihood of success with ESIs is low. A thorough clinical evaluation is emphasized to rule out other potential causes of pain, and alternative diagnostic tools like EMG/NCS may be useful. Ultimately, the authors concur with the study's implication that a comprehensive assessment is crucial before considering ESIs in this specific patient population.
EDITOR'S COMMENT - In New Zealand, it's not uncommon for radiology reports to only comment on surgically relevant but not necessarily all clinically relevant abnormalities of the spine. Some radiologists may only note the presence or absence of compression within the central canal and foramina. For diagnosing pain, however, nerve contact without obvious compression is also significant, and we must assess four key sites: the central canal, lateral recess, foramen, and the far lateral zone. It is imperative for clinicians to personally review all MRI scans they order, effectively providing a "double read." This practice becomes especially important in situations of clinical mismatch. It is also important to provide feedback to the radiologists so that they are aware what abnormalities we are interested in.
“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”
— The Hippocratic Oath: Modern Version, Lasagna 1964
