Eugene Y. Roh, MD

All Publications

• Posterior intra-articular hip injections: a pilot study investigating a new approach. Journal of ultrasound Kaufman, M. W., Nguyen, C., Meng, Y., Roh, E. 2024

  Abstract

  The purpose of this study was to investigate a novel posterior intra-articular hip injection approach while discussing the clinical pearls for methodology, accuracy, and associated adverse events. The goal was to investigate if this approach could potentially be used in those where the typical anterior access would be challenging.10 adults (age > 18 years) who were referred to a tertiary outpatient clinic for hip injection due to hip osteoarthritis or femoral acetabular impingement with labral tearing to a single academic sports medicine clinic. Patients were placed in prone position. Posterior structures were identified using a curvilinear transducer. A 22 gauge 3.5-6-inch spinal needle was advanced in-plane to the transducer towards the hip capsule at the head-neck junction of the femur from inferolateral to superomedial. A fluoroscopic arthrogram was obtained to evaluate needle placement accuracy. Location of the needle, direction of contrast flow, the rate of conversion to an anterior portal, and adverse events were analyzed.A fluoroscopic arthrogram was obtained after the first attempt in nine patients (90%). One patient (10%) was converted to the anterior approach due to inability to obtain the expected arthrogram. Two patients (20%) demonstrated mild adverse events.Ultrasound-guided posterior approach hip injection is accurate and without serious adverse events in our study. The posterior approach can be considered as an alternative approach for patients who cannot tolerate or may have technical difficulty with an anterior approach.

  View details for DOI 10.1007/s40477-023-00863-8

  View details for PubMedID 38311662

  View details for PubMedCentralID 3789916

• Neurogenic Thoracic Outlet Syndrome in Division 1 Collegiate Athletes: Presentation, Diagnosis, and Treatment. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Olson, E. M., Dyrek, P., Harris, T., Fereydooni, A., Lee, J. T., Kussman, A., Roh, E. 2023

  Abstract

  Athletes who engage in repetitive upper-extremity exercise are susceptible to neurogenic thoracic outlet syndrome (nTOS). We sought to identify typical presenting symptoms and common findings on diagnostic workup, in addition to evaluating rates of return to play following various treatment interventions.Retrospective chart review.Single institution.Medical records of Division 1 athletes containing the diagnosis of nTOS between the years 2000 and 2020 were identified. Athletes with arterial or venous thoracic outlet syndrome were excluded.Demographics, sport, participation status, clinical presentation, physical examination findings, diagnostic workup, and treatments provided.Rate of return to play (RTP) to collegiate athletics.Twenty-three female and 13 male athletes were diagnosed and treated for nTOS. Digit plethysmography showed diminished or obliterated waveforms with provocative maneuvers in 23 of 25 athletes. Forty-two percent were able to continue competing despite symptoms. Of the athletes who were initially unable to compete, 12% returned to full competition after physical therapy alone, 42% of those remaining were able to RTP after botulinum toxin injection, and an additional 42% of the remaining athletes RTP after thoracic outlet decompression surgery.Many athletes diagnosed with nTOS will be able to continue competing despite symptoms. Digit plethysmography is a sensitive diagnostic tool for nTOS to document anatomical compression at the thoracic inlet. Botulinum toxin injection had a significant positive effect on symptoms and a high rate of RTP (42%), allowing numerous athletes to avoid surgery and its prolonged recovery and associated risks.This study demonstrates that botulinum toxin injection had a high rate of return to full competition in elite athletes without the risks and recovery needed for surgical intervention, suggesting that this may be a good intervention especially among elite athletes who only experience symptoms with sport-related activities.

  View details for DOI 10.1097/JSM.0000000000001162

  View details for PubMedID 37207307

• Team's Average Acute:Chronic Workload Ratio Correlates with Injury Risk in NCAA Men's Soccer Team. PM & R : the journal of injury, function, and rehabilitation Bakal, D. R., Friedrich, T. R., Keane, G., White, B., Roh, E. Y. 2022

  Abstract

  INTRODUCTION: Research in multiple sports has shown that an individual's acute:chronic workload ratio (ACWR) correlates with injury. However, tailoring team trainings to each individual's ACWR is technically challenging, and has not been found to decrease injury risk.OBJECTIVE: We aimed to establish a more feasible method of utilizing the ACWR for injury prevention in soccer. In an NCAA men's soccer team, we assessed whether the team's average ACWR, as opposed to that of each individual, correlated with injuries sustained throughout the season.DESIGN: Injury and workload data were retrospectively evaluated for all players (n=23) of an NCAA men's soccer team during one 18-week season. Workload data for 5 GPS-derived workload variables (total distance, high-speed distance, accelerations, player load, and average velocity) were used to calculate the team's average daily acute and chronic workloads (accumulated load for each variable during the past 3 and 28days, respectively), and uncoupled ACWRs (acute workload divided by chronic workload for each variable). A retrospective cohort design was used to compare the team's workloads and ACWRs on days where ≥1 injury occurred versus days where 0 injuries occurred using binary logistic regression models.RESULTS: Trainings/games with injuries had higher acute workloads, lower chronic workloads, and higher ACWRs for all 5 workload variables. In multivariable analysis, risk factors for injury included a low chronic workload for total distance (OR 7.23, p=0.024) and an ACWR >1.4 for accelerations (OR 4.34, p=0.029).CONCLUSIONS: The team's injury risk was greater with low distance accumulation during the chronic period, and with an elevated ACWR for accelerations. Future intervention-based studies aimed at using ACWR load-management principles as a method of decreasing injury risk in soccer can consider tracking the team's average values with the goal of maintaining a consistent chronic workload for total distance and avoiding elevations in the ACWR for accelerations. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/pmrj.12923

  View details for PubMedID 36411734

• Impact of Scalene Muscle Botulinum Toxin Injection With and Without Surgery in Neurogenic Thoracic Outlet Syndrome. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Fereydooni, A., Ho, V. T., Olson, E. M., Dyrek, P., Harris, T., Kussman, A., Roh, E., Lee, J. T. 2022

  Abstract

  Scalene blocks are part of both the diagnostic and treatment algorithm for patients presenting with symptoms of neurogenic thoracic outlet syndrome (nTOS). However, there is a paucity of data on the utility of scalene botulinum toxin injection (BTI) before surgical decompression. We sought to determine the impact of BTI with and without surgery at a multidisciplinary referral center.Retrospective cohort study.Single institution tertiary academic center, 2011 to 2020.Seventy-seven consecutive patients.Scalene muscle BTI for nTOS with or without surgical decompression.Pain relief and Quick Disability of the Arm, Shoulder and Hand (QDASH) score.Seventy-seven patients, with a mean age of 31.4 years, had BTI for symptoms of nTOS. All patients underwent pretreatment physical therapy through the Edgelow protocol for a mean duration of 3.4 months. However, 72.7% had dynamic vascular compression on duplex ultrasound with provocative maneuvers and 85.7% had a positive physical examination finding. After BTI, 77.9% reported subjective relief, confirmed by an improved QDASH disability score. Thirty-one patients (40.3%) then went on to have further persistent symptoms and proceeded with first rib resection. After BTI + Surgery, 96.8% reported symptomatic relief and had a median QDASH score improvement of 21 (range: 10-40), with all reaching minimal clinically important differences in the QDASH score after combination therapy.In this reported series of chemodenervation in patients with nTOS, BTI is helpful in alleviating symptoms before definitive surgical decompression. BTI followed by first rib resection provides additional symptom improvement over BTI alone.

  View details for DOI 10.1097/JSM.0000000000001094

  View details for PubMedID 36367782

• Orthobiologic Injectables in the Ankle Joint: a Narrative Review MLTJ-MUSCLES LIGAMENTS AND TENDONS JOURNAL Roh, E. Y., Rana, M. S., McInnis, K. C., Bakal, D. R., Borgstrom, H., Borg-Stein, J. 2022; 12 (4): 453-477

  View details for DOI 10.32098/mltj.04.2022.01

  View details for Web of Science ID 000916206400001

• Impact of Scalene Muscle Botulinum Toxin Injection with and without Surgery in Neurogenic Thoracic Outlet Syndrome Fereydooni, A., Ho, V. T., Olson, E., Dyrek, P., Harris, T., Kussman, A., Roh, E. Y., Lee, J. T. MOSBY-ELSEVIER. 2021: E410

  View details for Web of Science ID 000707158200201

• Ultrasound of Thumb Muscles and Grasp Strength in Early Thumb Carpometacarpal Osteoarthritis. The Journal of hand surgery Lai, C., Kenney, D., Kerkhof, F., Finlay, A., Ladd, A., Roh, E. 2021

  Abstract

  PURPOSE: The pathophysiology of thumb carpometacarpal (CMC) osteoarthritis (OA) involves complex interactions between the ligaments and muscles supporting the joint. Factors such as muscle volume and strength may be more relevant in early disease. We used ultrasound as a noninvasive method to explore differences in the intrinsic hand muscles of patients with early CMC OA, as determined using physical exam and radiographs, and healthy controls. We also assessed differences in grip strength.METHODS: A convenience sample of postmenopausal women with early CMC OA diagnosed using a physical examination or radiographs was recruited from an orthopedic clinic specializing in hand surgery. Healthy controls who were matched for age and hand dominance were recruited from the same clinic. We used ultrasound to determine the length of the first metacarpal and the muscle thickness of the abductor pollicis brevis, opponens pollicis (OPP), and first dorsal interosseous. Grip strength measurements were taken using a standard Jamar dynamometer and 2 custom-designed tools for cylindrical grasp and pinch strength.RESULTS: Twenty-three subjects were enrolled, with a total of 32 thumbs measured: 15 thumbs with arthritis and 17 healthy thumbs. Multivariable logistic regression models indicated that thumbs with thicker OPP had 0.85 lower odds (95% CI= 0.71-0.97) of early OA, adjusting for hand dominance and the first metacarpal length. Linear regression models indicated no association between early OA and grip strength.CONCLUSIONS: The size of OPP may have a weak association with the diagnosis of early OA.CLINICAL RELEVANCE: This study supports further exploration of the role of OPP in stabilizing the CMC joint, particularly with regard to minimizing joint subluxation. This may be clinically relevant to providers who treat patients with CMC OA early in the course of the disease, when nonsurgical treatment is the most relevant.

  View details for DOI 10.1016/j.jhsa.2021.07.021

  View details for PubMedID 34509311

• Predictors Of Relief Following Botulinum Injection For Thoracic Outlet Syndrome Olson, E., Dyrek, P., Fereydooni, A., Harris, T., Lee, J. T., Kussman, A., Roh, E. Y. LIPPINCOTT WILLIAMS & WILKINS. 2021: 377

  View details for Web of Science ID 000693955700413

• Predicting Return To Play In NCAA Division 1 Athletes With Neurogenic Thoracic Outlet Syndrome Dyrek, P., Olson, E., Fereydooni, A., Harris, T., Kussman, A., Roh, E., Lee, J. T., Segovia, N. LIPPINCOTT WILLIAMS & WILKINS. 2021: 390

  View details for Web of Science ID 000693955700448

• Finger Pain In A Professional Dog Groomer Mullins, K., Roh, E. LIPPINCOTT WILLIAMS & WILKINS. 2020: 538–39

  View details for Web of Science ID 000590026302116

• Effectiveness of Ultrasound-Guided Pulsed Radiofrequency Treatment in Patients with Refractory Chronic Cervical Radicular Pain. Pain physician Lee, S. H., Choi, H. H., Roh, E. Y., Chang, M. C. 2020; 23 (3): E265–E272

  Abstract

  BACKGROUND: The effect of pulsed radiofrequency (PRF) stimulation for alleviating cervical radicular pain has been demonstrated in several previous studies.OBJECTIVES: We aimed to evaluate the effectiveness of PRF with ultrasound (US) guidance in patients with chronic cervical radicular pain that was refractory to repeated transforaminal epidural steroid injections (TFESIs).STUDY DESIGN: A prospective outcome study.SETTING: The outpatient clinic of a single academic medical center.METHODS: This study included 49 patients with chronic cervical radicular pain, unresponsive to repeated TFESIs, and who underwent PRF stimulation under US guidance. Using US, a cannula was inserted toward the cervical spinal nerve. The pain intensity was evaluated using the Numeric Rating Scale (NRS-11) for cervical radicular pain at pretreatment and 1, 3, and 6 months posttreatment; and the Neck Disability Index (NDI) was used for evaluating functional disability before treatment and 6 months posttreatment. Successful pain relief was defined as >= 50% reduction in the NRS-11 score as compared with the score before treatment.RESULTS: Cervical radicular pain was significantly reduced at 1, 3, and 6 months post-PRF (P < 0.001). At 6 months post-PRF, functional disability (NDI score) had significantly reduced, and 63.3% of the patients achieved successful pain relief.LIMITATIONS: The small number of included patients and no long-term follow-up.CONCLUSIONS: PRF stimulation under the guidance of US is a potentially effective treatment method for managing refractory chronic cervical radicular pain.KEY WORDS: Ultrasound, pulsed radiofrequency, cervical radicular pain, chronic pain.

  View details for PubMedID 32517402

• Sigma-1 receptor PET/MRI for identifying nociceptive sources of radiating low back pain Yoon, D., Cipriano, P., Carroll, I., Curtin, C., Roh, E., Wilson, T., Biswal, S. SOC NUCLEAR MEDICINE INC. 2020

  View details for Web of Science ID 000568290500159

• Effectiveness of Ultrasound-Guided Pulsed Radiofrequency Treatment in Patients with Refractory Chronic Cervical Radicular Pain PAIN PHYSICIAN Lee, S., Choi, H., Roh, E., Chang, M. 2020; 23 (3): E265–E271

  View details for Web of Science ID 000552905000003

• Orthobiologics for the Hip Region: A Narrative Review. PM & R : the journal of injury, function, and rehabilitation McInnis, K. C., Chen, E. T., Finnoff, J. T., Roh, E. Y., Borg Stein, J. 2020

  Abstract

  Management of hip region disorders is challenging. Orthobiologic treatments including platelet rich plasma (PRP), mesenchymal stem cell, and amniotic injectables have gained popularity as promising treatments despite a lack of robust evidence for their effectiveness. We review rationale and current evidence for orthobiologics for three common hip region conditions: hip osteoarthritis, gluteal tendinopathy, and proximal hamstring tendinopathy. Overall, the current state of evidence is extremely limited for orthobiologic treatments. and predominantly relevant to PRP injections. There is currently a lack of data to support the use of mesenchymal stem cells or amniotic injectables in these conditions of the hip. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/pmrj.12327

  View details for PubMedID 31953917

• Ultrasonographic measurement of the cross-sectional area of the axillary nerve MUSCLE & NERVE Yoon, J., Park, J., Levin, J., Roh, E. Y., Park, H., Won, S. 2019; 60 (1): 95–98

  View details for DOI 10.1002/mus.26480

  View details for Web of Science ID 000471831900023

• ULTRASONOGRAPHIC MEASUREMENT OF THE CROSS-SECTIONAL AREA OF THE AXILLARY NERVE. Muscle & nerve Yoon, J. S., Park, J. H., Levin, J., Roh, E. Y., Park, H. J., Won, S. J. 2019

  Abstract

  INTRODUCTION: The objectives of this study were to determine normal reference values for ultrasonographic measurement of the cross-sectional area (CSA) of the axillary nerve and to standardize the measurement methods.METHODS: Sixty healthy volunteers were evaluated. Ultrasonography was performed with the shoulder positioned in 100°-120° abduction and 90° external rotation. The CSA of the axillary nerve was measured bilaterally.RESULTS: The normal CSA of the right axillary nerve was 2.9 ± 1.1 mm2 . The side-to-side discrepancy was 22.8% ± 17.8%.DISCUSSION: These reference values may be helpful for investigating pathologies involving the axillary nerve.

  View details for PubMedID 30927449

• Golf Swing Rotational Velocity: The Essential Follow-Through ANNALS OF REHABILITATION MEDICINE-ARM Steele, K. M., Roh, E. Y., Mahtani, G., Meister, D. W., Ladd, A. L., Rose, J. 2018; 42 (5): 713–21

  View details for DOI 10.5535/arm.2018.42.5.713

  View details for Web of Science ID 000449459700008

• Golf Swing Rotational Velocity: The Essential Follow-Through. Annals of rehabilitation medicine Steele, K. M., Roh, E. Y., Mahtani, G., Meister, D. W., Ladd, A. L., Rose, J. 2018; 42 (5): 713–21

  Abstract

  OBJECTIVE: To evaluate if shoulder and pelvic angular velocities differ at impact or peak magnitude between professional and amateur golfers. Golf swing rotational biomechanics are a key determinant of power generation, driving distance, and injury prevention. We hypothesize that shoulder and pelvic angular velocities would be highly consistent in professionals.METHODS: Rotational velocities of the upper-torso and pelvis throughout the golf swing and in relation to phases of the golf swing were examined in 11 professionals and compared to 5 amateurs using three-dimensional motion analysis.RESULTS: Peak rotational velocities of professionals were highly consistent, demonstrating low variability (coefficient of variation [COV]), particularly upper-torso rotational velocity (COV=0.086) and pelvic rotational velocity (COV=0.079) during down swing. Peak upper-torso rotational velocity and peak X-prime, the relative rotational velocity of uppertorso versus pelvis, occurred after impact in follow-through, were reduced in amateurs compared to professionals (p=0.005 and p=0.005, respectively) and differentiated professionals from most (4/5) amateurs. In contrast, peak pelvic rotational velocity occurred in down swing. Pelvic velocity at impact was reduced in amateurs compared to professionals (p=0.019) and differentiated professionals from most (4/5) amateurs.CONCLUSION: Golf swing rotational velocity of professionals was consistent in pattern and magnitude, offering benchmarks for amateurs. Understanding golf swing rotational biomechanics can guide swing modifications to help optimize performance and prevent injury.

  View details for PubMedID 30404420

• Use of F-18-sodium fluoride bone PET for disability evaluation in ankle trauma: a pilot study BMC MEDICAL IMAGING Jeon, T., Kim, S., Park, J., Park, J., Roh, E. Y. 2018; 18: 34

  Abstract

  There are no objective and accurate rating tools for permanent impairment of traumatized ankles. The purpose of this study is to assess the role of 18F-Sodium fluoride (18F-NaF) positron emission tomography-computed tomography (PET/CT) bone scans in evaluating patients with limited ankle range of motion (ROM) after trauma.18F-NaF PET/CT was performed in 121 patients (75 men, 46 women; mean age: 45.8) who had ROM < 70% of normal after trauma affecting ankles. Metabolic target volume (MTV), the sum of voxels with standardized uptake value (SUV) > 2.5 was automatically obtained from the 3D volume that included the ankle joint. The maximum & mean SUV (SUVmax & SUVmean), and the total lesion activity (TLA) were measured.The median period from injury to performing 18F-NaF PET/CT was 290 days. The causes of injury were as follows: fracture (N = 95), Achilles tendon rupture (N = 12), and ligament injury (N = 12). Hot uptake in the ankle was seen in 113 of 121 patients. The fracture group had higher SUVmax, SUVmean, and TLA values than the non-fracture group. More limited ROM correlated with higher hot-uptake parameters (SUVmax, SUVmean, TLA). In subgroup analysis, the same correlations were present in the fracture, but not in the non-fracture group.18F-NaF PET/CT can provide considerable information in impairment evaluations of limited ankle ROM, particularly in fracture around the ankle. Thus, 18F-NaF bone PET/CT may provide an additional option as an objective imaging tool in disability assessment after ankle injury.

  View details for PubMedID 30236078

• Poster 156 Synovial Osteochondromatosis as a Rare Cause of Hip Pain: A Case Report. PM & R : the journal of injury, function, and rehabilitation Pun, M., Roh, E. Y. 2016; 8 (9S): S213-?

  View details for DOI 10.1016/j.pmrj.2016.07.197

  View details for PubMedID 27672924

• Comparison of Muscle Onset Activation Sequences between a Golf or Tennis Swing and Common Training Exercises Using Surface Electromyography: A Pilot Study. Journal of sports medicine (Hindawi Publishing Corporation) Vasudevan, J. M., Logan, A., Shultz, R., Koval, J. J., Roh, E. Y., Fredericson, M. 2016; 2016: 3987486-?

  Abstract

  Aim. The purpose of this pilot study is to use surface electromyography to determine an individual athlete's typical muscle onset activation sequence when performing a golf or tennis forward swing and to use the method to assess to what degree the sequence is reproduced with common conditioning exercises and a machine designed for this purpose. Methods. Data for 18 healthy male subjects were collected for 15 muscles of the trunk and lower extremities. Data were filtered and processed to determine the average onset of muscle activation for each motion. A Spearman correlation estimated congruence of activation order between the swing and each exercise. Correlations of each group were pooled with 95% confidence intervals using a random effects meta-analytic strategy. Results. The averaged sequences differed among each athlete tested, but pooled correlations demonstrated a positive association between each exercise and the participants' natural muscle onset activation sequence. Conclusion. The selected training exercises and Turning Point™ device all partially reproduced our athletes' averaged muscle onset activation sequences for both sports. The results support consideration of a larger, adequately powered study using this method to quantify to what degree each of the selected exercises is appropriate for use in both golf and tennis.

  View details for DOI 10.1155/2016/3987486

  View details for PubMedID 27403454

• Atlas of Ultrasound-Guided Musculoskeletal Injections Malanga, G., Mautner, K., Roh, E. Y., et al McGraw Hill Education. 2013
• The Relationship between Golf Swing Trunk Rotation Biomechanics and Low Back Pain in Golfers Spineline Said, M., Johnson, E., Roh, E. 2013; Sep Oct: 21-26
• Preseason Training for Golfers with Low Back Pain Spineline Roh Eugene Y, Geraci M, Smuck M 2012; Jan Feb: 17-21
• Basic Appearance of Ultrasound Structures and Pitfalls PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA McDonald, S., Fredericson, M., Roh, E. Y., Smuck, M. 2010; 21 (3): 461-?

  Abstract

  The role of ultrasound in musculoskeletal imaging is expanding as technology advances and clinicians become better educated about its clinical applications. The main use of musculoskeletal ultrasound to physiatrists is to examine the soft tissues of the body and to diagnose pathologic changes. Ultrasound can be used to assist clinicians in performing interventional procedures. However, to successfully integrate this technology into their clinical practices, physicians must be familiar with the normal and abnormal appearance of tissues. They also must recognize the clinically relevant limitations and pitfalls associated with the use of ultrasound.

  View details for DOI 10.1016/j.pmr.2010.04.002

  View details for PubMedID 20797545