Sam Dyer, PA-C, MHS, is a NCCPA-certified physician assistant with more than 20 years of practice experience in orthopedics. He also holds a Certificate of Added Qualifications in Orthopaedic Surgery from the NCCPA. He practices at Emerge Orthopedics in Chapel Hill, North Carolina, and Durham, North Carolina. He is the current president of the PAOS, and writes an orthopedic blog on the PAOS website titled the OrthoPA-C. He has also authored an onboarding manual for PAs new to orthopedics, which can currently be read by PAOS members on the PAOS website, and plans to publish the work in the future. He has written numerous forum posts for the PAOS website and PAOS newsletter. He enjoys seeing a variety of patients and conditions in his practice. He also has developed a charity advocacy program for the PAOS titled PAOS CARES, where he teaches primary care providers at community health centers and rural health clinics MSK injection techniques.


BLOG: 31-year-old who developed an acute viral infection as a child

by Sam Dyer, PA-C, MHS

This case involves a 31-year-old man who developed an acute viral infection as a child while living in West Africa. He said there was no vaccine available to children in his community and after the attack, he was left with significant knee and leg muscle atrophy. He has developed worsening knee joint pain and difficulty with transfers.

He said that even his “good leg” causes some discomfort. He has pain with walking and at rest and NSAIDs are not helping. On exam, the patient is a well-developed well-nourished pleasant man in no apparent distress. He has an antalgic gait to the left. There is marked atrophy of his quads, hamstring and calf muscles. There is a palpable osteophyte along the medial femoral condyle. His range of motion is slightly decreased and his ligaments are stable. See the images. What is it?

Figure 1.What is it?
Source:Sam Dyer, PA-C, MHS, Emerge Orthopedics

Polio and post-polio syndrome

Polio is an acute inflammatory viral disease affecting multiple organ systems. In the musculoskeletal system, the disease affects motor neurons causing paralysis of muscle tissue. The disease is uncommon these days in the United States since the creation of the polio vaccine, but you will still see the occasional patient with post-polio syndrome, which is characterized by progressive muscle weakness occurring years after an acute poliomyelitis attack. Affected extremities have obvious muscle wasting and atrophy. It is very common that these patients develop degenerative joint disease due to the lack of supporting structures.

The treatment is physical therapy and if degenerative changes present, NSAIDs, intra-articular cortisone injections and possible referral for joint arthroplasty. Joint arthroplasty is controversial however due to the poor outcomes associated with instability from the diffuse muscle atrophy and weakness. Many would recommend arthrodesis as the standard.