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Episode 49 Carpal Tunnel Syndrome

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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: The New Awakening by Alex Grohl

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Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Answers for Episode 48 Osteoporosis/RA

Question 1

A 64-year-old postmenopausal woman with rheumatoid arthritis presents after sustaining a vertebral fracture. Which factor most strongly contributes to her increased fracture risk compared to age-matched controls?

B. Chronic systemic inflammation activating osteoclasts

Question 2

According to current recommendations, which patient should undergo bone mineral density (BMD) screening for osteoporosis?

C. A 42-year-old woman with RA taking ≥2.5 mg prednisolone daily for 4 months

Question 3

Which medication is most effective for increasing bone mineral density and reducing vertebral fractures in patients with RA and glucocorticoid-induced osteoporosis?

C. Denosumab

Paper for Next Week:

Michael Kj, Jesper Petersen, Michael Ries Dünweber, Jesper L.vind Andersen, Lars Engebretsen, Stig Peter Magnusso,Dilemma in the Treatment of Sports Injuries in Athletes: Tendon Overuse, Muscle Strain, and Tendon Rupture, Scandinavian Journal of Medicine & Science in Sports, 2025; 35:e70026

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 48 Osteoporosis

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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: A Promise Kept by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Answers for Episode 47 Fibromyalgia

Question 1: Pathophysiology

A 42-year-old woman presents with chronic widespread pain, fatigue, and cognitive difficulties. Functional MRI reveals increased activation in the posterior insula and secondary somatosensory cortex. Which of the following neurotransmitters is most likely elevated in her cerebrospinal fluid and contributes to her pain hypersensitivity?

B. Substance P

Question 2: Diagnosis

According to the 2016 American College of Rheumatology (ACR) criteria, which of the following combinations is sufficient to establish a diagnosis of fibromyalgia?

C. WPI = 5, SSS = 9, symptoms for 3 months

Question 3: Treatment

A 50-year-old female with fibromyalgia is started on pharmacologic therapy. Which of the following medications is FDA-approved for fibromyalgia and has shown efficacy at doses of 300–600 mg/day?

B. Pregabalin

Paper for Next Week:

Mikahla E. Gay, Jose G. Lima, Vanessa Vieites, Starlie C. Belnap, Richard Morgan
Comparison of Diagnostic Modalities for Carpal Tunnel Syndrome: A Systematic Review, Cureus, September 17, 2025

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 47 Fibromyalgia

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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: Beats Through the Ashes by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Answers for Episode 46 Gout

Question 1: Pathophysiology and Molecular Mechanisms

A 58-year-old male presents with recurrent gout flares. Genetic testing reveals a mutation in the NFAT5 gene. Based on recent findings, which of the following best describes the role of NFAT5 in gout pathogenesis?

C. NFAT5 enhances uric acid production through a feedback loop involving aldose reductase

Question 2: Diagnostic Imaging in Gout

According to the 2023 EULAR recommendations, which imaging modality is most effective for both diagnosing gout and monitoring crystal deposition and inflammation?

C. Dual-Energy Computed Tomography (DECT)

Question 3: Therapeutic Innovations

A new oral drug, dapansutrile (OLT1177), is being evaluated in Phase II/III trials for gout. What is its primary mechanism of action?

C. Selective inhibition of the NLRP3 inflammasome

Paper for Next Week:

Fiona Kirkham-Wilson, Elaine Dennison1, Osteoporosis and Rheumatoid Arthritis: A Review of Current Understanding and Practice, British Journal of Hospital Medicine, 2024 Nov 30;85(11):1-11.

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 46 Gout

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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: Fall Dreaming (Chill Ambient) by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Answers for Episode 45 Neck Pain

Question 1

A 35-year-old patient presents with chronic mechanical neck pain lasting 8 months. The physician considers dry needling (DN) as a treatment option. Based on the systematic review and meta-analysis by Aleid et al., which of the following outcomes is MOST likely to show significant improvement after DN compared to control therapy?

B. Pain Pressure Threshold (PPT)

Question 2

In the same meta-analysis, which statement BEST describes the effect of dry needling on cervical range of motion?

B. DN improves flexion and right rotation but not extension or lateral flexions

Question 3

Which of the following is TRUE regarding the overall evidence quality and limitations of the studies included in the meta-analysis?

C. Most studies had high risk of bias and lacked adequate blinding

Paper for Next Week:

Filipovic T, Filipović A, Nikolic D, Gimigliano F. Stevanov J, Hrkovic M, & Bosanac I, Fibromyalgia: Understanding, Diagnosis and Modern Approaches to Treatment. Journal of Clinical Medicine, 2025, 14(3), 955.

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 45 Neck Pain

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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: Through the Ashes by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Answers for Episode 44 Low Back Pain

Question 1

A 45-year-old patient presents with chronic midline low back pain that worsens with sitting and forward flexion. MRI shows Modic type 1 changes at L4-L5. Conservative therapy has failed. Which pharmacologic intervention is supported by some evidence for this patient’s condition?

B. Long-term oral antibiotics (amoxicillin ± clavulanic acid)

Question 2

Which of the following statements about provocative discography is TRUE?

C. It involves injecting contrast into the nucleus pulposus under controlled pressure to reproduce concordant pain.

Question 3

Which minimally invasive intervention has moderate evidence supporting its use for refractory discogenic low back pain?

C. Biacuplasty (cooled radiofrequency)

Paper for Next Week:

L. Punzi, L. Scagnellato, P. Galozzi, C. Baggio, A. Damasco, F. Oliviero, R. Ramonda, Gout: one year in review 2025, Clin Exp Rheumatol 2025; 43: 799-808.

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 44.1 Medical Malpractice with Johnathan Robe esq. Part 2

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Intro/Outro: Night Detective by Amaksi

Courtesy of Pixabay under Creative Commons for non-Commercial Educational use only.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 44 Low Back Pain

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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: Vision of Tomorrow by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Answers for Episode 43 Rheumatoid Arthritis

Question 1: Pathogenesis and Risk Factors

A 45-year-old woman with a family history of rheumatoid arthritis (RA) presents with fatigue and intermittent joint stiffness. Laboratory testing reveals the presence of anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF), but no clinical synovitis is observed. Which of the following best describes the current understanding of the pathogenesis of RA in this patient?

C. Autoantibodies may originate in mucosal tissues and spread systemically

Question 2: Imaging and Early Detection

A 38-year-old man with anti-CCP positivity and musculoskeletal symptoms undergoes ultrasound imaging, which reveals subclinical synovitis. According to recent studies, what is the clinical significance of this finding?

B. Subclinical synovitis is a strong predictor of imminent inflammatory arthritis

Question 3: Pharmacologic Prevention of RA

A clinical trial evaluates the use of abatacept in patients with undifferentiated arthritis and positive anti-CCP antibodies. Participants receive weekly subcutaneous injections of 125 mg abatacept for six months. What was the primary outcome of this intervention according to the ADJUST trial?

B. Abatacept reduced RA development and structural damage

Paper for Next Week:

Abdulsalam M. Aleid, et al. Dry needling for mechanical neck pain: A systematic review and meta-analysis of randomized controlled trials, Surgical Neurology International, 2025, 16 (44)

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 43.1 Johnathan Robe esq. Part 1

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Intro/Outro: Night Detective by Amaksi

Courtesy of Pixabay under Creative Commons for non-Commercial Educational use only.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.