Beruflich Dokumente
Kultur Dokumente
S329
injuries (10%), and fractures (3%). The most common etiology of severe
injury (season ending or athlete missed more than 22 days) was nerve
injuries (42%), followed by fracture (22%) and muscular injuries (17%).
Conclusions: High school cervical spine injury rates and severity vary by
sport. Continued surveillance, study and education are warranted to further
understand trends and develop evidence based prevention guidelines.
Level of Evidence: Level III
Poster 197-D
Ultrasound-Guided Lidocaine Injection Directs
Successful Talus Os Trigonum Resection: A
Case Report
Elizabeth A. Barton, MD (University of Missouri-Columbia, Columbia,
MO, United States), Jane Anne Emerson, MD, Mohammad Agha, MD
Disclosures: Elizabeth Barton: I Have No Relevant Financial Relationships To Disclose
Case/Program Description: A 15-year-old overweight female was
referred to PM&R by orthopedics due to unilateral ankle pain and gait
abnormality noted since childhood. Examination demonstrated point
tenderness inferior and posterior to the lateral malleolus and sharp
pain with plantar flexion, dorsiflexion, inversion and weight bearing.
Range of motion, strength and neurological examination were normal.
The affected foot was markedly pronated and everted in weight
bearing and gait was antalgic. MRI revealed os trigonum of the talus
with subcutaneous peroneal tendon edema.
Setting: Physical Medicine & Rehabilitation clinic.
Results: Using a posterolateral, in-plane long axis approach, diagnostic
ultrasound-guided injection of lidocaine was performed directly to the os
trigonum. Patient reported immediate pain relief and gait normalized
briefly. Steroid injection was considered, but surgical excision was elected. Two months following successful surgery, the patient reported pain
relief and demonstrated neutral foot positioning with gait.
Discussion: Typically, os trigonum is an incidental finding with an incidence estimated to be between 3-15%. Extreme plantar flexion can
impinge the posterior talus between the tibia and calcaneus, causing
painful symptoms and is frequently used in the diagnosis of Os Trigonum
Syndrome. In this case, ultrasound-guided injection allowed accurate
diagnosis and foot position was corrected with surgical excision.
Conclusions: The presence of symptomatic os trigonum, though
infrequent, can negatively affect foot positioning, comfort, and gait
mechanics. Ultrasound-guided lidocaine injection can be a useful
diagnostic tool that can direct definitive treatment.
Level of Evidence: Level V
Poster 197-E
Hip Pain Secondary to Intramuscular Lipoma of
Tensor Fascia Lata: A Case Report
Alexander Feng, MD (Temple University Hospital, Philadelphia,
Pennsylvania, United States), Ilya Igolnikov, MD, Cora H. Brown, MD,
Michael M. Weinik, DO
Disclosures: Alexander Feng: I Have No Relevant Financial Relationships To Disclose
Case/Program Description: A 69-year-old man presents for evaluation
of chronic hip pain. He describes the pain as sharp, non-radiating.
Exacerbating factors include long walks and internal rotation. On
manual muscle testing, he had bilateral hip flexion and abduction
weakness but normal hip adduction without notable muscle atrophy or
fasciculation. Functionally, he had a non-antalgic gait, normal limb
advancement, stability, and clearance, but was unable to perform
heel/toe walk. The spinous processes, paraspinal musculature, PSIS,
piriformis and greater trochanteric regions are non-tender. Hip range
of motion is full. Femoral nerve stretch test, Patricks test, Kemps
test were negative. Obers test was positive. There was a palpable left
anterior hip mass.
S330
NEUROLOGICAL REHABILITATION
Poster 373-A
Immunoglobulin Treatment of Miller Fisher Variant of
Acute Demyelinating Inflammatory Polyneuropathy
with Underlying Chronic Inflammatory Demyelinating
Polyneuropathy: A Case Report
John W. Hawkins, DO (William Beaumont Hospital, Royal Oak, MI,
United States)
Disclosures: John Hawkins: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description: A 62-year-old woman with history of a sensory dominant variant of chronic inflammatory demyelinating polyneuropathy (CIDP) presented to the emergency center as a transfer from
an outside hospital with fevers, headache, myalgia, oral paresthesia,
double vision, and generalized weakness. On laboratory testing she was
influenza B positive. Her neurologist was consulted and she was diagnosed
with the Miller Fisher variant of acute inflammatory demyelinating polyneuropathy (AIDP). Intravenous immunoglobulin (IVIG) was prescribed
and she received pretreatment of acetaminophen, methylprednisolone,
and diphenhydramine. Prior to treatment the patient had no sensation in
her bilateral lower extremities below the knee for two years. The day
after her first treatment of IVIG, the patients strength had slightly
improved and she was also having paresthesias bilaterally below the knee.
As she became medically stable, she began to participate in therapy and
was eventually transferred to the inpatient rehabilitation floor (IPR).
Setting: Tertiary Care Center.
Results: Upon initial evaluation by the physical medicine service, the
patient had no anti-gravity movement of the bilateral lower extremities. In the upper extremities she did have anti-gravity strength of the
deltoids and elbow flexion. She was unable to ambulate. After two
treatments with IVIG and one month with IPR she achieved dramatic
improvements. She regained sensation in the lower extremities and
was able to ambulate 170 feet with standby assistance and no assistive
device. The patient was also independent with all activities of daily
living and she was discharged home with her husband.
Discussion: With IVIG and IPR, this patient was able to reach a functional status even better than her baseline.
Conclusions: While recovery of baseline function is almost always a
logical goal, there are instances when a patient could improve even
beyond that baseline. With proper medical and physical treatment
patients can often achieve a quality of life that is better than they
have experienced in several years.
Level of Evidence: Level V
Poster 373-B
Demographic and Clinical Features of Children and
Adolescents with Spinal Cord Injury: A Turkish
Hospital-Based Study
Umut Guzelkucuk, MD (Turkish Armed Forces Rehabilitation Center,
Ankara, Turkey), Yasin Demir, MD, Koray Aydemir, Assistant Professor
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Disclosures: U
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