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Poster 224 Hip Range of Motion for Specific Hip Disorders: An Important Parameter to Assess in Patients With Low Back Pain
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a positive Beevor sign, which occurs when the superior portion of an abdominal muscle such as the rectus abdominis is intact but the inferior portion is weak. Based on the these findings, a thoracic magnetic resonance imaging was ordered to evaluate for other Tarlov cysts, which were found eroding the left foramen and encroaching on the T10 nerve root. The diagnosis was confirmed after an abdominal EMG. Setting: Outpatient pain management and electrodiagnostic clinic. Results: The cause of the patient’s symptoms was found to be a radiculopathy caused by Tarlov cysts and not an abdominal-wall entrapment neuropathy. Discussion: Tarlov cysts are cerebrospinal fluid-filled sacs with spinal nerve root fibers within the cyst wall, most often seen in the sacral region, however, they may be present anywhere in the spine. Most of these cysts are asymptomatic and found in 5%-9% of the general population, whereas symptomatic Tarlov cysts are much rarer, especially in the thoracic area. When Tarlov cysts are found in the sacral area, there may be other areas of the spine that have these cysts, thus prompting further magnetic resonance imaging evaluation of other symptomatic areas. Conclusions: Case reported is a rare case of thoracic Tarlov cyst–induced radiculopathy that mimics an abdominal entrapment neuropathy with left abdominal wall paresis in a patient with a history of multiple abdominal surgeries.
Poster 223 Why Do I Recommend Therapeutic Medial Branch Blocks After Cervical Spine Operations? A Descriptive Study With 3 Case Scenarios. Foad Elahi, MD (University of Iowa, Chicago, IL, United States). Disclosures: F. Elahi, none. Objective: Numerous factors can contribute to inadequate pain management immediately after surgery, including a lack of sufficient surgeon training, fear of the surgical field being violated by an intervention, indeed, potential adverse effects associated with injections as well as a lack of appropriate patient follow-up are among those. Currently, no interventional pain-procedure recommendation exists for the patients. Design: We reviewed 100 charts of the cervical spine surgeries. Patients with persistent postsurgical pain were not routinely treated with therapeutic medial branch blocks. A positive treatment response with patients sufficiently satisfied with the relief were identified. Participants: Of the 100 operations performed, 30 were microscopic one level discectomy, 11 were artificial disk operations, 46 were C5-C6 one level cage, and 13 were fusions with cage and plate. Three patients had undergone diagnostic and/or therapeutic medial branch block on unilateral cervical C3- C7, on postoperative day 12 after all other modalities of pain management had failed. All 3 cases at 3-month, 6-month, and 12-month follow-up were still complaining of cervical pain and discomfort. All other cases recovered from surgery, with no obvious chronic pain issue. Discussion: In this study, we describe in detail the pain generators after common surgical interventions, present in detail those 3 cases presentation, and review the literature about the importance of proper pain management after cervical spine surgeries. We describe
PRESENTATIONS
the rationale behind early intervention, along with proper medical management.
Poster 224 Hip Range of Motion for Specific Hip Disorders: An Important Parameter to Assess in Patients With Low Back Pain. Heidi Prather, DO (Washington University School of Medicine, St Louis, MO, United States); John Clohisy, MD, Marcie Harris Hayes, PT, DPT, MSCI, OCS, Devyani M. Hunt, MD, Alexander Sheng, MD, Linda VanDillen, PhD, PT. Disclosures: H. Prather, NIH grant, research grants; NASS secretary, board of directors, other nonfinancial relationship; PM&R senior editor, other; Spineline editor, other. Objective: The objective was to document hip range of motion (ROM) patterns for specific hip disorders and to further elucidate their relationship with low back pain. Design: Prospective descriptive study. Setting: Tertiary university. Participants: Adult patients and asymptomatic volunteers. Interventions: Not applicable. Methods: Adult patients from an orthopedic surgeon’s practice and asymptomatic adult volunteers were recruited and examined by a physiatrist who completed goniometric hip ROM measurements. All the patients were assessed before surgery for the following hip disorders: osteoarthritis (OA), femoroacetabular impingement, or developmental hip dysplasia. Measurements in supine included hip flexion (HF), abduction (ABD), adduction, internal rotation (HFIR), and external rotation (HFER) with the hip flexed to 90°. Measurements in prone included hip internal rotation and external rotation with the knee flexed to 90°, and hip extension (EXT). The mean value of 3 measurements was used for analysis. Comparisons were made between (1) asymptomatic volunteers and patients with hip disorders and (2) patients with these specific hip disorders. Main Outcome Measures: Hip ROM. Results: Ten patients per type of hip disorder (17 women, 13 men) with a mean age of 35 years (21-55 years) and 50 asymptomatic volunteers (25 women, 25 men) with a mean age of 32 years (18-51 years) were examined. Patients with OA were compared with asymptomatics had significantly less (P⬍.0001) ROM for all measures except ABD, prone included hip internal rotation, and EXT. Patients with femoroacetabular impingement compared with asymptomatic volunteers had significantly less HF, HFIR, HFER, and ABD (P⫽.05 to P⬍.0001). Patients with developmental hip dysplasia compared with asymptomatic volunteers had significantly more ABD (P⬍.0001). Conclusions: Patients with OA, femoroacetabular impingement, and developmental hip dysplasia hip disorders have unique hip ROM patterns. Hip ROM has been linked to movement patterns of the lumbar region and to low back pain. Documenting the hip ROM patterns is the first step to understanding the relationship between specific hip and low back pain disorders.
a positive Beevor sign, which occurs when the superior portion of an abdominal muscle such as the rectus abdominis is intact but the inferior portion is weak. Based on the these findings, a thoracic magnetic resonance imaging was ordered to evaluate for other Tarlov cysts, which were found eroding the left foramen and encroaching on the T10 nerve root. The diagnosis was confirmed after an abdominal EMG. Setting: Outpatient pain management and electrodiagnostic clinic. Results: The cause of the patient’s symptoms was found to be a radiculopathy caused by Tarlov cysts and not an abdominal-wall entrapment neuropathy. Discussion: Tarlov cysts are cerebrospinal fluid-filled sacs with spinal nerve root fibers within the cyst wall, most often seen in the sacral region, however, they may be present anywhere in the spine. Most of these cysts are asymptomatic and found in 5%-9% of the general population, whereas symptomatic Tarlov cysts are much rarer, especially in the thoracic area. When Tarlov cysts are found in the sacral area, there may be other areas of the spine that have these cysts, thus prompting further magnetic resonance imaging evaluation of other symptomatic areas. Conclusions: Case reported is a rare case of thoracic Tarlov cyst–induced radiculopathy that mimics an abdominal entrapment neuropathy with left abdominal wall paresis in a patient with a history of multiple abdominal surgeries.
Poster 223 Why Do I Recommend Therapeutic Medial Branch Blocks After Cervical Spine Operations? A Descriptive Study With 3 Case Scenarios. Foad Elahi, MD (University of Iowa, Chicago, IL, United States). Disclosures: F. Elahi, none. Objective: Numerous factors can contribute to inadequate pain management immediately after surgery, including a lack of sufficient surgeon training, fear of the surgical field being violated by an intervention, indeed, potential adverse effects associated with injections as well as a lack of appropriate patient follow-up are among those. Currently, no interventional pain-procedure recommendation exists for the patients. Design: We reviewed 100 charts of the cervical spine surgeries. Patients with persistent postsurgical pain were not routinely treated with therapeutic medial branch blocks. A positive treatment response with patients sufficiently satisfied with the relief were identified. Participants: Of the 100 operations performed, 30 were microscopic one level discectomy, 11 were artificial disk operations, 46 were C5-C6 one level cage, and 13 were fusions with cage and plate. Three patients had undergone diagnostic and/or therapeutic medial branch block on unilateral cervical C3- C7, on postoperative day 12 after all other modalities of pain management had failed. All 3 cases at 3-month, 6-month, and 12-month follow-up were still complaining of cervical pain and discomfort. All other cases recovered from surgery, with no obvious chronic pain issue. Discussion: In this study, we describe in detail the pain generators after common surgical interventions, present in detail those 3 cases presentation, and review the literature about the importance of proper pain management after cervical spine surgeries. We describe
PRESENTATIONS
the rationale behind early intervention, along with proper medical management.
Poster 224 Hip Range of Motion for Specific Hip Disorders: An Important Parameter to Assess in Patients With Low Back Pain. Heidi Prather, DO (Washington University School of Medicine, St Louis, MO, United States); John Clohisy, MD, Marcie Harris Hayes, PT, DPT, MSCI, OCS, Devyani M. Hunt, MD, Alexander Sheng, MD, Linda VanDillen, PhD, PT. Disclosures: H. Prather, NIH grant, research grants; NASS secretary, board of directors, other nonfinancial relationship; PM&R senior editor, other; Spineline editor, other. Objective: The objective was to document hip range of motion (ROM) patterns for specific hip disorders and to further elucidate their relationship with low back pain. Design: Prospective descriptive study. Setting: Tertiary university. Participants: Adult patients and asymptomatic volunteers. Interventions: Not applicable. Methods: Adult patients from an orthopedic surgeon’s practice and asymptomatic adult volunteers were recruited and examined by a physiatrist who completed goniometric hip ROM measurements. All the patients were assessed before surgery for the following hip disorders: osteoarthritis (OA), femoroacetabular impingement, or developmental hip dysplasia. Measurements in supine included hip flexion (HF), abduction (ABD), adduction, internal rotation (HFIR), and external rotation (HFER) with the hip flexed to 90°. Measurements in prone included hip internal rotation and external rotation with the knee flexed to 90°, and hip extension (EXT). The mean value of 3 measurements was used for analysis. Comparisons were made between (1) asymptomatic volunteers and patients with hip disorders and (2) patients with these specific hip disorders. Main Outcome Measures: Hip ROM. Results: Ten patients per type of hip disorder (17 women, 13 men) with a mean age of 35 years (21-55 years) and 50 asymptomatic volunteers (25 women, 25 men) with a mean age of 32 years (18-51 years) were examined. Patients with OA were compared with asymptomatics had significantly less (P⬍.0001) ROM for all measures except ABD, prone included hip internal rotation, and EXT. Patients with femoroacetabular impingement compared with asymptomatic volunteers had significantly less HF, HFIR, HFER, and ABD (P⫽.05 to P⬍.0001). Patients with developmental hip dysplasia compared with asymptomatic volunteers had significantly more ABD (P⬍.0001). Conclusions: Patients with OA, femoroacetabular impingement, and developmental hip dysplasia hip disorders have unique hip ROM patterns. Hip ROM has been linked to movement patterns of the lumbar region and to low back pain. Documenting the hip ROM patterns is the first step to understanding the relationship between specific hip and low back pain disorders.