- Email: [email protected]
Poster 27 Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain and the Female Athlete Triad
PM&R
Conclusions: The balance treatment using a visual feedback mechanism when in a pair of shoes was not helpful in improving the balancing ability when compared to the conventional physical therapy only. But there was a statistically significant effect when patients received the balance training when barefoot. In order to increase the balance performance, this study strongly suggests that the balance training must be performed using a visual feedback treatment in barefoot. Poster 27 Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain and the Female Athlete Triad. Johnny Yi, MD (Loyola University Medical Center, Maywood, IL, United States); Sandi Tenfelde, PhD; Dina Tell, PhD; Cynthia Brincat, MD, PhD; Colleen Fitzgerald, MD. Disclosures: J. Yi, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To estimate the prevalence of pelvic floor disorders (PFD), pelvic girdle pain (PGP) and the female athlete triad (Triad) in the female triathlete population and to determine an association between PFD and PGP or Triad. Design: Web-based survey. Setting: Nationwide survey for female triathletes >18 years old. Participants: 311 subjects participated from 7 different regions of the US. Interventions: NA Main Outcome Measures: Using validated questionnaires, we estimate the prevalence of PFD and PGP in the female triathlete population. We also used the female athlete triad screening questionnaire to evaluate the prevalence of those at risk for the Triad. Percentage and continuous variables were analyzed using a Chisquare and Student’s T-test. Correlations were analyzed with the Spearman Correlation using SPSS version 20.0 (Chicago, Illinois). Results or Clinical Course: 311 women with a median age range of 35-44 years responded. Participants were mostly White/ Caucasian (89.7%), nonsmokers (99.4%), premenopausal (80%) and had a mean BMI of 22. Mean weekly training was as follows: running 3.7 days, biking 2.9 days and swimming 2.4 days.16% endorsed urgency urinary incontinence (UUI), 37.4% stress urinary incontinence (SUI), 5% pelvic organ prolapse (POP) and 28% anal incontinence (AI). Training mileage and intensity were not associated with PFD. Parity was associated with higher prevalence of SUI (55 vs 24%, p¼.001) and POP (8 vs 3%, p¼.05). 18% of respondents had PGP but rated it as not disabling per the PGQ with a mean score of 26.7 (SD¼6.0). Those with SUI, UUI and AI had higher levels of PGP (SUI p¼.05, UUI p¼.03, AI p¼.03). 75% of respondents completed the triad questionnaire and 22% screened positive for low energy availability, 24% for menstrual irregularities, and 29% for abnormal bone strength. 24% screened positive for one arm of the triad. There was no significant association between PFD and the Triad. Conclusions: 1 in 3 triathletes endorse symptoms of PFD. About 1 in 4 triathletes screen positive for at least one component of the Triad. Although PGP was notable is triathletes, it was not functionally limiting. While both PFD and the Triad are prevalent in female triathletes, they are often ignored. Physicians caring for women should screen and treat these patients appropriately to avoid possible long-term sequelae and improve overall quality of life.
Vol. 6, Iss. 9S, 2014
S191
Poster 28 Successful Treatment of Popliteal Artery Entrapment Syndrome with a History of Freiberg’s Disease: A Case Report. Keziah Sully, MD (Hospital of the University of Pennsylvania, Philadelphia, PA, United States); John M. Vasudevan, MD. Disclosures: K. Sully, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: The patient presented with a 3-year history of progressive right-sided posterior exertional leg pain (ELP). She had a history of Freiberg’s disease of her right foot, managed conservatively shortly before the onset of ELP. Pain was tight, cramping, aggravated with brisk walking, and relieved with rest. Ibuprofen, acetaminophen, and physical therapy were ineffective. Examination was notable for fatigue and pain with repeated toe raises, and prominent calf musculature. Magnetic resonance imaging was unremarkable. Compartment pressure testing was normal according to Pedowitz criteria, excluding chronic exertional compartment syndrome. A magnetic resonance angiogram with provocative positioning revealed medial displacement and interruption of the right popliteal artery posterior to the intercondylar notch, worsened during plantarflexion, consistent with Type 2 popliteal artery entrapment. The chronicity of her condition compromised the integrity of the artery and surgery with venous graft was utilized along with tissue release. Program Description: 18-year-old female long-distance runner. Setting: Multidisciplinary Sports Medicine Clinic. Results or Clinical Course: Post-operative ankle brachial indices were normal, and duplex ultrasound demonstrated graft patency. There were complications of graft occlusion requiring revision and extravascular hematoma requiring evacuation. Two months post-surgery, the ELP had resolved and she successfully progressed toward full activity. Discussion: Popliteal artery entrapment often involves predisposing congenital variations of leg anatomy. One suspected etiology of Freiberg’s disease is vascular compromise to the 2nd metatarsal head, usually during adolescence. Given the timing of her two diagnoses, it is plausible that the entrapment of the popliteal artery may have restricted vascular supply to the metatarsal head. This is the first reported case, to our knowledge, of popliteal artery entrapment with an associated history of Freiberg’s disease. Conclusions: Popliteal artery entrapment syndrome is a rare cause of ELP, and should be considered when other causes have been excluded. This case highlights a possible association with Freiberg’s disease in the same limb. Poster 29 Exercise is Medicine: One Man’s Journey from Stem Cell Transplant to the Wasatch Front 100 Mile Endurance Run in 365 days: A Case Report. Robert Engelen, DO (University of Utah, Salt Lake City, UT, United States); Pamela A. Hansen, MD. Disclosures: R. Engelen, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: The patient is an active father of three who was diagnosed with Stage III Mantle Cell Lymphoma after discovering an enlarged axillary lymph node in March 2012. The patient understood the need to continue exercising to mitigate the effects of
Conclusions: The balance treatment using a visual feedback mechanism when in a pair of shoes was not helpful in improving the balancing ability when compared to the conventional physical therapy only. But there was a statistically significant effect when patients received the balance training when barefoot. In order to increase the balance performance, this study strongly suggests that the balance training must be performed using a visual feedback treatment in barefoot. Poster 27 Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain and the Female Athlete Triad. Johnny Yi, MD (Loyola University Medical Center, Maywood, IL, United States); Sandi Tenfelde, PhD; Dina Tell, PhD; Cynthia Brincat, MD, PhD; Colleen Fitzgerald, MD. Disclosures: J. Yi, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To estimate the prevalence of pelvic floor disorders (PFD), pelvic girdle pain (PGP) and the female athlete triad (Triad) in the female triathlete population and to determine an association between PFD and PGP or Triad. Design: Web-based survey. Setting: Nationwide survey for female triathletes >18 years old. Participants: 311 subjects participated from 7 different regions of the US. Interventions: NA Main Outcome Measures: Using validated questionnaires, we estimate the prevalence of PFD and PGP in the female triathlete population. We also used the female athlete triad screening questionnaire to evaluate the prevalence of those at risk for the Triad. Percentage and continuous variables were analyzed using a Chisquare and Student’s T-test. Correlations were analyzed with the Spearman Correlation using SPSS version 20.0 (Chicago, Illinois). Results or Clinical Course: 311 women with a median age range of 35-44 years responded. Participants were mostly White/ Caucasian (89.7%), nonsmokers (99.4%), premenopausal (80%) and had a mean BMI of 22. Mean weekly training was as follows: running 3.7 days, biking 2.9 days and swimming 2.4 days.16% endorsed urgency urinary incontinence (UUI), 37.4% stress urinary incontinence (SUI), 5% pelvic organ prolapse (POP) and 28% anal incontinence (AI). Training mileage and intensity were not associated with PFD. Parity was associated with higher prevalence of SUI (55 vs 24%, p¼.001) and POP (8 vs 3%, p¼.05). 18% of respondents had PGP but rated it as not disabling per the PGQ with a mean score of 26.7 (SD¼6.0). Those with SUI, UUI and AI had higher levels of PGP (SUI p¼.05, UUI p¼.03, AI p¼.03). 75% of respondents completed the triad questionnaire and 22% screened positive for low energy availability, 24% for menstrual irregularities, and 29% for abnormal bone strength. 24% screened positive for one arm of the triad. There was no significant association between PFD and the Triad. Conclusions: 1 in 3 triathletes endorse symptoms of PFD. About 1 in 4 triathletes screen positive for at least one component of the Triad. Although PGP was notable is triathletes, it was not functionally limiting. While both PFD and the Triad are prevalent in female triathletes, they are often ignored. Physicians caring for women should screen and treat these patients appropriately to avoid possible long-term sequelae and improve overall quality of life.
Vol. 6, Iss. 9S, 2014
S191
Poster 28 Successful Treatment of Popliteal Artery Entrapment Syndrome with a History of Freiberg’s Disease: A Case Report. Keziah Sully, MD (Hospital of the University of Pennsylvania, Philadelphia, PA, United States); John M. Vasudevan, MD. Disclosures: K. Sully, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: The patient presented with a 3-year history of progressive right-sided posterior exertional leg pain (ELP). She had a history of Freiberg’s disease of her right foot, managed conservatively shortly before the onset of ELP. Pain was tight, cramping, aggravated with brisk walking, and relieved with rest. Ibuprofen, acetaminophen, and physical therapy were ineffective. Examination was notable for fatigue and pain with repeated toe raises, and prominent calf musculature. Magnetic resonance imaging was unremarkable. Compartment pressure testing was normal according to Pedowitz criteria, excluding chronic exertional compartment syndrome. A magnetic resonance angiogram with provocative positioning revealed medial displacement and interruption of the right popliteal artery posterior to the intercondylar notch, worsened during plantarflexion, consistent with Type 2 popliteal artery entrapment. The chronicity of her condition compromised the integrity of the artery and surgery with venous graft was utilized along with tissue release. Program Description: 18-year-old female long-distance runner. Setting: Multidisciplinary Sports Medicine Clinic. Results or Clinical Course: Post-operative ankle brachial indices were normal, and duplex ultrasound demonstrated graft patency. There were complications of graft occlusion requiring revision and extravascular hematoma requiring evacuation. Two months post-surgery, the ELP had resolved and she successfully progressed toward full activity. Discussion: Popliteal artery entrapment often involves predisposing congenital variations of leg anatomy. One suspected etiology of Freiberg’s disease is vascular compromise to the 2nd metatarsal head, usually during adolescence. Given the timing of her two diagnoses, it is plausible that the entrapment of the popliteal artery may have restricted vascular supply to the metatarsal head. This is the first reported case, to our knowledge, of popliteal artery entrapment with an associated history of Freiberg’s disease. Conclusions: Popliteal artery entrapment syndrome is a rare cause of ELP, and should be considered when other causes have been excluded. This case highlights a possible association with Freiberg’s disease in the same limb. Poster 29 Exercise is Medicine: One Man’s Journey from Stem Cell Transplant to the Wasatch Front 100 Mile Endurance Run in 365 days: A Case Report. Robert Engelen, DO (University of Utah, Salt Lake City, UT, United States); Pamela A. Hansen, MD. Disclosures: R. Engelen, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: The patient is an active father of three who was diagnosed with Stage III Mantle Cell Lymphoma after discovering an enlarged axillary lymph node in March 2012. The patient understood the need to continue exercising to mitigate the effects of