Poster 95 Oncologist’s Attitude and Knowledge about Cancer Rehabilitation

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wave therapy has also been described as a non-invasive, affordable treatment for myositis ossificans with few side effects. Surgical excision remains the definitive treatment. Conclusions: Rehabilitation physicians should be aware of the possibility of myositis ossificans traumaticus in patients with recent trauma and proper prophylactic measures should be initiated. Level of Evidence: Level V Poster 93 Rare Presentation of Three Limb Compartment Syndrome: A Case Report Austin C. Myers, MD, MBA (East Carolina University/Vidant Medical Center, Greenville, North Carolina, United States), Clinton E. Faulk, MD Disclosures: Austin Myers: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 55-year-old AA female with past medical history of substance abuse (cocaine use, alcohol abuse, and nicotine dependence), depression, chronic pain, Sjogren’s syndrome, osteomalacia, hypothyroidism and recently diagnosed stage IV abdominal neuroendocrine tumor with liver masses presented with complaints of bilateral leg pain and difficulty ambulating. Initial CPK was >44,000, and within a short time patient noted increased extremity pain; pulses became non-detectable, and emergency fasciotomy was performed on bilateral lower extremities and left upper extremity. With aggressive fluid management, CPK began trending down, but severe weakness remained. No specific etiology was ever determined for severe rhabdomyolysis and compartment syndrome, but was thought to be secondary to statin use and possible drug interaction e either from prescription medication (possibly PPI) or illicit drug. Setting: Inpatient Rehabilitation of Academic Medical Center. Results: Patient was admitted to inpatient rehab, and at that time she was able to ambulate 6’ with rolling walker and contact guard assist; she was also required maximum assistance with dressing. She made significant functional gains during rehab stay, and was able to ambulate independently well over 300 feet, and was independent with dressing. Surgery team followed with wound monitoring, and these healed well. Discussion: Compartment syndrome is typically seen after a specific inciting event such as trauma. This patient did not have a traumatic injury, however she was recently diagnosed with a neuroendocrine tumor, and had a history of illicit drug abuse with alcohol and tobacco use concomitantly. All of these factors could have been contributory to development of compartment syndrome in this patient. Conclusions: This patient’s case is unique in that no traumatic event occurred, and she developed compartment syndrome in three extremities. No definitive etiology has been discovered; however, patient did demonstrate significant improvement as CPK normalized, along with intensive therapy. Level of Evidence: Level V Poster 94 Mononeuritis Multiplex Secondary to HCV Cryoglobulinemia and Rheumatoid Vasculitis: A Case Report Abhishek Patel, DO (University Medical Center of Pittsburgh, Pittsburgh, PA, United States) Disclosures: Abhishek Patel: I Have No Relevant Financial Relationships To Disclose Case/Program Description: This is a 71-year-old woman with a past medical history of rheumatoid arthritis and untreated hepatitis C virus who presented with a new right foot drop and generalized pain. On examination she had weakness in the right dorsiflexors and on further exam patient had weakness in the right wrist extensors. MRI of the brain and lumbar spine was unremarkable for stenosis or herniation. Work up was revealing for ANA+ and above normal Rheumatoid Factor. She was started on Rituximab infusion. The patient was sent for NCS/ EMG showed evidence asymmetric generalized sensory motor

polyneuropathy with conduction blocks involving right fibular nerve, right tibial nerve, and right superficial radial mononeuropathy. Nerve biopsy was performed revealing necrotizing vasculitis. The patient was started on pulse steroid therapy and completed a prednisone taper. Her foot dorsiflexion improved to a 3/5 from 0/5 on admission. She still had inability to clear the right lower extremity and thus ankle foot orthosis was recommended. She was discharged to transitional care unit for rehabilitation needs. Setting: Acute Inpatient Floor. Results: At one week, the patient was readmitted to inpatient floors possible infection at her nerve biopsy site. At that time, we reassessed the patient and she made significant recovery of her dorsiflexors to a 3/5. AFO was discontinued and she was in fact modified independent with a cane (which she used at baseline prior to admission). Discussion: Mononeuritis Multiplex is a rare neurologic/neurovascular disorder and in this particular patient the cause was thought to be untreated hepatitis C cryoglobulinemia and rheumatoid vasculitis. Her workup was consistent with chronic hepatitis C infection and cryoglobulinemia workup was positive for cryoglobulins II and III, along with low complement C4 factors. Biopsy showed vasculitis with eosinophilic infiltrates consistent with history of HCV cryoglobulinemia. However, fibularis brevis muscle biopsy showed necrotizing vasculitis consistent with rheumatoid vasculitis given. EMG findings were interesting in that right sural and bilateral superficial peroneal sensory spots were absent, right radial sensory response was low with right fibular motor response to EDB showed low amplitude and prolonged distal latency and conduction block as well as the right tibial nerve. The right ulnar motor response was slowed across the elbow needle study showed fibrillations in the right gastroc. Conclusions: Mononeuritis Multiplex has a myriad of etiologies however untreated hepatitis C and rheumatoid arthritis flares simultaneously is an unusual phenomenon confirmed by NCS and EMG findings but most notably histological studies. Both are treated and respond well with pulse steroid therapies and the patient’s function was essentially unchanged. Level of Evidence: Level V Poster 95 Oncologist’s Attitude and Knowledge about Cancer Rehabilitation Rau´l A. Rosario-Concepcio´n, MD (University of Puerto Rico, Guaynabo, Puerto Rico, Puerto Rico), Fernando L. Sepu´lveda-Irizarry, MD, Yailiz B. Calderı´n Pellot, MS4, Marı´a E. Echevarrı´a, MD, Carmen E. Lo´pez-Acevedo, MD Disclosures: Rau ´n: I Have No Relevant Financial ´l Rosario-Concepcio Relationships To Disclose Objective: To assess the awareness and referral patterns among oncologists for rehabilitation in both pediatric and adult cancer patients. Design: Cross-sectional study. Setting: Medical Oncology State Society Annual Meeting. Participants: 42 oncologists completed a 10 item questionnaire. Interventions: All willing oncologists were handed a short questionnaire focused on demographics, knowledge and clinical practices about rehabilitation in cancer patients for the past 12 months. Main Outcome Measures: Identify the frequency, reasons, at what point in the continuum of care do oncologists refer cancer patients for rehabilitation. Determine the risk/benefit perception by oncologists about rehabilitation in their patients and its correlation to patient referrals, prognosis, type of cancer and type of symptoms. Results: Up to 88% of oncologists received minimal or zero education about cancer rehabilitation, its benefits and indications. This resulted in 72% of oncologists referring less than 15% of their patients for rehabilitation with almost 1/3 of the subjects referring less than 5% of patients. However, 92% think that rehabilitation is always or frequently beneficial for their patients. Meanwhile 36% decide not to refer patients if prognosis is less than 6 months, and 40% of the

Abstracts / PM R 8 (2016) S151-S332 physicians sampled avoid referring patients for rehab with a life expectancy of less than 3 months and 1 month. Conclusions: Even though medical oncology specialists have some knowledge that rehabilitation is beneficial for their patients, there continues to be a low referral pattern among oncologists, describing poor access, lack of information about cancer rehabilitation and economic difficulties as barriers. Further efforts should be undertaken to emphasize the importance of integrating rehabilitation techniques in the care of cancer patients. Level of Evidence: Level II Poster 96 Medial Pectoral Nerve Mononeuropathy: A Case Report Anupam Sinha, MS, DO (Rothman Institute, Mount Laurel, New Jersey, United States), Sunny Gupta, DO, Mitesh Patel, MD Disclosures: Anupam Sinha: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 48-year-old right hand dominant male weightlifter presented for evaluation of right chest area loss of muscle mass for 6 months. He reported a history of shoveling snow and weight lifting. He denied any specific trauma or injury, however he noticed an insidious onset of weakness in his right pectoral area. This was especially evident when doing push-ups or chest exercises. He also noticed right pectoralis muscle atrophy. An MRI of his right shoulder was normal. He denied any numbness, tingling, or weakness in his upper limbs. On physical examination, there was atrophy of the right pectoralis. Gross strength testing of his chest muscles was normal. Examination of the right shoulder was also normal. Setting: Outpatient orthopedic practice. Results: An MRI of his chest was ordered and revealed slight thinning of the right pectoralis major muscle as compared to the left. The right pectoralis major muscle had a thickness of 2.9 cm compared to 3.3 cm on the left side. Electrodiagnostic studies showed normal motor and sensory nerve conductions of the right arm. Needle study of the right arm was unremarkable except for polyphasic motor units found in the sternal head of the pectoralis major. The electrodiagnostic impression was that of a right medial pectoral mononeuropathy with evidence of reinnervation. Discussion: The medial pectoral nerve arises from the medial cord of the brachial plexus and innervates the sternal portion of the pectoralis major muscle. Mononeuropathy of the medial pectoral nerve is rare. Proposed mechanisms include stretch injury related to strenuous chest exercises1 and compressive injury where the nerve passes through the pectoralis minor. Conclusions: While mononeuropathies in weightlifters have been reported, isolated lesions involving the medial pectoral nerve are rare. This diagnosis should be considered in weightlifters presenting with loss of strength isolated to unilateral pectoral muscles. Level of Evidence: Level V Poster 97 Statin-Induced Rhabdomyolysis Triggered by Concomitant Colchicine Administration: A Case Report Michael J. Auriemma, MD (Washington Hospital Center/Georgetown University, Washington, DC, United States), Robert D. Bunning, MD FACP FACR Disclosures: Michael Auriemma: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 55-year-old man with relevant past medical history of gout and hyperlipidemia was admitted for rehabilitation of deconditioning after initially presenting to an acute care hospital with rhabdomyolysis. Prior to developing rhabdomyolysis, he had been taking febuxostat and colchicine for his gout. One week prior to his acute care admission, he decided to restart atorvastatin

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on his own despite having previously been discontinued on statin therapy secondary to a history of muscle cramping. He developed generalized weakness affecting the legs greater than the arms and proximal muscles greater than distal muscles. Reflexes were grossly diminished. Initial creatine kinase (CK) was elevated to 222,166. Atorvastatin, febuxostat, and colchicine were all discontinued. Through acute inpatient rehabilitation his overall functional status improved from maximum assist to independent. His CK at discharge had decreased to 461. Colchicine was later restarted as an outpatient without incident. Setting: Inpatient Rehabilitation Unit. Results: The patient presented with rhabdomyolysis secondary to statin toxicity triggered by concomitant administration of colchicine. Through acute care management and acute rehabilitation, the patient improved both medically and functionally. Discussion: Statins are known to carry a risk of muscle toxicity, ranging in severity from myalgias to rhabdomyolysis. The overall risk of rhabdomyolysis is estimated to be 0.1%. Colchicine has been shown to cause myoneuropathy as a side effect itself. Atorvastatin is metabolized via the CYP3A4 enzyme while colchicine is a CYP3A4 substrate competitor. Through this CYP3A4 interaction, the combination of atorvastatin and colchicine further increases the risk of musclerelated toxicity. Conclusions: Muscle toxicity is a potential side effect from statin and colchicine therapy. The combination of both increases the risk of such side effects. The occurrence of rhabdomyolysis secondary to statin therapy is an absolute contraindication to continued statin use. Level of Evidence: Level V Poster 98 Cerebral Infarction Secondary to Cement Embolism Through a Patent Foramen Ovale After Percutaneous Kyphoplasty: A Case Report Braden M. Boji, MD (Oakwood Heritage Hospital, Berkley, MI, United States), Johnathan Ho, MD Disclosures: Braden Boji: I Have No Relevant Financial Relationships To Disclose Case/Program Description: This patient presented to the hospital with low back pain one week after sustaining a ground-level fall at home. MRI of the lumbar spine revealed an acute L3 compression fracture. She underwent percutaneous kyphoplasty with polymethylmethacrylate cement three days later. The following day, she developed right hemiplegia, expressive aphasia, and dysphagia. A noncontrast CT of the head demonstrated left temporoparietal lobe densities suggestive of foreign material. MRI of the brain confirmed the infarcts. CT angiography of the brain revealed poor circulation in the left MCA. A transesophageal echocardiogram demonstrated a patent foramen ovale (PFO). She was transferred to the inpatient rehabilitation unit after medical stability. Setting: Inpatient Rehabilitation Unit. Results: The patient participated thoroughly in the rehabilitation program. On day 6, her Functional Independence Measure (FIM) score was 68 and by day 11, it was 92. Prior to discharge, she as able to ambulate at modified independent level with a standard walker. She went home two days later. Discussion: There are rare case reports of cerebral infarction due to cement crossing the PFO after percutaneous kyphoplasty. In our patient, despite the foreign etiology of her stroke, she made great strides in her recovery. She did not experience any seizure activity during her rehabilitation course. Conclusions: It is possible for extravasated cement from percutaneous kyphoplasty to travel through Batson’s venous plexus to the azygous system, and gain access to the arterial system via the PFO. Level of Evidence: Level V