- Email: [email protected]
Achillean Tendinopathy or Haglund's Disease: Role of PMR. Case Report
S234
Poster 272 Acute Septic Arthritis Following Soft Tissue Filler Injection to Buttocks: A Case Report. Antigone Argyriou, MD (Montefiore Medical Center, Bronx, NY, United States); Roshni G. Durgam, MD. Disclosures: A. Argyriou, No Disclosures: I Have Nothing To Disclose. Case Description: A 53-year-old woman with a past medical history of human immunodeficiency virus, presented to the Emergency Room with two days of fever, malaise and multiple swollen painful joints. On physical exam, the patient was febrile with multiple inflamed, erythematous and tender joints. Aspiration with gram stain and culture was performed showing leukocytes with gram-positive bacteria. The patient was treated with broad-spectrum antibiotics with resolution of fever and swelling but continued to have significant stiffness and diminished range of motion of affected joints. She had difficulty ambulating due to the pain. Initially, no source of infection was identified however, on physical examination multiple hard, tender skin nodules were found throughout bilateral buttocks. Upon further questioning, the patient admitted to having a cosmetic procedure in the Dominican Republic to enhance the appearance of her buttocks eight weeks prior to presentation. Setting: Tertiary Care Hospital. Results or Clinical Course: Following administration of antibiotics and adequate pain control, the patient underwent therapy in an acute rehab setting. The patient had significant improvement in joint range of motion with improved functional mobility. She was discharged home after completing her rehabilitation course. Discussion: Injectable fillers have been used extensively over the last several decades for soft tissue augmentation. There are many types of injectable fillers used for augmentation including hyaluronic acid, collagen, calcium hydroxylapatite, poly-L-lactic acid and polymethyl methacrylate. Acute septic arthritis can develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection, which in this case, arose from injectable fillers used for buttock enhancement. Conclusions: This is the first reported case of septic arthritis following soft tissue filler injections for cosmetic purposes. The use of injectable silicone for cosmetic purposes is becoming increasingly popular leading to a rise in non-professional procedures using impure or unregulated fillers of questionable quality. Although severe systemic reactions are rare, clinicians should be aware of such procedures and inquire about them specifically as they are frequently under-reported. Poster 273 Achillean Tendinopathy or Haglund’s Disease: Role of PMR. Case Report. El hassan Kassimi (University Hospital Casablanca Morocco, Casablanca, Morocco); Abdelfettah Youness, MD; Mariam Bouchikhi, Doctor; Asma Kadir, Doctor; Fatima Lmidamani, Doctor; Abdellatif Elfatimi, Doctor. Disclosures: E. Kassimi, No Disclosures: I Have Nothing To Disclose. Case Description: A 23-year-old student with no medical history who presented with troublesome heel pain on walking and
PRESENTATIONS
on foot wearing followed by, a month later, the appearance of a purplish swelling at the back of the heel. The radiograph showed the existence of a conflict between the Achilles tendon and the posterosuperior corner of the calcaneus associated with an achillean tendinitis on MRI. After failure of functional treatment, the patient has a surgical regularization aboard posterosuperior of the calcaneus with combing of the Achilles tendon followed by functional treatment.The evolution was favorable with regression of pain and recovery of daily activities. Setting: Musculoskeletal disorders. Results or Clinical Course: The evolution was favorable with regression of pain and recovery of daily activities. Discussion: Haglund’s disease is a painful swelling of the back foot, in relation with a foot shoes conflict, related to morphological abnormality of the posterosuperior tuberosity of the calcaneus along with retrocalcaneal bursitis and pre-achillean tendinopathy. It is a disabling condition especially among athletes. Functional treatment is possible and should be well studied. In addition to skin care, removing the conflict with suitable footwear during acute periods and an adjustment of foothills posterior of the shoe, which should not be tightened beside bursitis. A heel height adjusted prevents the rocker back of the calcaneus cavus. The indication for surgery is after failure of conservative treatment. Conclusions: Haglund’s disease is among the causes of posterior heel pain causing especially professional disability. The role of PMR is to manage this disease at the preventive and curative treatment. Poster 507 A Retrospective Evaluation of Physical Therapy Compliance with Physiatrist Therapy Orders in Low Back Pain. Jennifer Villacorta, MD (UAMS, Little Rock, AR, United States); Patrick Kortebein, MD. Disclosures: J. Villacorta, No Disclosures: I Have Nothing To Disclose. Objective: To determine the extent of physical therapist compliance with physical medicine and rehabilitation physicians (“physiatrist”) prescribed physical therapy orders for patients with low back pain. Design: Retrospective chart review. Setting: Veterans hospital affiliated with an academic medical center. Participants: Convenience sample of 100 patients referred to a physiatrist for initial evaluation of low back pain, and subsequently referred for and evaluated by physical therapy at the same facility. Interventions: Not applicable. Main Outcome Measures: Physical therapist compliance with a physiatrist physical therapy prescription. Results or Clinical Course: The physical therapists at this facility were compliant with 61% of the physiatrist prescribed physical therapy orders (mean 3 therapy orders per patient). Conclusions: It appears that most physical medicine and rehabilitation physicians are confident that physiatric directed physical therapy results in better patient outcomes. However, there is no objective data to support this belief. The results of our study indicate that in this particular facility, physical therapists are compliant with a physiatrist’s physical therapy prescription for low back pain slightly more than half the time. These results are an initial step in the process of determining the efficacy of physiatric directed physical therapy.
Poster 272 Acute Septic Arthritis Following Soft Tissue Filler Injection to Buttocks: A Case Report. Antigone Argyriou, MD (Montefiore Medical Center, Bronx, NY, United States); Roshni G. Durgam, MD. Disclosures: A. Argyriou, No Disclosures: I Have Nothing To Disclose. Case Description: A 53-year-old woman with a past medical history of human immunodeficiency virus, presented to the Emergency Room with two days of fever, malaise and multiple swollen painful joints. On physical exam, the patient was febrile with multiple inflamed, erythematous and tender joints. Aspiration with gram stain and culture was performed showing leukocytes with gram-positive bacteria. The patient was treated with broad-spectrum antibiotics with resolution of fever and swelling but continued to have significant stiffness and diminished range of motion of affected joints. She had difficulty ambulating due to the pain. Initially, no source of infection was identified however, on physical examination multiple hard, tender skin nodules were found throughout bilateral buttocks. Upon further questioning, the patient admitted to having a cosmetic procedure in the Dominican Republic to enhance the appearance of her buttocks eight weeks prior to presentation. Setting: Tertiary Care Hospital. Results or Clinical Course: Following administration of antibiotics and adequate pain control, the patient underwent therapy in an acute rehab setting. The patient had significant improvement in joint range of motion with improved functional mobility. She was discharged home after completing her rehabilitation course. Discussion: Injectable fillers have been used extensively over the last several decades for soft tissue augmentation. There are many types of injectable fillers used for augmentation including hyaluronic acid, collagen, calcium hydroxylapatite, poly-L-lactic acid and polymethyl methacrylate. Acute septic arthritis can develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection, which in this case, arose from injectable fillers used for buttock enhancement. Conclusions: This is the first reported case of septic arthritis following soft tissue filler injections for cosmetic purposes. The use of injectable silicone for cosmetic purposes is becoming increasingly popular leading to a rise in non-professional procedures using impure or unregulated fillers of questionable quality. Although severe systemic reactions are rare, clinicians should be aware of such procedures and inquire about them specifically as they are frequently under-reported. Poster 273 Achillean Tendinopathy or Haglund’s Disease: Role of PMR. Case Report. El hassan Kassimi (University Hospital Casablanca Morocco, Casablanca, Morocco); Abdelfettah Youness, MD; Mariam Bouchikhi, Doctor; Asma Kadir, Doctor; Fatima Lmidamani, Doctor; Abdellatif Elfatimi, Doctor. Disclosures: E. Kassimi, No Disclosures: I Have Nothing To Disclose. Case Description: A 23-year-old student with no medical history who presented with troublesome heel pain on walking and
PRESENTATIONS
on foot wearing followed by, a month later, the appearance of a purplish swelling at the back of the heel. The radiograph showed the existence of a conflict between the Achilles tendon and the posterosuperior corner of the calcaneus associated with an achillean tendinitis on MRI. After failure of functional treatment, the patient has a surgical regularization aboard posterosuperior of the calcaneus with combing of the Achilles tendon followed by functional treatment.The evolution was favorable with regression of pain and recovery of daily activities. Setting: Musculoskeletal disorders. Results or Clinical Course: The evolution was favorable with regression of pain and recovery of daily activities. Discussion: Haglund’s disease is a painful swelling of the back foot, in relation with a foot shoes conflict, related to morphological abnormality of the posterosuperior tuberosity of the calcaneus along with retrocalcaneal bursitis and pre-achillean tendinopathy. It is a disabling condition especially among athletes. Functional treatment is possible and should be well studied. In addition to skin care, removing the conflict with suitable footwear during acute periods and an adjustment of foothills posterior of the shoe, which should not be tightened beside bursitis. A heel height adjusted prevents the rocker back of the calcaneus cavus. The indication for surgery is after failure of conservative treatment. Conclusions: Haglund’s disease is among the causes of posterior heel pain causing especially professional disability. The role of PMR is to manage this disease at the preventive and curative treatment. Poster 507 A Retrospective Evaluation of Physical Therapy Compliance with Physiatrist Therapy Orders in Low Back Pain. Jennifer Villacorta, MD (UAMS, Little Rock, AR, United States); Patrick Kortebein, MD. Disclosures: J. Villacorta, No Disclosures: I Have Nothing To Disclose. Objective: To determine the extent of physical therapist compliance with physical medicine and rehabilitation physicians (“physiatrist”) prescribed physical therapy orders for patients with low back pain. Design: Retrospective chart review. Setting: Veterans hospital affiliated with an academic medical center. Participants: Convenience sample of 100 patients referred to a physiatrist for initial evaluation of low back pain, and subsequently referred for and evaluated by physical therapy at the same facility. Interventions: Not applicable. Main Outcome Measures: Physical therapist compliance with a physiatrist physical therapy prescription. Results or Clinical Course: The physical therapists at this facility were compliant with 61% of the physiatrist prescribed physical therapy orders (mean 3 therapy orders per patient). Conclusions: It appears that most physical medicine and rehabilitation physicians are confident that physiatric directed physical therapy results in better patient outcomes. However, there is no objective data to support this belief. The results of our study indicate that in this particular facility, physical therapists are compliant with a physiatrist’s physical therapy prescription for low back pain slightly more than half the time. These results are an initial step in the process of determining the efficacy of physiatric directed physical therapy.