- Email: [email protected]
Poster 132 A Juxta-Articular Cyst of the Hip Causing Sciatic Nerve Compression in a Master Athlete: A Case Report
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Abstracts / PM R 8 (2016) S151-S332
Design: Cross-sectional study. Setting: An academic PM&R residency program. Participants: 17 PM&R residents total, consisting of 7 postgraduate year 2 (PGY-2) residents, 5 PGY-3 residents, and 5 PGY-4 residents. The 7 PGY-2 residents were further subdivided into 2 residents with prior clinical MSK US training and 5 residents without prior clinical MSK US training. All PGY-3 and PGY-4 residents had completed prior clinical MSK US training. Interventions: Online questionnaire and competency examination. Main Outcome Measures: Average percentage correct score on competency examination and average value (graded on a scale from 1 e 5) of qualitative measures (interest, confidence, satisfaction, and importance) regarding MSK US. Results: Average correct score for all residents was 72.44% 6.53%. Average interest in MSK US was 3.94 0.49. Average confidence with MSK US basic concepts, US of the shoulder, and US of the wrist and hand was 2.71 0.44, 2.65 0.41, and 2.59 0.51, respectively. Average satisfaction with quantity and quality of MSK US education was 2.18 0.42 and 2.71 0.50, respectively. Average importance of MSK US education relative to other PM&R topics was 3.71 0.53. Conclusions: There is high interest in MSK US and high importance given to MSK US education by PM&R residents; unfortunately, there is low individual confidence and low satisfaction with the current educational curriculum. Competency examination shows a minimally competent knowledge of MSK US, which would benefit from targeted enhancement with additional time and resource investment. Level of Evidence: Level III Poster 130 A Rare Cause of Hip Pain in a Young Male. A Case Report Mary Apiafi, MD (Albert Einstein College of Medicine, Montefiore Medical Ctr, Bronx, NY, United States), Tony Wanich, MD Disclosures: Mary Apiafi: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 43-year-old man with acute onset of right hip pain, moderate intensity, 6/10, onset was a few days prior to presentation after doing shopping at the mall for a few hours. Location of pain was the right lateral hip and groin, more noticeable upon standing or twisting at the hips, aching, and relieved with rest. Ambulation was unlimited, and he was able to perform his ADLs without difficulty. Physical examination was unremarkable except for mild pain with resisted hip flexion on right. Diagnosis was right hip flexor versus abductor strain. Patient was started on Naproxen and scheduled for follow up four days later. On follow up, pain persisted, but physical examination remained unchanged. Setting: Outpatient Orthopedic Sports Medicine Clinic. Results: X-ray of the hip returned unremarkable. A corticosteroid injection to right hip was given with mild relief immediately. Upon follow up he reported that his pain had worsened, and his ambulation now limited to 2 blocks with a straight cane, and he was limited in ADLs. An MRI was obtained and this revealed bone marrow edema suggestive of transient osteoporosis of the hip. Discussion: Transient osteoporosis of the hip is a rare cause of hip pain. It causes temporary bone loss in the hip, during which it is at greater risk for breaking. It is idiopathic in nature, seen in Asian population mostly in middle age men, and women in their third trimester of pregnancy. Patients present with acute onset severe hip pain, in the front of the thigh, the groin, the side of the hip, or the buttocks. Pain is worse with weight bearing, and a noticeable limp may be seen. ROM is slightly limited and is usually painless, except at extreme range. Most often occurs in the hip joint, but can also affect the knee, ankle and foot. The pain may increase over time and may become disabling. X-ray may show a subtle decrease in bone density of the femoral head, but this is very difficult to see. DEXA is not effective in diagnoses. MRI is the recommended method of investigation for
diagnosis and monitoring, which will show bone marrow edema. Treatment is conservative with analgesia and NSAIDs, a period of restricted weight bearing, physical therapy, and Calcium with Vitamin D. With proper diagnosis and treatment, most patients with can expect complete resolution of symptoms within 6 to 12 months. Bone strength will return to normal in the majority of cases. A small percentage of patients may have recurrence later in life, to the same hip or to the opposite hip. Conclusions: This case highlights the importance of entertaining the diagnosis of transient osteoporosis of the hip in patients presenting with complaints of acute hip pain as early accurate diagnosis is key. Level of Evidence: Level V Poster 131 Tibial Neuropathy Secondary to Baker Cyst: A Case Report Ryan Woods, MD (Mayo Clinic of Rochester, Rochester, MN, United States), Jacob L. Sellon, MD Disclosures: Ryan Woods: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 63-year-old man initially presenting to primary care clinic with 3-4 weeks of acute left low back pain with right lower limb pain and paresthesias. Lumbar radiographs showed degenerative changes, and a preliminary diagnosis of right S1 radiculopathy was made. After a course of physical therapy, patient’s low back pain improved, however, his right lower limb symptoms progressed. He was then referred to PM&R clinic. Setting: Tertiary Academic Medical Center. Results: On PM&R clinic examination, there were no compelling signs of lumbar radiculopathy. However, lower limb symptoms were reproduced with knee flexion and McMurray testing during knee examination. Electrodiagnostic testing revealed an active distal tibial mononeuropathy with ongoing re-innervation. Knee MRI demonstrated a degenerative medial meniscus tear with associated Baker cyst. There was increased T2 signal of the tibial nerve below the knee with patchy denervation changes within the deep posterior and anterior muscular compartments of the lower leg. Patient underwent ultrasound guided popliteal cyst aspiration/fenestration with knee joint corticosteroid injection. Symptoms resolved within two weeks following procedure. Discussion: Tibial neuropathy is uncommon and normally occurs within the popliteal fossa as the nerve passes under the arch of the soleus muscle. Less commonly, space-occupying lesions within the popliteal fossa, such as Baker cysts, can independently or secondarily contribute to nerve compression within this region. Symptoms can include weakness of ankle inversion and plantar flexion as well as sensory changes within the heel and occasionally along the sural nerve distribution. Careful clinical exam, electrodiagnosis, and soft tissue imaging with MRI or ultrasound are essential in making the diagnosis. Conclusions: Tibial neuropathy is a relatively uncommon lower limb neuropathy that may mimick S1 radiculopathy, though these can usually be distinguished by a careful clinical exam. Clinicians should consider tibial nerve entrapment in patients presenting with lower limb pain/paresthesias, especially in the setting of a popliteal cyst. Level of Evidence: Level V Poster 132 A Juxta-Articular Cyst of the Hip Causing Sciatic Nerve Compression in a Master Athlete: A Case Report Luis A. Sanchez-Colon, MD (University of Puerto Rico, Caguas, Puerto Rico, United States), Juan Carlos Galloza-Otero, MD, Luis Baerga, MD, William F. Micheo, MD Disclosures: Luis Sanchez-Colon: I Have No Relevant Financial Relationships To Disclose
Abstracts / PM R 8 (2016) S151-S332 Case/Program Description: Case of a 62-year-old female runner who presented with chronic left hip pain. It is worse with prolonged running and intermittent radiation to posterior thigh with associated recurrent hamstring strains. During a competition she felt left leg weakness and foot slapping symptoms. She denied prior trauma, hip injury or previous episodes of weakness. Physical examination revealed normal muscle bulk, no atrophy and no visible or palpable mass. She had mild tenderness over the posterior hip and left sacroiliac joint and presented loss of left hip external rotation with mild discomfort during internal/external rotation. Setting: Outpatient primary care sports medicine and pain clinic. Results: MRI revealed a small, well-circumscribed cyst identified along the anatomical course of the sciatic nerve, noted anterior to the piriformis muscle. Symptomatic compression of the sciatic nerve by a juxta-articular cyst was diagnosed, using musculoskeletal ultrasound. A sono-guided cyst aspiration was attempted but not successful, followed by a corticosteroid injection into the cyst. The patient only felt partial hip pain relief and was able to tolerate rehabilitation program and jogging for short distances. Treatment options offered include a second attempt of cyst aspiration and re-administration of corticosteroid injection or an intraarticular hip injection. Also an orthopedic evaluation will be requested. Discussion: Intervertebral disk disorders are the most common cause of sciatic pain. Atypical causes include acute external compression, trauma, piriformis syndrome, tumors, sacroiliac joint dysfunction and hip disorders. Few cases have been reported of sciatic nerve compression by juxta-articular cysts and to our knowledge, this is the first case reported in an athlete. Conclusions: This case presents a unique opportunity to evaluate the clinical considerations regarding atypical causes of sciatic pain, its diagnosis and treatment. Special considerations in management should be considered in this population in order to preserve patient’s functional status and athletic performance. Level of Evidence: Level V
Poster 133 Analysis of Pain and Functionality in Knee Osteoarthritis Patients after Sodium Hyaluronate Viscosupplementation Erika M. Suzigan, RN (Santa Casa Sao Paulo, Sao Paulo, Brazil), Eduardo E. Rocha, MD, Cyro Scala Jr, MD Disclosures: Erika Suzigan: I Have No Relevant Financial Relationships To Disclose Objective: The aim of this study was to evaluate the benefits in relation to pain, knee range of motion gain and functionality after intraarticular application of sodium hyaluronate in patients with primary knee osteoarthritis. Design: Cohort prospective study. Setting: Pain rehabilitation center. Participants: Viscosupplementation with sodium hyaluronate was studied in 13 patients with primary knee osteoarthritis, some bilateral, in a total of 24 knees. The sample is composed of 25% males and 75 % females, mean age of 60.1 years and mean body mass index of 27.27. Interventions: Five weekly hyaluronic acid infiltrations were applied in 24 knees. The patients were assessed before the study, after each application and 1 and 5 months after the last application. Main Outcome Measures: Lequesne index for knee osteoarthritis, Knee Range of Movement, Visual Analog Scale. Results: The pain scale (VAS) shows a statistically significant decrease from the initial assessment to the subsequent assessments. The same was observed in the Lequesne score, with significant differences (P>.016). The knee range of movement increases but not with a significant difference.
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Conclusions: The knee sodium hyaluronate viscosupplementation is a good therapeutic option in osteoarthritis to decrease pain, improve functionality at least 5 months. Level of Evidence: Level IV Poster 134 Treatment of Chronic Sacroiliac Pain in a Patient with Resolved Pyogenic Sacroiliitis in the Post-Partum State: A Case Report Kiersten Swayne, BS (UNC School of Medicine, Chapel Hill, North Carolina, United States), Dorothea H. Ellis, MD, Kevin Carneiro, DO, Michelle Ikoma Disclosures: Kiersten Swayne: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 29-year-old woman with persistent low back pain after treatment for post-partum pyogenic sacroiliitis. Setting: Outpatient clinic. Results: The patient first presented to the hospital with fever and low back pain 3 weeks postpartum and was found to have septic sacroiliitis. She received 7 weeks of intravenous antibiotics for oxacillinsensitive Staphylococcus aureus (OSSA) bacteremia secondary to pyogenic sacroiliitis. Although the etiology of this infection was unknown, the patient had undergone a spinal epidural prior to vaginal birth. She was monitored in the Infectious Disease clinic after discharge from the hospital, with resolution of infection and inflammatory markers normalized at 6 month follow up. Unfortunately, she reported persistent sacroiliac pain and was referred to PM&R for further management. Treatment with a sacroiliac steroid injection was not first pursued in this case, despite potential benefits in pain management, due to higher risk of recurrent infection. The patient was, therefore, prescribed a more conservative treatment program of pelvic rehabilitation as the initial intervention to address her chronic pain. Discussion: This is the first reported case, to our knowledge, of postpartum pyogenic sacroiliitis in a PM&R journal. While sacroiliitis is a common condition treated by physiatrists, infection is an uncommon source. Conclusions: Infections in the sacroiliac joint are a rare but possible cause of sacroiliitis. Prior to choosing steroidal injection as a treatment modality it is important to rule out infection as the potential source of a patient’s sacroiliitis. Level of Evidence: Level V Poster 135 Sonographic Evaluation of the Achilles and Patellar Tendons in Runners Belmarie Rodriguez Santiago, MD (University of Puerto Rico School of Medicine, San Juan, Puerto Rico, United States), Fernando Sepulveda Irizarry, MD, Rafael Acevedo, MD, Gerardo Miranda, William F. Micheo, MD, Luis Baerga, MD Disclosures: Belmarie Rodriguez Santiago: I Have No Relevant Financial Relationships To Disclose Objective: To evaluate sonographic measurements of the Achilles and Patellar tendons in runners and the impact that different factors might have on tendon thickness. Design: Cross-sectional study. Setting: Two running clubs near a University Hospital. Participants: 40 subjects who train consistently for races of variable distances (5k, 10K, half and full marathons) from two running clubs. Interventions: Sonographic measurement of the Achilles and Patellar tendons (long-axis and short-axis) were recorded and analyzed. Its relation to various intrinsic (age, body mass index, gender) and extrinsic (foot strike, surface, time and distance each person ran per
Abstracts / PM R 8 (2016) S151-S332
Design: Cross-sectional study. Setting: An academic PM&R residency program. Participants: 17 PM&R residents total, consisting of 7 postgraduate year 2 (PGY-2) residents, 5 PGY-3 residents, and 5 PGY-4 residents. The 7 PGY-2 residents were further subdivided into 2 residents with prior clinical MSK US training and 5 residents without prior clinical MSK US training. All PGY-3 and PGY-4 residents had completed prior clinical MSK US training. Interventions: Online questionnaire and competency examination. Main Outcome Measures: Average percentage correct score on competency examination and average value (graded on a scale from 1 e 5) of qualitative measures (interest, confidence, satisfaction, and importance) regarding MSK US. Results: Average correct score for all residents was 72.44% 6.53%. Average interest in MSK US was 3.94 0.49. Average confidence with MSK US basic concepts, US of the shoulder, and US of the wrist and hand was 2.71 0.44, 2.65 0.41, and 2.59 0.51, respectively. Average satisfaction with quantity and quality of MSK US education was 2.18 0.42 and 2.71 0.50, respectively. Average importance of MSK US education relative to other PM&R topics was 3.71 0.53. Conclusions: There is high interest in MSK US and high importance given to MSK US education by PM&R residents; unfortunately, there is low individual confidence and low satisfaction with the current educational curriculum. Competency examination shows a minimally competent knowledge of MSK US, which would benefit from targeted enhancement with additional time and resource investment. Level of Evidence: Level III Poster 130 A Rare Cause of Hip Pain in a Young Male. A Case Report Mary Apiafi, MD (Albert Einstein College of Medicine, Montefiore Medical Ctr, Bronx, NY, United States), Tony Wanich, MD Disclosures: Mary Apiafi: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 43-year-old man with acute onset of right hip pain, moderate intensity, 6/10, onset was a few days prior to presentation after doing shopping at the mall for a few hours. Location of pain was the right lateral hip and groin, more noticeable upon standing or twisting at the hips, aching, and relieved with rest. Ambulation was unlimited, and he was able to perform his ADLs without difficulty. Physical examination was unremarkable except for mild pain with resisted hip flexion on right. Diagnosis was right hip flexor versus abductor strain. Patient was started on Naproxen and scheduled for follow up four days later. On follow up, pain persisted, but physical examination remained unchanged. Setting: Outpatient Orthopedic Sports Medicine Clinic. Results: X-ray of the hip returned unremarkable. A corticosteroid injection to right hip was given with mild relief immediately. Upon follow up he reported that his pain had worsened, and his ambulation now limited to 2 blocks with a straight cane, and he was limited in ADLs. An MRI was obtained and this revealed bone marrow edema suggestive of transient osteoporosis of the hip. Discussion: Transient osteoporosis of the hip is a rare cause of hip pain. It causes temporary bone loss in the hip, during which it is at greater risk for breaking. It is idiopathic in nature, seen in Asian population mostly in middle age men, and women in their third trimester of pregnancy. Patients present with acute onset severe hip pain, in the front of the thigh, the groin, the side of the hip, or the buttocks. Pain is worse with weight bearing, and a noticeable limp may be seen. ROM is slightly limited and is usually painless, except at extreme range. Most often occurs in the hip joint, but can also affect the knee, ankle and foot. The pain may increase over time and may become disabling. X-ray may show a subtle decrease in bone density of the femoral head, but this is very difficult to see. DEXA is not effective in diagnoses. MRI is the recommended method of investigation for
diagnosis and monitoring, which will show bone marrow edema. Treatment is conservative with analgesia and NSAIDs, a period of restricted weight bearing, physical therapy, and Calcium with Vitamin D. With proper diagnosis and treatment, most patients with can expect complete resolution of symptoms within 6 to 12 months. Bone strength will return to normal in the majority of cases. A small percentage of patients may have recurrence later in life, to the same hip or to the opposite hip. Conclusions: This case highlights the importance of entertaining the diagnosis of transient osteoporosis of the hip in patients presenting with complaints of acute hip pain as early accurate diagnosis is key. Level of Evidence: Level V Poster 131 Tibial Neuropathy Secondary to Baker Cyst: A Case Report Ryan Woods, MD (Mayo Clinic of Rochester, Rochester, MN, United States), Jacob L. Sellon, MD Disclosures: Ryan Woods: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 63-year-old man initially presenting to primary care clinic with 3-4 weeks of acute left low back pain with right lower limb pain and paresthesias. Lumbar radiographs showed degenerative changes, and a preliminary diagnosis of right S1 radiculopathy was made. After a course of physical therapy, patient’s low back pain improved, however, his right lower limb symptoms progressed. He was then referred to PM&R clinic. Setting: Tertiary Academic Medical Center. Results: On PM&R clinic examination, there were no compelling signs of lumbar radiculopathy. However, lower limb symptoms were reproduced with knee flexion and McMurray testing during knee examination. Electrodiagnostic testing revealed an active distal tibial mononeuropathy with ongoing re-innervation. Knee MRI demonstrated a degenerative medial meniscus tear with associated Baker cyst. There was increased T2 signal of the tibial nerve below the knee with patchy denervation changes within the deep posterior and anterior muscular compartments of the lower leg. Patient underwent ultrasound guided popliteal cyst aspiration/fenestration with knee joint corticosteroid injection. Symptoms resolved within two weeks following procedure. Discussion: Tibial neuropathy is uncommon and normally occurs within the popliteal fossa as the nerve passes under the arch of the soleus muscle. Less commonly, space-occupying lesions within the popliteal fossa, such as Baker cysts, can independently or secondarily contribute to nerve compression within this region. Symptoms can include weakness of ankle inversion and plantar flexion as well as sensory changes within the heel and occasionally along the sural nerve distribution. Careful clinical exam, electrodiagnosis, and soft tissue imaging with MRI or ultrasound are essential in making the diagnosis. Conclusions: Tibial neuropathy is a relatively uncommon lower limb neuropathy that may mimick S1 radiculopathy, though these can usually be distinguished by a careful clinical exam. Clinicians should consider tibial nerve entrapment in patients presenting with lower limb pain/paresthesias, especially in the setting of a popliteal cyst. Level of Evidence: Level V Poster 132 A Juxta-Articular Cyst of the Hip Causing Sciatic Nerve Compression in a Master Athlete: A Case Report Luis A. Sanchez-Colon, MD (University of Puerto Rico, Caguas, Puerto Rico, United States), Juan Carlos Galloza-Otero, MD, Luis Baerga, MD, William F. Micheo, MD Disclosures: Luis Sanchez-Colon: I Have No Relevant Financial Relationships To Disclose
Abstracts / PM R 8 (2016) S151-S332 Case/Program Description: Case of a 62-year-old female runner who presented with chronic left hip pain. It is worse with prolonged running and intermittent radiation to posterior thigh with associated recurrent hamstring strains. During a competition she felt left leg weakness and foot slapping symptoms. She denied prior trauma, hip injury or previous episodes of weakness. Physical examination revealed normal muscle bulk, no atrophy and no visible or palpable mass. She had mild tenderness over the posterior hip and left sacroiliac joint and presented loss of left hip external rotation with mild discomfort during internal/external rotation. Setting: Outpatient primary care sports medicine and pain clinic. Results: MRI revealed a small, well-circumscribed cyst identified along the anatomical course of the sciatic nerve, noted anterior to the piriformis muscle. Symptomatic compression of the sciatic nerve by a juxta-articular cyst was diagnosed, using musculoskeletal ultrasound. A sono-guided cyst aspiration was attempted but not successful, followed by a corticosteroid injection into the cyst. The patient only felt partial hip pain relief and was able to tolerate rehabilitation program and jogging for short distances. Treatment options offered include a second attempt of cyst aspiration and re-administration of corticosteroid injection or an intraarticular hip injection. Also an orthopedic evaluation will be requested. Discussion: Intervertebral disk disorders are the most common cause of sciatic pain. Atypical causes include acute external compression, trauma, piriformis syndrome, tumors, sacroiliac joint dysfunction and hip disorders. Few cases have been reported of sciatic nerve compression by juxta-articular cysts and to our knowledge, this is the first case reported in an athlete. Conclusions: This case presents a unique opportunity to evaluate the clinical considerations regarding atypical causes of sciatic pain, its diagnosis and treatment. Special considerations in management should be considered in this population in order to preserve patient’s functional status and athletic performance. Level of Evidence: Level V
Poster 133 Analysis of Pain and Functionality in Knee Osteoarthritis Patients after Sodium Hyaluronate Viscosupplementation Erika M. Suzigan, RN (Santa Casa Sao Paulo, Sao Paulo, Brazil), Eduardo E. Rocha, MD, Cyro Scala Jr, MD Disclosures: Erika Suzigan: I Have No Relevant Financial Relationships To Disclose Objective: The aim of this study was to evaluate the benefits in relation to pain, knee range of motion gain and functionality after intraarticular application of sodium hyaluronate in patients with primary knee osteoarthritis. Design: Cohort prospective study. Setting: Pain rehabilitation center. Participants: Viscosupplementation with sodium hyaluronate was studied in 13 patients with primary knee osteoarthritis, some bilateral, in a total of 24 knees. The sample is composed of 25% males and 75 % females, mean age of 60.1 years and mean body mass index of 27.27. Interventions: Five weekly hyaluronic acid infiltrations were applied in 24 knees. The patients were assessed before the study, after each application and 1 and 5 months after the last application. Main Outcome Measures: Lequesne index for knee osteoarthritis, Knee Range of Movement, Visual Analog Scale. Results: The pain scale (VAS) shows a statistically significant decrease from the initial assessment to the subsequent assessments. The same was observed in the Lequesne score, with significant differences (P>.016). The knee range of movement increases but not with a significant difference.
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Conclusions: The knee sodium hyaluronate viscosupplementation is a good therapeutic option in osteoarthritis to decrease pain, improve functionality at least 5 months. Level of Evidence: Level IV Poster 134 Treatment of Chronic Sacroiliac Pain in a Patient with Resolved Pyogenic Sacroiliitis in the Post-Partum State: A Case Report Kiersten Swayne, BS (UNC School of Medicine, Chapel Hill, North Carolina, United States), Dorothea H. Ellis, MD, Kevin Carneiro, DO, Michelle Ikoma Disclosures: Kiersten Swayne: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 29-year-old woman with persistent low back pain after treatment for post-partum pyogenic sacroiliitis. Setting: Outpatient clinic. Results: The patient first presented to the hospital with fever and low back pain 3 weeks postpartum and was found to have septic sacroiliitis. She received 7 weeks of intravenous antibiotics for oxacillinsensitive Staphylococcus aureus (OSSA) bacteremia secondary to pyogenic sacroiliitis. Although the etiology of this infection was unknown, the patient had undergone a spinal epidural prior to vaginal birth. She was monitored in the Infectious Disease clinic after discharge from the hospital, with resolution of infection and inflammatory markers normalized at 6 month follow up. Unfortunately, she reported persistent sacroiliac pain and was referred to PM&R for further management. Treatment with a sacroiliac steroid injection was not first pursued in this case, despite potential benefits in pain management, due to higher risk of recurrent infection. The patient was, therefore, prescribed a more conservative treatment program of pelvic rehabilitation as the initial intervention to address her chronic pain. Discussion: This is the first reported case, to our knowledge, of postpartum pyogenic sacroiliitis in a PM&R journal. While sacroiliitis is a common condition treated by physiatrists, infection is an uncommon source. Conclusions: Infections in the sacroiliac joint are a rare but possible cause of sacroiliitis. Prior to choosing steroidal injection as a treatment modality it is important to rule out infection as the potential source of a patient’s sacroiliitis. Level of Evidence: Level V Poster 135 Sonographic Evaluation of the Achilles and Patellar Tendons in Runners Belmarie Rodriguez Santiago, MD (University of Puerto Rico School of Medicine, San Juan, Puerto Rico, United States), Fernando Sepulveda Irizarry, MD, Rafael Acevedo, MD, Gerardo Miranda, William F. Micheo, MD, Luis Baerga, MD Disclosures: Belmarie Rodriguez Santiago: I Have No Relevant Financial Relationships To Disclose Objective: To evaluate sonographic measurements of the Achilles and Patellar tendons in runners and the impact that different factors might have on tendon thickness. Design: Cross-sectional study. Setting: Two running clubs near a University Hospital. Participants: 40 subjects who train consistently for races of variable distances (5k, 10K, half and full marathons) from two running clubs. Interventions: Sonographic measurement of the Achilles and Patellar tendons (long-axis and short-axis) were recorded and analyzed. Its relation to various intrinsic (age, body mass index, gender) and extrinsic (foot strike, surface, time and distance each person ran per