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Poster 133 Analysis of Pain and Functionality in Knee Osteoarthritis Patients after Sodium Hyaluronate Viscosupplementation
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
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.
S205
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