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Poster 159 Assessing the Accuracy of Ultrasound Guided Carpometacarpal Joint Injections: A Cadaver Study
S214
Abstracts / PM R 8 (2016) S151-S332
precise localization of swelling (intra- vs extra-articular), and would have spared this patient myriad intra-articular needling attempts. Furthermore, in those with symptomatic gouty tophus, sonographically-guided tophus aspiration could be therapeutic. Conclusions: Just as it is useful for evaluating a traumatic knee injury, musculoskeletal ultrasound can aid in localizing and characterizing lesions of atraumatic knee swelling. Level of Evidence: Level V Poster 159 Assessing the Accuracy of Ultrasound Guided Carpometacarpal Joint Injections: A Cadaver Study Armen Derian, MD (University of Miami, Miami, FL, United States), Ricardo Vasquez-Duarte, MD, Julia Amundson, BS, Douglas Johnson-Greene, PhD Disclosures: Armen Derian: I Have No Relevant Financial Relationships To Disclose Objective: To determine the accuracy of ultrasound guidance when injecting the carpometacarpal (CMC) joint, as compared to palpation based (“blind”) injections. Design: Randomized, blinded, prospective. Setting: University anatomy laboratory. Participants: 18 embalmed cadavers, 36 CMC joints. Interventions: 18 CMC joints were randomized to ultrasound guided injections and the other 18 to palpation based injections. 1cc of blue latex solution was injected into each joint. The specimens were then dissected, and the distribution of the latex was graded for accuracy of the intraarticular injection by two independent raters. Main Outcome Measures: Accuracy was based on a four-point rating scale of 0-25%, 26-50%, 51-75%, 76-100% of the latex solution within the joint. Inter-rater reliability was also a secondary measure. Results: Accuracy was 50% or less for both blind (n ¼ 11 of 18 cases) and ultrasound (12 of 18 cases) conditions. The mean rating was 2.1 for the blind and the ultrasound conditions, which was not statistically significant (F ¼ .04; P < .76). Chi-square analysis testing differences in accuracy for the two conditions was not statistically significant. Interrater reliability was calculated to ascertain the accuracy of the ratings between the two independent raters. The Cronbach’s alpha for rater 1 was .74, which represents an acceptable level of reliability. Friedman’s Chi square for the two raters was 2.3 (P < .13) indicating no significant difference between raters. For Rater 2 the Cronbach’s alpha was .63, which is slightly below an acceptable level of reliability. Friedman’s Chi square for the index and rater 2 comparison was 5.7 (P < .017), which did suggest statistically significant differences between raters. Conclusions: Ultrasound guidance did not improve the accuracy of CMC joint injections in cadavers. However, the high reliability minimizes random error of the instrument, the assessment scale, which can be used in future studies. Level of Evidence: Level II Poster 160 Transient Unilateral Ptosis in Collegiate Hockey Player Due to Concussion: A Case Report Gene Tekmyster, DO (The Orthopaedic and Sports Medical Center, New York, NY, United States), Arya Minaie, MS1 Disclosures: Gene Tekmyster: I Have No Relevant Financial Relationships To Disclose Case/Program Description: Patient is a 19-year-old female collegiate ice hockey goalie who was struck in the left temple area with a puck during practice. She was wearing her usual protection, including a helmet. The patient has a history of one previously diagnosed sports related concussion (SRC). Immediately after impact, patient felt the onset of a headache, pressure behind her left eye, and blurry vision.
A CT of the head was taken in the emergency department (ED) and was noted as negative for fractures and hemorrhage. Examination by an ophthalmologist revealed 20/50 visual acuity in the left eye. MRI was ordered and was negative for any acute abnormalities. An incidental finding of T2 hyperintense lesion within the pituitary gland was found. A Neurologist examination several days later noted a normal physical exam with the exception of left eye ptosis. Three weeks after injury, all concussion symptoms were resolved with persistent unilateral left eye ptosis. The patient, at this point, had returned to a full academic schedule, but was still restricted from athletic activity. Six weeks after initial injury the patient had resolution of all symptoms, including ptosis, and after negative repeat MRI and MRA was cleared to return to full athletic participation by both the neurologist and team physician. Setting: Outpatient multi specialty sports medicine practice. Results: N/A. Discussion: Cranial nerve palsies are rarely seen in minor head trauma and are even less commonly seen in patients with normal brain imaging. When evaluating athletes for SRC, clinicians need to be vigilant to rule out any potential brain injury, especially with focal neurologic findings. Several cases of concussion related cranial nerve palsy have been reported in the literature with no clear etiology. Conclusions: To the best of our knowledge, concussion related third cranial nerve palsy without internuclear opthalmoplegia and normal imaging has not been previously described in the literature. Level of Evidence: Level IV Poster 161 Descriptive Study of Injuries in High School Baseball Academy Juan C. Perez, MD (University of Puerto Rico, Arecibo, Puerto Rico, United States), William F. Micheo, MD, Gerardo Miranda-Comas, MD, Jose L. Rios Russo, MSIV, Brian M. Cervoni, MD Disclosures: Juan Perez: I Have No Relevant Financial Relationships To Disclose Objective: To investigate the most common type of injuries in athletes who trained in high school baseball academies. Design: Observational Cohort Study. Setting: Baseball High School Academy. Participants: 116 baseball athletes ranging from ages 15-18 in high school from grades 10-12. Interventions: Not applicable. Main Outcome Measures: Injuries and opportunities for injury (exposures) were recorded daily by a certified athletic trainer for an academic year. The definition for injury was defined as any event reported that required removal from practice or game. Data recorded included body part, type of injury, time loss from participation, new or recurrence, and whether it occurred in practice or game. Athlete exposure ratio was calculated to determine rate of injury per 1000 athlete exposures. Results: Injury rates utilizing athletes-exposures (A-Es) resulted in 6.18 per 1000 A-Es. The most common injured body part was the dominant shoulder/elbow region, accounting for 35% of all reported injuries. The most common type of injury was of the muscle tendon strain variety, accounting for 80% of all reported injury types. Injuries where three times more likely to occur during practice when compared to games. Although the injury rate is low compared to other sports, 50% of injuries are severe and required at least 8 days of time loss from participation. There was a 23% recurrence rate of injury throughout the year. Conclusions: The most common injury reported was dominant shoulder/elbow injuries of the muscle tendon strain variety. Injuries are more likely to occur during practice and half of reported injuries require more than 8 days time loss from activity. Rate of injury is similar compared to previous reported studies involving high school baseball athletes. Level of Evidence: Level I
Abstracts / PM R 8 (2016) S151-S332
precise localization of swelling (intra- vs extra-articular), and would have spared this patient myriad intra-articular needling attempts. Furthermore, in those with symptomatic gouty tophus, sonographically-guided tophus aspiration could be therapeutic. Conclusions: Just as it is useful for evaluating a traumatic knee injury, musculoskeletal ultrasound can aid in localizing and characterizing lesions of atraumatic knee swelling. Level of Evidence: Level V Poster 159 Assessing the Accuracy of Ultrasound Guided Carpometacarpal Joint Injections: A Cadaver Study Armen Derian, MD (University of Miami, Miami, FL, United States), Ricardo Vasquez-Duarte, MD, Julia Amundson, BS, Douglas Johnson-Greene, PhD Disclosures: Armen Derian: I Have No Relevant Financial Relationships To Disclose Objective: To determine the accuracy of ultrasound guidance when injecting the carpometacarpal (CMC) joint, as compared to palpation based (“blind”) injections. Design: Randomized, blinded, prospective. Setting: University anatomy laboratory. Participants: 18 embalmed cadavers, 36 CMC joints. Interventions: 18 CMC joints were randomized to ultrasound guided injections and the other 18 to palpation based injections. 1cc of blue latex solution was injected into each joint. The specimens were then dissected, and the distribution of the latex was graded for accuracy of the intraarticular injection by two independent raters. Main Outcome Measures: Accuracy was based on a four-point rating scale of 0-25%, 26-50%, 51-75%, 76-100% of the latex solution within the joint. Inter-rater reliability was also a secondary measure. Results: Accuracy was 50% or less for both blind (n ¼ 11 of 18 cases) and ultrasound (12 of 18 cases) conditions. The mean rating was 2.1 for the blind and the ultrasound conditions, which was not statistically significant (F ¼ .04; P < .76). Chi-square analysis testing differences in accuracy for the two conditions was not statistically significant. Interrater reliability was calculated to ascertain the accuracy of the ratings between the two independent raters. The Cronbach’s alpha for rater 1 was .74, which represents an acceptable level of reliability. Friedman’s Chi square for the two raters was 2.3 (P < .13) indicating no significant difference between raters. For Rater 2 the Cronbach’s alpha was .63, which is slightly below an acceptable level of reliability. Friedman’s Chi square for the index and rater 2 comparison was 5.7 (P < .017), which did suggest statistically significant differences between raters. Conclusions: Ultrasound guidance did not improve the accuracy of CMC joint injections in cadavers. However, the high reliability minimizes random error of the instrument, the assessment scale, which can be used in future studies. Level of Evidence: Level II Poster 160 Transient Unilateral Ptosis in Collegiate Hockey Player Due to Concussion: A Case Report Gene Tekmyster, DO (The Orthopaedic and Sports Medical Center, New York, NY, United States), Arya Minaie, MS1 Disclosures: Gene Tekmyster: I Have No Relevant Financial Relationships To Disclose Case/Program Description: Patient is a 19-year-old female collegiate ice hockey goalie who was struck in the left temple area with a puck during practice. She was wearing her usual protection, including a helmet. The patient has a history of one previously diagnosed sports related concussion (SRC). Immediately after impact, patient felt the onset of a headache, pressure behind her left eye, and blurry vision.
A CT of the head was taken in the emergency department (ED) and was noted as negative for fractures and hemorrhage. Examination by an ophthalmologist revealed 20/50 visual acuity in the left eye. MRI was ordered and was negative for any acute abnormalities. An incidental finding of T2 hyperintense lesion within the pituitary gland was found. A Neurologist examination several days later noted a normal physical exam with the exception of left eye ptosis. Three weeks after injury, all concussion symptoms were resolved with persistent unilateral left eye ptosis. The patient, at this point, had returned to a full academic schedule, but was still restricted from athletic activity. Six weeks after initial injury the patient had resolution of all symptoms, including ptosis, and after negative repeat MRI and MRA was cleared to return to full athletic participation by both the neurologist and team physician. Setting: Outpatient multi specialty sports medicine practice. Results: N/A. Discussion: Cranial nerve palsies are rarely seen in minor head trauma and are even less commonly seen in patients with normal brain imaging. When evaluating athletes for SRC, clinicians need to be vigilant to rule out any potential brain injury, especially with focal neurologic findings. Several cases of concussion related cranial nerve palsy have been reported in the literature with no clear etiology. Conclusions: To the best of our knowledge, concussion related third cranial nerve palsy without internuclear opthalmoplegia and normal imaging has not been previously described in the literature. Level of Evidence: Level IV Poster 161 Descriptive Study of Injuries in High School Baseball Academy Juan C. Perez, MD (University of Puerto Rico, Arecibo, Puerto Rico, United States), William F. Micheo, MD, Gerardo Miranda-Comas, MD, Jose L. Rios Russo, MSIV, Brian M. Cervoni, MD Disclosures: Juan Perez: I Have No Relevant Financial Relationships To Disclose Objective: To investigate the most common type of injuries in athletes who trained in high school baseball academies. Design: Observational Cohort Study. Setting: Baseball High School Academy. Participants: 116 baseball athletes ranging from ages 15-18 in high school from grades 10-12. Interventions: Not applicable. Main Outcome Measures: Injuries and opportunities for injury (exposures) were recorded daily by a certified athletic trainer for an academic year. The definition for injury was defined as any event reported that required removal from practice or game. Data recorded included body part, type of injury, time loss from participation, new or recurrence, and whether it occurred in practice or game. Athlete exposure ratio was calculated to determine rate of injury per 1000 athlete exposures. Results: Injury rates utilizing athletes-exposures (A-Es) resulted in 6.18 per 1000 A-Es. The most common injured body part was the dominant shoulder/elbow region, accounting for 35% of all reported injuries. The most common type of injury was of the muscle tendon strain variety, accounting for 80% of all reported injury types. Injuries where three times more likely to occur during practice when compared to games. Although the injury rate is low compared to other sports, 50% of injuries are severe and required at least 8 days of time loss from participation. There was a 23% recurrence rate of injury throughout the year. Conclusions: The most common injury reported was dominant shoulder/elbow injuries of the muscle tendon strain variety. Injuries are more likely to occur during practice and half of reported injuries require more than 8 days time loss from activity. Rate of injury is similar compared to previous reported studies involving high school baseball athletes. Level of Evidence: Level I