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Poster 211: Transient Osteoporosis of the Hip in Pregnancy Presenting as Low Back Pain: A Case Report
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Poster 211 Transient Osteoporosis of the Hip in Pregnancy Presenting as Low Back Pain: A Case Report. Ramya Nagarajan, MD (William Beaumont Hospital, Royal Oak, MI); Christine C. Chamberlain, MD. Disclosures: R. Nagarajan, None. Patients or Programs: A 31-year-old pregnant woman with low back pain 3 weeks before delivery. Program Description: This patient was seen in the hospital for low back radiating to the right knee. Based on history and clinical examination, differential at that time included sacroiliitis versus less likely low-grade lumbar radiculopathy. She was sent home with an SI belt and physical therapy for stretching and lumbar stabilization. She returned for follow up in the resident clinic 3 weeks postpartum when she demonstrated antalgic gait and significant hip irritability. A radiograph of the hips revealed asymmetrically increased osteopenia involving the right femoral head with blurring of the trabecular markings suspicious for transient osteoporosis of the hip. She was immediately asked to get an MRI of the hip, which showed multiple patchy regions of bone marrow edema in the right femoral head, acetabulum, ischial tuberosity, left femoral head and left acetabulum, which confirmed transient osteoporosis. Setting: PM and R resident clinic. Results: She continued to take NSAIDs and narcotic medications but refused to go to physical therapy, because it had not worked for her previously. The hip pain improved within 2 months of her delivery and she was walking without any assist device and without a limp. She was advised to follow up for another MRI or radiograph to make sure she did not have AVN. Conclusions: Transient osteoporosis of the hip during pregnancy is an uncommon condition, which must be suspected in any patient presenting with low back pain that radiates to the knee. It may occur concurrently with mechanical low back pain or radiculopathy. A high level of suspicion as well as thorough musculoskeletal and gait examinations are imperative to prevent deleterious outcomes such as femoral neck fracture or subsequent AVN.
Poster 212 Ultrasound Diagnosis of Symptomatic Epineural Ganglion Cyst of the Ulnar Nerve: A Case Report. Irim Ciolino, MD (National Rehabilitation Hospital, Washington, DC); Victor Ibrahim, MD. Disclosures: I. Ciolino, None. Patients or Programs: A 35-year-old woman with ulnar nerve compression by a ganglion cyst in her right forearm. Program Description: The patient presented to the outpatient physiatry clinic with complaints of chronic burning
PRESENTATIONS
pain, paresthesias, and numbness in her right forearm, medial wrist, and fifth digit. These symptoms began insidiously over 10 years prior, but had recently worsened in severity over the last 6 months. Before initial presentation, she had extensive medical treatment including physical therapy, splinting and Lyrica with no improvement. On examination her sensation to light touch was diminished along the right medial forearm, wrist and fifth digit. She was also noted to have decreased hand grip strength, negative cervical compression testing, and negative Tinel sign at the wrist and elbow. Electrodiagnostic studies were obtained which demonstrated an isolated dorsal ulnar cutaneous neuropathy. Given these findings, she underwent ultrasound examination of the right distal extremity, which demonstrated a 1-cm diffuse epineural cyst extending from the cubital tunnel to the ulnar styloid. She then underwent a steroid injection into the cyst, which provided temporary relief of symptoms. The patient was eventually referred to orthopedic surgery and underwent ulnar nerve decompression surgery. Setting: Rehabilitation outpatient clinic. Results: At 8 weeks after surgery, she had complete resolution of all her symptoms and successfully completed occupational therapy. Discussion: While ulnar neuropathic pain syndromes are a common presentation to physiatry, this case demonstrates the effective use of neurodiagnostics and ultrasound in expediting the unique diagnosis of a symptomatic ulnar epineural cyst. Conclusions: Musculoskeletal ultrasound should be considered as an extension of the physical examination, allowing the practitioner to more quickly and efficiently determine an accurate diagnosis in patients with vague peripheral neuropathy.
Poster 213 Ultrasound-guided Platelet-rich Plasma Injection in a 70-Year-Old Tennis Player With a Partial Tear of the Achilles Tendon: A Case Report. Thomas R. Saullo, MD (Hospital for Special Surgery, New York, NY); David Hoffman; Gregory E. Lutz, MD. Disclosures: T. R. Saullo, None. Patients or Programs: A 70-year-old man presenting with a chronic partial tear of the Achilles tendon. Program Description: This case report describes the clinical and radiographic response of a partial tear of the Achilles tendon to platelet rich plasma (PRP) injections. The patient presented with 1 week of persistent left calf pain. Initial treatment consisted of 2 weeks of relative rest and use of a Cam Walker boot after which the patient reported no pain. However, 5 weeks after the injury the patient attempted to resume playing tennis resulting in an immediate return of pain. An MRI of his left ankle 8 weeks after the initial injury
Poster 211 Transient Osteoporosis of the Hip in Pregnancy Presenting as Low Back Pain: A Case Report. Ramya Nagarajan, MD (William Beaumont Hospital, Royal Oak, MI); Christine C. Chamberlain, MD. Disclosures: R. Nagarajan, None. Patients or Programs: A 31-year-old pregnant woman with low back pain 3 weeks before delivery. Program Description: This patient was seen in the hospital for low back radiating to the right knee. Based on history and clinical examination, differential at that time included sacroiliitis versus less likely low-grade lumbar radiculopathy. She was sent home with an SI belt and physical therapy for stretching and lumbar stabilization. She returned for follow up in the resident clinic 3 weeks postpartum when she demonstrated antalgic gait and significant hip irritability. A radiograph of the hips revealed asymmetrically increased osteopenia involving the right femoral head with blurring of the trabecular markings suspicious for transient osteoporosis of the hip. She was immediately asked to get an MRI of the hip, which showed multiple patchy regions of bone marrow edema in the right femoral head, acetabulum, ischial tuberosity, left femoral head and left acetabulum, which confirmed transient osteoporosis. Setting: PM and R resident clinic. Results: She continued to take NSAIDs and narcotic medications but refused to go to physical therapy, because it had not worked for her previously. The hip pain improved within 2 months of her delivery and she was walking without any assist device and without a limp. She was advised to follow up for another MRI or radiograph to make sure she did not have AVN. Conclusions: Transient osteoporosis of the hip during pregnancy is an uncommon condition, which must be suspected in any patient presenting with low back pain that radiates to the knee. It may occur concurrently with mechanical low back pain or radiculopathy. A high level of suspicion as well as thorough musculoskeletal and gait examinations are imperative to prevent deleterious outcomes such as femoral neck fracture or subsequent AVN.
Poster 212 Ultrasound Diagnosis of Symptomatic Epineural Ganglion Cyst of the Ulnar Nerve: A Case Report. Irim Ciolino, MD (National Rehabilitation Hospital, Washington, DC); Victor Ibrahim, MD. Disclosures: I. Ciolino, None. Patients or Programs: A 35-year-old woman with ulnar nerve compression by a ganglion cyst in her right forearm. Program Description: The patient presented to the outpatient physiatry clinic with complaints of chronic burning
PRESENTATIONS
pain, paresthesias, and numbness in her right forearm, medial wrist, and fifth digit. These symptoms began insidiously over 10 years prior, but had recently worsened in severity over the last 6 months. Before initial presentation, she had extensive medical treatment including physical therapy, splinting and Lyrica with no improvement. On examination her sensation to light touch was diminished along the right medial forearm, wrist and fifth digit. She was also noted to have decreased hand grip strength, negative cervical compression testing, and negative Tinel sign at the wrist and elbow. Electrodiagnostic studies were obtained which demonstrated an isolated dorsal ulnar cutaneous neuropathy. Given these findings, she underwent ultrasound examination of the right distal extremity, which demonstrated a 1-cm diffuse epineural cyst extending from the cubital tunnel to the ulnar styloid. She then underwent a steroid injection into the cyst, which provided temporary relief of symptoms. The patient was eventually referred to orthopedic surgery and underwent ulnar nerve decompression surgery. Setting: Rehabilitation outpatient clinic. Results: At 8 weeks after surgery, she had complete resolution of all her symptoms and successfully completed occupational therapy. Discussion: While ulnar neuropathic pain syndromes are a common presentation to physiatry, this case demonstrates the effective use of neurodiagnostics and ultrasound in expediting the unique diagnosis of a symptomatic ulnar epineural cyst. Conclusions: Musculoskeletal ultrasound should be considered as an extension of the physical examination, allowing the practitioner to more quickly and efficiently determine an accurate diagnosis in patients with vague peripheral neuropathy.
Poster 213 Ultrasound-guided Platelet-rich Plasma Injection in a 70-Year-Old Tennis Player With a Partial Tear of the Achilles Tendon: A Case Report. Thomas R. Saullo, MD (Hospital for Special Surgery, New York, NY); David Hoffman; Gregory E. Lutz, MD. Disclosures: T. R. Saullo, None. Patients or Programs: A 70-year-old man presenting with a chronic partial tear of the Achilles tendon. Program Description: This case report describes the clinical and radiographic response of a partial tear of the Achilles tendon to platelet rich plasma (PRP) injections. The patient presented with 1 week of persistent left calf pain. Initial treatment consisted of 2 weeks of relative rest and use of a Cam Walker boot after which the patient reported no pain. However, 5 weeks after the injury the patient attempted to resume playing tennis resulting in an immediate return of pain. An MRI of his left ankle 8 weeks after the initial injury