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Poster 227 Rehabilitation of a Patient With Delayed Fixation of Pubic Symphysis Diastasis: A Case Report
PM&R
Poster 225 Ultrasonographic Identification of Coracohumeral Ligament: A Cadaveric Study. Sun G. Chung, MD, PhD (SNUH, Seoul, Korea, Republic of); So-Ra Baek, PhD, Seung Ho Han, Hogeun Kim, Keewon Kim, U-Young Lee. Disclosures: S. G. Chung, none. Objective: To identify which structure under ultrasonographic view is the true coracohumeral ligament (CHL) by correlating sonographic versus dissectional anatomy. Design: Prospective laboratory investigation. Setting: Anatomy laboratory at a medical school. Participants: 10 fresh frozen cadaveric shoulders. Interventions: With ultrasonography, 3 structures, which originated from the coracoid process inserting into the rotator interval, were identified as possible CHLs: an echogenic band from the lateral tip of the coracoid process to the rotator interval, a fibrillar structure that originated on the upper surface of the coracoid process, and a hypoechoic structure immediately under the coracoacromial ligament that originated from the mid portion of the coracoid process. Under ultrasound guidance, 3 different colored rubber markers were inserted into each of the structures through a 16-gauge intravenous catheter. Main Outcome Measures: Anatomical dissection was done to find which structure with a specific colored marker was the real CHL. Results: The lateral tip of the coracoid process to the rotator interval was identified to be loose fascial connective tissues covering the subscapularis tendon. The upper surface of the coracoid process was found to be the pectoralis minor tendon overriding the coracoid process. mid portion of the coracoid process was the true CHL, which was visualized more prominently by rotating the shoulder externally. Conclusions: CHL was identified as the structure that originated from the mid portion of the coracoids process deeper to the coracoacromial ligament, with slightly low echogenicity. It should be noted that the adjacent connective tissues could be easily confused with CHL.
Poster 226 Hip and Pelvic Pathology Mimicking Lumbago: A Retrospective Chart Review of Spine Center Referrals. Akhil Chhatre, MD (University of Kansas Medical Center, Leawood, KS, United States); George Varghese, MD. Disclosures: A. Chhatre, none. Objective: To examine the percentage of nonspinal causes of pain among patients referred to an academic comprehensive spine center as lumbago. Our hypothesis is that primary hip and pelvis pathology does indeed present as lumbago approximately 20% of the time, including radiating pain down the lower extremity. Design: Retrospective chart review. Setting: New outpatient referrals for back pain seen in academic spine center. Participants: New outpatient referrals for back pain seen in the spine center from November 2008 to November 2010. Interventions: Not applicable.
Vol. 3, Iss. 10S1, 2011
S249
Main Outcome Measures: The retrospective chart review was conducted by using common lumbago hip and pelvic pathology diagnosis codes used in the spine center. This was compared with the total new lumbago incidence seen in the spine center by the same physicians. We also examined the history of presenting illness, positive physical examination findings, and final diagnosis to better understand the presentation. Results: There were 500 patients who presented as new referrals for lumbago. Of these patients, 20% were given a primary diagnosis of hip or pelvic pathology, such as degenerative joint disease, sacroiliitis, trochanteric bursitis, or avascular necrosis, based on positive physical examination findings, history, and/or after final medical workup. Conclusions: The true incidence of primary hip pathology presenting as lumbago is higher than the general clinician may suspect. Based on our findings, we believe that this should be explored on a larger scale. In addition, the physician should be aware of hip pathology mimicking lumbago so to avoid unnecessary investigations and expensive interventional procedures.
Poster 227 Rehabilitation of a Patient With Delayed Fixation of Pubic Symphysis Diastasis: A Case Report. Bobby Oommen, MD (SUNY Downstate Medical Center, Brooklyn, NY, United States); Matthew Dounel, MD MPH, Paul A. Pipia, MD. Disclosures: B. Oommen, none. Patients or Programs: A 56-year-old African American woman. Program Description: The patient, with medical history of degenerative disease of bilateral knee joints, presented to the emergency department with pain in pelvic area after a fall. Pelvic radiographs revealed pubic symphysis diastasis of 4 cm, and she was treated conservatively. She failed conservative medical management secondary to pain, and 4 months later underwent internal fixation of the left sacroiliac joint with fixation of the anterior pubis with revision 1 week later. She reported no bowel or bladder dysfunction. During this period, she was advised non-weight bearing on the left leg and weight bearing as tolerated on the right side, and was discharged to a subacute facility. However, the patient was unable to ambulate, so the anterior pelvic hardware was removed after 3 months of placement and was referred to acute inpatient rehabilitation for ambulation. Setting: Acute inpatient rehabilitation. Results: The patient made progress in acute rehabilitation and was able to walk independently with a walker and decreased pain. Discussion: Pelvic diastasis of more than 1 cm in female patients with multiple child birth may be normal width but diastasis more than 2.5 cm represents ligamentous damage at sacroiliac joint and maybe associated with bladder or urethral injury. Surgical fixation is indicated for diastasis of more than 2.5 cm for early stabilization of the pelvis, resulting in pain relief and thereby faster rehabilitation. Conclusions: Early fixation of pelvic diastasis of more than 2.5 cm results in better pain relief and early ambulation. Late fixation may result in inability to fully close the diastasis and functional impairment due to pain and instability.
Poster 225 Ultrasonographic Identification of Coracohumeral Ligament: A Cadaveric Study. Sun G. Chung, MD, PhD (SNUH, Seoul, Korea, Republic of); So-Ra Baek, PhD, Seung Ho Han, Hogeun Kim, Keewon Kim, U-Young Lee. Disclosures: S. G. Chung, none. Objective: To identify which structure under ultrasonographic view is the true coracohumeral ligament (CHL) by correlating sonographic versus dissectional anatomy. Design: Prospective laboratory investigation. Setting: Anatomy laboratory at a medical school. Participants: 10 fresh frozen cadaveric shoulders. Interventions: With ultrasonography, 3 structures, which originated from the coracoid process inserting into the rotator interval, were identified as possible CHLs: an echogenic band from the lateral tip of the coracoid process to the rotator interval, a fibrillar structure that originated on the upper surface of the coracoid process, and a hypoechoic structure immediately under the coracoacromial ligament that originated from the mid portion of the coracoid process. Under ultrasound guidance, 3 different colored rubber markers were inserted into each of the structures through a 16-gauge intravenous catheter. Main Outcome Measures: Anatomical dissection was done to find which structure with a specific colored marker was the real CHL. Results: The lateral tip of the coracoid process to the rotator interval was identified to be loose fascial connective tissues covering the subscapularis tendon. The upper surface of the coracoid process was found to be the pectoralis minor tendon overriding the coracoid process. mid portion of the coracoid process was the true CHL, which was visualized more prominently by rotating the shoulder externally. Conclusions: CHL was identified as the structure that originated from the mid portion of the coracoids process deeper to the coracoacromial ligament, with slightly low echogenicity. It should be noted that the adjacent connective tissues could be easily confused with CHL.
Poster 226 Hip and Pelvic Pathology Mimicking Lumbago: A Retrospective Chart Review of Spine Center Referrals. Akhil Chhatre, MD (University of Kansas Medical Center, Leawood, KS, United States); George Varghese, MD. Disclosures: A. Chhatre, none. Objective: To examine the percentage of nonspinal causes of pain among patients referred to an academic comprehensive spine center as lumbago. Our hypothesis is that primary hip and pelvis pathology does indeed present as lumbago approximately 20% of the time, including radiating pain down the lower extremity. Design: Retrospective chart review. Setting: New outpatient referrals for back pain seen in academic spine center. Participants: New outpatient referrals for back pain seen in the spine center from November 2008 to November 2010. Interventions: Not applicable.
Vol. 3, Iss. 10S1, 2011
S249
Main Outcome Measures: The retrospective chart review was conducted by using common lumbago hip and pelvic pathology diagnosis codes used in the spine center. This was compared with the total new lumbago incidence seen in the spine center by the same physicians. We also examined the history of presenting illness, positive physical examination findings, and final diagnosis to better understand the presentation. Results: There were 500 patients who presented as new referrals for lumbago. Of these patients, 20% were given a primary diagnosis of hip or pelvic pathology, such as degenerative joint disease, sacroiliitis, trochanteric bursitis, or avascular necrosis, based on positive physical examination findings, history, and/or after final medical workup. Conclusions: The true incidence of primary hip pathology presenting as lumbago is higher than the general clinician may suspect. Based on our findings, we believe that this should be explored on a larger scale. In addition, the physician should be aware of hip pathology mimicking lumbago so to avoid unnecessary investigations and expensive interventional procedures.
Poster 227 Rehabilitation of a Patient With Delayed Fixation of Pubic Symphysis Diastasis: A Case Report. Bobby Oommen, MD (SUNY Downstate Medical Center, Brooklyn, NY, United States); Matthew Dounel, MD MPH, Paul A. Pipia, MD. Disclosures: B. Oommen, none. Patients or Programs: A 56-year-old African American woman. Program Description: The patient, with medical history of degenerative disease of bilateral knee joints, presented to the emergency department with pain in pelvic area after a fall. Pelvic radiographs revealed pubic symphysis diastasis of 4 cm, and she was treated conservatively. She failed conservative medical management secondary to pain, and 4 months later underwent internal fixation of the left sacroiliac joint with fixation of the anterior pubis with revision 1 week later. She reported no bowel or bladder dysfunction. During this period, she was advised non-weight bearing on the left leg and weight bearing as tolerated on the right side, and was discharged to a subacute facility. However, the patient was unable to ambulate, so the anterior pelvic hardware was removed after 3 months of placement and was referred to acute inpatient rehabilitation for ambulation. Setting: Acute inpatient rehabilitation. Results: The patient made progress in acute rehabilitation and was able to walk independently with a walker and decreased pain. Discussion: Pelvic diastasis of more than 1 cm in female patients with multiple child birth may be normal width but diastasis more than 2.5 cm represents ligamentous damage at sacroiliac joint and maybe associated with bladder or urethral injury. Surgical fixation is indicated for diastasis of more than 2.5 cm for early stabilization of the pelvis, resulting in pain relief and thereby faster rehabilitation. Conclusions: Early fixation of pelvic diastasis of more than 2.5 cm results in better pain relief and early ambulation. Late fixation may result in inability to fully close the diastasis and functional impairment due to pain and instability.