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Poster 281 Intra-Articular Autologous Platelet Rich Plasma Hip Injection May Result in Osteogenesis: A Case Report
PM&R
Discussion: Suprascapular neuropathy is a rare cause of refractory shoulder pain. There are two areas of nerve compression, the suprascapular and spinoglenoid notches. Although there are other reported cases of suprascapular neuropathy due to labral tears, this clinical entity remains difficult to diagnose and often leads to expensive and unnecessary workups as illustrated by this case. Conclusions: This case demonstrates the importance of obtaining a careful history including mechanism of injury and a thorough physical examination. Overreliance on diagnostic tests in the absence of clinical correlation can lead to unnecessary workups. Knowledge of the potential neurologic complications of labral tears can raise clinical suspicion and lead to earlier diagnosis. Poster 280 Anomalous Flexor Digitorium Superficialis in a Patient with Carpal Tunnel Syndrome Diagnosed by Electrosonodiagnosis: A Case Report. Jason Tucker, MD (VCU, Apt #2C, VA, United States); Gary Goldberg, MD; Tyler Anderson, BS. Disclosures: J. Tucker, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: A 63 YO male was referred to the Electromyography (EMG) lab with a history of intermittent dominant hand paresthesiae involving all five digits and mild grip strength weakness. Nerve conductions were most consistent with focal median mononeuropathy across the wrist moderate in severity. Needle EMG was limited due lack of patient tolerance. A focused NMUSI examination demonstrated an enlarged median nerve at the carpal tunnel entrance and an anomalous distal extension of the FDS into the carpal tunnel dynamically compressing the median nerve, particularly with active PIP flexion. Setting: Tertiary Care Veterans Affairs Medical Center. Results or Clinical Course: A FDS causing focal median mononeuropathy at the wrist clinically consistent with CTS. Discussion: EMG is able to measure electrophysiological nerve dysfunction but unable to assess for associated structural abnormalities. High resolution NMUSI can fill this void by providing real time, dynamic structural evaluation. This report demonstrates the value of NMUSI in identifying an anomalous structure within the carpal tunnel that would have otherwise gone undetected. The identification of this space occupying lesion causing dynamic compression of the median nerve in the carpal tunnel allowed us to make more informed recommendations directed toward relieving symptoms and avoid the progression of potentially irreversible symptomatology and reduction in functioning. Conclusions: Electrosonodiagnosis can serve to integrate complementary physiological and morphological information with the history and physical resulting in improved diagnostic accuracy and the most appropriate management of pathology. Poster 281 Intra-Articular Autologous Platelet Rich Plasma Hip Injection May Result in Osteogenesis: A Case Report. Marwa Ahmed, MD, MS (Spine and Sports Medicine of New York, New York, NY, United States); Andre Panagos, MD, MS. Disclosures: M. Ahmed, No Disclosures: I Have No Relevant Financial Relationships to Disclose.
Vol. 6, Iss. 9S, 2014
S283
Case Description: The patient underwent an autologous platelet-rich plasma (PRP) injection of the left hip to address pain related to moderate to severe degenerative joint disease. Comparative DEXA bone density measurements of the left femoral neck showed a T-score range from -2.7 to -2.2 over the ages of 51-63. DEXA T-score at the age of 65 and 3 months post-PRP injection of the left hip showed an incidental and ipsilateral 12.2% increase as compared to DEXA results 2 years prior. Of important note, the patient was not taking any medications targeted to the prevention or treatment of osteopenia during this time with the exception of intermittent Vitamin D supplementation. Setting: Private Practice. Results or Clinical Course: At one and five months postprocedure, an 85% improvement was noted in the patient’s symptoms. The incidental increase in the patient’s bone mineral density (BMD) suggests that intra-articular PRP injectate may improve local BMD. Discussion: While PRP’s osteogenic properties are not novel, we believe this report is the first to document a translation of this property as an increase in femoral neck BMD following an ipsilateral intra-articular PRP injection. With the advancing population age, osteoporotic fractures are predicted to become an even greater economic burden, cause of morbidity, disability and in the case of hip fractures, even premature death. The application of PRP for the prevention or treatment of osteoporosis has been a looming question with exciting implications. Conclusions: The use and clinical validation of PRP is still in its early stages. Further research is necessary in establishing a clear relationship between PRP and the prevention and/or treatment of osteoporosis in humans. PRP may be able to offer a safer but also potentially more localized treatment alternative to the available medications today, which have notoriously resulted in clinically significant side-effects. Poster 282 An Unusual Case of Chronic Distal Weakness in the Unilateral Upper Extremity: A Case Report. Eric Leung (Mount Sinai School of Medicine, New York, NY, United States); Mikiko Murakami, DO; David Bressler, MD. Disclosures: E. Leung, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: A 51-year-old Asian female with chronic right upper extremity weakness was referred for evaluation of right hand weakness. Symptoms began insidiously about 15 years ago with gradual progressive weakness, stabilizing after 5 years. In the past few months, she reports progressive weakness. Review of systems was negative. There was no cervical pain or sensory deficits. Significant examination findings include intrinsic muscle wasting and weakness in her right hand. There were no sensory deficits or pathologic reflexes. Setting: Tertiary Care Hospital. Results or Clinical Course: EMG/NCV: Motor nerve conduction studies, including ulnar segmentals, demonstrated normal bilateral ulnar and median normal distal latency, amplitude and conduction velocity. Sensory nerve evaluations displayed normal bilateral median, ulnar and dorsal ulnar cutaneous nerves peak latency and amplitude. Both the ulnar and median F wave responses were within normal limits and without significant
Discussion: Suprascapular neuropathy is a rare cause of refractory shoulder pain. There are two areas of nerve compression, the suprascapular and spinoglenoid notches. Although there are other reported cases of suprascapular neuropathy due to labral tears, this clinical entity remains difficult to diagnose and often leads to expensive and unnecessary workups as illustrated by this case. Conclusions: This case demonstrates the importance of obtaining a careful history including mechanism of injury and a thorough physical examination. Overreliance on diagnostic tests in the absence of clinical correlation can lead to unnecessary workups. Knowledge of the potential neurologic complications of labral tears can raise clinical suspicion and lead to earlier diagnosis. Poster 280 Anomalous Flexor Digitorium Superficialis in a Patient with Carpal Tunnel Syndrome Diagnosed by Electrosonodiagnosis: A Case Report. Jason Tucker, MD (VCU, Apt #2C, VA, United States); Gary Goldberg, MD; Tyler Anderson, BS. Disclosures: J. Tucker, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: A 63 YO male was referred to the Electromyography (EMG) lab with a history of intermittent dominant hand paresthesiae involving all five digits and mild grip strength weakness. Nerve conductions were most consistent with focal median mononeuropathy across the wrist moderate in severity. Needle EMG was limited due lack of patient tolerance. A focused NMUSI examination demonstrated an enlarged median nerve at the carpal tunnel entrance and an anomalous distal extension of the FDS into the carpal tunnel dynamically compressing the median nerve, particularly with active PIP flexion. Setting: Tertiary Care Veterans Affairs Medical Center. Results or Clinical Course: A FDS causing focal median mononeuropathy at the wrist clinically consistent with CTS. Discussion: EMG is able to measure electrophysiological nerve dysfunction but unable to assess for associated structural abnormalities. High resolution NMUSI can fill this void by providing real time, dynamic structural evaluation. This report demonstrates the value of NMUSI in identifying an anomalous structure within the carpal tunnel that would have otherwise gone undetected. The identification of this space occupying lesion causing dynamic compression of the median nerve in the carpal tunnel allowed us to make more informed recommendations directed toward relieving symptoms and avoid the progression of potentially irreversible symptomatology and reduction in functioning. Conclusions: Electrosonodiagnosis can serve to integrate complementary physiological and morphological information with the history and physical resulting in improved diagnostic accuracy and the most appropriate management of pathology. Poster 281 Intra-Articular Autologous Platelet Rich Plasma Hip Injection May Result in Osteogenesis: A Case Report. Marwa Ahmed, MD, MS (Spine and Sports Medicine of New York, New York, NY, United States); Andre Panagos, MD, MS. Disclosures: M. Ahmed, No Disclosures: I Have No Relevant Financial Relationships to Disclose.
Vol. 6, Iss. 9S, 2014
S283
Case Description: The patient underwent an autologous platelet-rich plasma (PRP) injection of the left hip to address pain related to moderate to severe degenerative joint disease. Comparative DEXA bone density measurements of the left femoral neck showed a T-score range from -2.7 to -2.2 over the ages of 51-63. DEXA T-score at the age of 65 and 3 months post-PRP injection of the left hip showed an incidental and ipsilateral 12.2% increase as compared to DEXA results 2 years prior. Of important note, the patient was not taking any medications targeted to the prevention or treatment of osteopenia during this time with the exception of intermittent Vitamin D supplementation. Setting: Private Practice. Results or Clinical Course: At one and five months postprocedure, an 85% improvement was noted in the patient’s symptoms. The incidental increase in the patient’s bone mineral density (BMD) suggests that intra-articular PRP injectate may improve local BMD. Discussion: While PRP’s osteogenic properties are not novel, we believe this report is the first to document a translation of this property as an increase in femoral neck BMD following an ipsilateral intra-articular PRP injection. With the advancing population age, osteoporotic fractures are predicted to become an even greater economic burden, cause of morbidity, disability and in the case of hip fractures, even premature death. The application of PRP for the prevention or treatment of osteoporosis has been a looming question with exciting implications. Conclusions: The use and clinical validation of PRP is still in its early stages. Further research is necessary in establishing a clear relationship between PRP and the prevention and/or treatment of osteoporosis in humans. PRP may be able to offer a safer but also potentially more localized treatment alternative to the available medications today, which have notoriously resulted in clinically significant side-effects. Poster 282 An Unusual Case of Chronic Distal Weakness in the Unilateral Upper Extremity: A Case Report. Eric Leung (Mount Sinai School of Medicine, New York, NY, United States); Mikiko Murakami, DO; David Bressler, MD. Disclosures: E. Leung, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: A 51-year-old Asian female with chronic right upper extremity weakness was referred for evaluation of right hand weakness. Symptoms began insidiously about 15 years ago with gradual progressive weakness, stabilizing after 5 years. In the past few months, she reports progressive weakness. Review of systems was negative. There was no cervical pain or sensory deficits. Significant examination findings include intrinsic muscle wasting and weakness in her right hand. There were no sensory deficits or pathologic reflexes. Setting: Tertiary Care Hospital. Results or Clinical Course: EMG/NCV: Motor nerve conduction studies, including ulnar segmentals, demonstrated normal bilateral ulnar and median normal distal latency, amplitude and conduction velocity. Sensory nerve evaluations displayed normal bilateral median, ulnar and dorsal ulnar cutaneous nerves peak latency and amplitude. Both the ulnar and median F wave responses were within normal limits and without significant