Poster 282: A Case Report of a Recurrent Gastroc Strain Treated with Platelet Rich Plasma Injections

Abstracts / PM R 9 (2017) S131-S290 pain while running a race. Shortly after completing the race at her typical pace, she began to have sudden onset vertigo with nausea and emesis causing her to collapse. Emergency medical staff was immediately called and she was transported to the hospital. On work up in the emergency department, CT angiography of the neck revealed an acute focal right vertebral artery dissection at C2-C3. MRI of the brain additionally showed a right cerebellar vermis stroke. Setting: Academic Medical Hospital. Results: The mechanistic cause of the patient’s dissection and stroke remained cryptogenic. The patient was started on a heparin drip with transition to warfarin for anticoagulation and secondary stroke prevention. She was admitted to inpatient stroke rehabilitation and discharged to home after 5 days of rehabilitation at an independent level. While at inpatient rehabilitation, she was started on Clonazepam 0.5mg three times daily as needed for vertigo, which controlled her symptoms. She is enrolled in vestibular outpatient physical therapy. The patient plans to run the Boston marathon in 2017 which she has already qualified for. Discussion: Vertebral artery dissection with stroke in sports is a rare condition but should be considered in those with neck pain as this is the most common presenting feature. This condition remains difficult to diagnose as clinical presentations commonly involve minimal trauma to the neck. The mechanistic cause of this condition in sports remains poorly understood as individuals often do not have vascular risk factors. Intravenous heparin followed by warfarin is usually recommended for anticoagulation treatment to prevent further thromboembolic complications. Conclusions: As vertebral artery dissection with stroke can be severely disabling, physicians caring for athletes should be aware and educated on this condition. Level of Evidence: Level V Poster 282: A Case Report of a Recurrent Gastroc Strain Treated with Platelet Rich Plasma Injections

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Disclosures: Ajax Yang: I Have No Relevant Financial Relationships To Disclose Case/Program Description: Adhesive capsulitis (AC) often develops after prolonged shoulder immobilization. In our experience, we observed more cases of AC in individuals with tetraplegia than paraplegia as a result of spinal cord injury (SCI). Hydraulic capsular distension (HCD) is an accepted method for treating AC in able-bodied individuals. However, HCD has not been described in SCI literature. We propose that HCD therapy as an option to mitigate AC in individuals with SCI. This is a 38-year-old man with incomplete tetraplegia since 2015. He was admitted to our inpatient rehab service in October 2016. A notable complication that ensued since his injury included left shoulder. Extensive left shoulder heterotopic ossification was initially considered due to nearly absent glenohumeral joint ROM. However, left shoulder radiography was normal. The diagnosis of AC was made. Setting: Inpatient SCI Rehabilitation. Results: Under ultrasound visualization, we performed glenohumeral intra-articular injection of 4cc 1% lidocaine, 1cc kenalog and 18cc 3% hypertonic saline. Afterwards, the left shoulder was routinely mobilized in all planes of motion. The following passive ROM were obtained on day 7 post injection- flexion: 0-40 , extension: 0 , abduction: 0-55 , external rotation: 0-25 and internal rotation: 0-40 . Patient also reported moderately decreased discomfort during stretching exercises. Repeated injection on day 8 of 4cc 1%-lidocaine and 20cc 3%-hypertonic saline followed by routine stretching yielded additional significant ROM gain in all directions on day 15. Discussion: Unrestricted shoulder movement plays an integral part of placing hand in space that allows an individual to manipulate and interact with one’s surroundings. This is particularly important in individuals with SCI that often rely on their upper extremities for mobility and self-care. The ability to transfer and drive a wheelchair could mean the difference between living independently versus needing an attendant. Conclusions: HCD is effective in improving shoulder passive ROM caused by AC in an individual with tetraplegia. Level of Evidence: Level V

Thomas S. Nabity, MD (Michigan Neurology Associates) Disclosures: Thomas Nabity: I Have No Relevant Financial Relationships To Disclose Case/Program Description: After failing conservative care with NSAIDs, rest, ice, modalities including therapeutic ultrasound and TENS, 6 weeks of physical therapy and dedicated home exercises, a 38year-old suffering from chronic recurrent bilateral gastroc strains with visible tears on ultrasound was injected with platelet rich plasma (PRP) injections. Setting: Outpatient Private Practice. Results: Patient felt pain improvement within 2 weeks and was able to resume competitive activities within 4 weeks. Repeat ultrasound imaging demonstrated resolution of tears at 6 weeks. Discussion: PRP injections offer a safe and effective treatment for a multitude of musculoskeletal conditions including chronic strains involving the musculotendinous junction. PRP should be considered sooner in the treatment algorithm when athletes do not heal within the anticipated timeline for their injury or suffer from a recurring injury. Conclusions: This patient demonstrated a remarkably quick recovery and ability to return to competition after failing multiple attempts of the traditional conservative treatments. PRP should be considered not only a reasonable and safe treatment for strains of the musculotendinous junction, but a very cost effective treatment as well. Level of Evidence: Level V Poster 283: Hydraulic Capsular Distension for Treating Adhesive Capsulitis in an Individual with Tetraplegia: A Case Report Ajax Yang, MD, MPT (Icahn School of Medicine at Mount Sinai, New York, NY, United States), Anokhi Mehta, MD, Thomas n. Bryce, MD

Poster 284: Deep Vein Thrombosis Presenting as Posterior Knee Pain After Playing Soccer: A Case Report Amit Bhargava, MD, MS, RMSK (Advanced Interventional Pain and Sports, Owings Mills, Maryland, United States) Disclosures: Amit Bhargava: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 32-year-old man presented with right knee pain. 2 weeks earlier, he had twisted left ankle following which he played soccer. Two days later he developed right knee pain. He felt he was putting more stress on the right knee due to left ankle injury. Right knee felt stiff. There was tenderness at the popliteal fossa and posteromedial aspect of right thigh. There was no swelling. Varus, valgus and Lachman test was negative. Right ankle dorsiflexion increased pain in popliteal fossa and stretching sensation in the calf. MRI was ordered as patient was leaving for trekking in another country for 3 weeks. MRI findings were consistent with DVT involving the popliteal vein and low grade anterior cruciate ligament sprain. On further evaluation patient was found to have factor V Leiden. Setting: Private medical office. Results: The patient stopped taking warfarin after 11/2 years. Following that, he was recommended to take aspirin for long journey. Discussion: This is the first reported case, to our knowledge, of DVT presenting as posterior knee pain after playing soccer. We do not recommend MRI immediately for knee pain. MRI was obtained to rule out any internal derangement of the knee before patient left for another country for trekking. Conclusions: DVT can present as posterior knee pain after playing. There should be a high suspicion for DVT if a patient presents with posterior knee pain. Level of Evidence: Level V