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Poster 34 Spinal Accessory Nerve Palsy Following Cervical Lymph Node Biopsy: A Case Report
PM&R
GENERAL REHABILITATION (NEUROMUSCULAR MEDICINE, PEDIATRIC REHABILITATION, MEDICAL REHABILITATION) Poster 33 Preventing Further Amputation in Adult Diabetic Amputee. David Berbrayer, MD, Bsc (MED), FRCPC, DABPMR (University of Toronto, Toronto, Ontario, ON, Canada). Disclosures: D. Berbrayer, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To identify strategies used by diabetic lower extremity amputees to prevent further amputation. Design: A cross-sectional survey was conducted on diabetic amputees >18 years registered at an academic hospital. A 26-question selfadministered questionnaire was used to obtain information on demographics, clinical characteristics, foot care, lifestyle modifications, compliance with medication and blood glucose monitoring. Questions were selected from Summary of Diabetic Self-Care Activities Measure. Setting: Academic Teaching Hospital. Participants: Type 2 diabetics (>18 years) with amputation. Interventions: 26 Question Diabetic Self Care Questionnaire administered. Main Outcome Measures: Information on demographics, clinical characteristics foot care, lifestyle, compliance with medication and blood glucose monitoring obtained from Diabetic Self Care Questionnaire. Results or Clinical Course: Ten type 2 diabetes mellitus participants -mean age of participants was 61 years. 80% were male. 50% were single. 80% living with family. 80% annual income of 0-$19,999. 60% had college or university education. The mean body mass index was 32 kg/m. Participants were diagnosed with diabetes 17 years ago, and received a lower limb amputation 3 years ago. Mean time between diagnosis and amputation was 14 years. 90% of participants had a transtibial amputation, and 10% had a transfemoral amputation. 50% participants checked their feet on a daily basis within the past week. 50% wore special shoes. 40% wore socks. 20% compliant with blood sugar monitoring. 40% walked 30 minutes/week. Conclusions: Overall, compliance with foot care was poor among diabetic amputees. Adherence to eating plan and regular physical activity was also low. Healthcare providers should improve self-care among diabetic amputees through various education methods. Healthcare professionals should ensure discussion of foot care and general diabetes self-management with a patient after an amputation, and repeat discussion of self-care at follow-up appointments. Literature suggests face-to-face education of self-care is more effective than other information delivery methods, and that the use of booster sessions improved clinical outcomes. Interactive education methods have been shown to have higher effectiveness on patient behavior comparing to didactic sessions. Diabetic patients had equally poor foot care after and before an amputation. Poster 34 Spinal Accessory Nerve Palsy Following Cervical Lymph Node Biopsy: A Case Report. Anupam Sinha, DO (Rothman Institute, Philadelphia, PA, United States); Madhuri Dholakia, MD. Disclosures: A. Sinha, No Disclosures: I Have No Relevant Financial Relationships to Disclose.
Vol. 6, Iss. 9S, 2014
S193
Case Description: A 65-year-old right-hand-dominant woman status post melanoma removal from her scalp and left cervical lymph node dissection 4 months earlier presented with subsequent pain and weakness in her left shoulder. She initially did have some mild paresthesias in the left upper extremity, but this had resolved. She noted atrophy of the left upper back muscles. She denied any significant distal upper extremity symptoms. She denied any bowel, bladder, or balance disturbance. On examination, she was noted to have lateral winging of the left scapula. There was atrophy of the left upper and middle trapezius muscles. Upper extremity strength was 5/5 except for trace weakness noted with left shoulder abduction, flexion, and elevation. Reflexes were 2/4, with absent upper motor neuron signs. Setting: Outpatient orthopedic practice. Results or Clinical Course: MRI of the left shoulder revealed mild supraspinatus tendinosis. Electrodiagnostic studies of the left upper extremity were performed. Motor nerve conduction studies of the left median and left ulnar were normal. Sensory nerve conduction studies of the left median, left ulnar, and left radial nerve were normal. Needle EMG examination of the left upper, middle, and lower trapezius muscles showed evidence of significant denervation with reduced recruitment. Needle EMG examination of the left deltoid, left supraspinatus, and left infraspinatus muscles were found to be normal. The patient was diagnosed with a left spinal accessory nerve injury. Discussion: The superficial course of the spinal accessory nerve in the posterior cervical triangle makes it susceptible to injury. Injury to the spinal accessory nerve can lead to dysfunction of the trapezius. Nerve injury is a rare complication after neck surgery (eg, lymph node biopsy, parotid surgery, carotid surgery). It may also be injured by a direct blow to the neck or wrenching injury to the arm or neck. Conclusions: Spinal accessory nerve injury is a rare complication of cervical lymph node biopsy. The clinician should consider electrodiagnostic studies with attention to the trapezius muscles when suspecting injury to this nerve. Poster 35 Metastatic Prostate Cancer Presenting as Lumbar Spinal Stenosis: A Case Report. Anupam Sinha, DO (Rothman Institute, Philadelphia, PA, United States); Madhuri Dholakia, MD; Gautam Kothari, DO. Disclosures: A. Sinha, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: An 80-year-old man with a history of prostate cancer presented with a complaint of right lower back pain radiating to the right groin, anterior thigh and proximal lateral thigh for the past 3 months. His pain was markedly worse with standing or walking, and better with lying down. Pain was a sharp 10/10 discomfort, getting worse over time. He complained of right leg weakness, but denied paresthesias. His family also noted a decrease in overall functioning, with progression from a cane to walker to a wheelchair in a very short time period. He denied bowel or bladder issues. Physical examination revealed painful lumbar flexion and extension. He
GENERAL REHABILITATION (NEUROMUSCULAR MEDICINE, PEDIATRIC REHABILITATION, MEDICAL REHABILITATION) Poster 33 Preventing Further Amputation in Adult Diabetic Amputee. David Berbrayer, MD, Bsc (MED), FRCPC, DABPMR (University of Toronto, Toronto, Ontario, ON, Canada). Disclosures: D. Berbrayer, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To identify strategies used by diabetic lower extremity amputees to prevent further amputation. Design: A cross-sectional survey was conducted on diabetic amputees >18 years registered at an academic hospital. A 26-question selfadministered questionnaire was used to obtain information on demographics, clinical characteristics, foot care, lifestyle modifications, compliance with medication and blood glucose monitoring. Questions were selected from Summary of Diabetic Self-Care Activities Measure. Setting: Academic Teaching Hospital. Participants: Type 2 diabetics (>18 years) with amputation. Interventions: 26 Question Diabetic Self Care Questionnaire administered. Main Outcome Measures: Information on demographics, clinical characteristics foot care, lifestyle, compliance with medication and blood glucose monitoring obtained from Diabetic Self Care Questionnaire. Results or Clinical Course: Ten type 2 diabetes mellitus participants -mean age of participants was 61 years. 80% were male. 50% were single. 80% living with family. 80% annual income of 0-$19,999. 60% had college or university education. The mean body mass index was 32 kg/m. Participants were diagnosed with diabetes 17 years ago, and received a lower limb amputation 3 years ago. Mean time between diagnosis and amputation was 14 years. 90% of participants had a transtibial amputation, and 10% had a transfemoral amputation. 50% participants checked their feet on a daily basis within the past week. 50% wore special shoes. 40% wore socks. 20% compliant with blood sugar monitoring. 40% walked 30 minutes/week. Conclusions: Overall, compliance with foot care was poor among diabetic amputees. Adherence to eating plan and regular physical activity was also low. Healthcare providers should improve self-care among diabetic amputees through various education methods. Healthcare professionals should ensure discussion of foot care and general diabetes self-management with a patient after an amputation, and repeat discussion of self-care at follow-up appointments. Literature suggests face-to-face education of self-care is more effective than other information delivery methods, and that the use of booster sessions improved clinical outcomes. Interactive education methods have been shown to have higher effectiveness on patient behavior comparing to didactic sessions. Diabetic patients had equally poor foot care after and before an amputation. Poster 34 Spinal Accessory Nerve Palsy Following Cervical Lymph Node Biopsy: A Case Report. Anupam Sinha, DO (Rothman Institute, Philadelphia, PA, United States); Madhuri Dholakia, MD. Disclosures: A. Sinha, No Disclosures: I Have No Relevant Financial Relationships to Disclose.
Vol. 6, Iss. 9S, 2014
S193
Case Description: A 65-year-old right-hand-dominant woman status post melanoma removal from her scalp and left cervical lymph node dissection 4 months earlier presented with subsequent pain and weakness in her left shoulder. She initially did have some mild paresthesias in the left upper extremity, but this had resolved. She noted atrophy of the left upper back muscles. She denied any significant distal upper extremity symptoms. She denied any bowel, bladder, or balance disturbance. On examination, she was noted to have lateral winging of the left scapula. There was atrophy of the left upper and middle trapezius muscles. Upper extremity strength was 5/5 except for trace weakness noted with left shoulder abduction, flexion, and elevation. Reflexes were 2/4, with absent upper motor neuron signs. Setting: Outpatient orthopedic practice. Results or Clinical Course: MRI of the left shoulder revealed mild supraspinatus tendinosis. Electrodiagnostic studies of the left upper extremity were performed. Motor nerve conduction studies of the left median and left ulnar were normal. Sensory nerve conduction studies of the left median, left ulnar, and left radial nerve were normal. Needle EMG examination of the left upper, middle, and lower trapezius muscles showed evidence of significant denervation with reduced recruitment. Needle EMG examination of the left deltoid, left supraspinatus, and left infraspinatus muscles were found to be normal. The patient was diagnosed with a left spinal accessory nerve injury. Discussion: The superficial course of the spinal accessory nerve in the posterior cervical triangle makes it susceptible to injury. Injury to the spinal accessory nerve can lead to dysfunction of the trapezius. Nerve injury is a rare complication after neck surgery (eg, lymph node biopsy, parotid surgery, carotid surgery). It may also be injured by a direct blow to the neck or wrenching injury to the arm or neck. Conclusions: Spinal accessory nerve injury is a rare complication of cervical lymph node biopsy. The clinician should consider electrodiagnostic studies with attention to the trapezius muscles when suspecting injury to this nerve. Poster 35 Metastatic Prostate Cancer Presenting as Lumbar Spinal Stenosis: A Case Report. Anupam Sinha, DO (Rothman Institute, Philadelphia, PA, United States); Madhuri Dholakia, MD; Gautam Kothari, DO. Disclosures: A. Sinha, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: An 80-year-old man with a history of prostate cancer presented with a complaint of right lower back pain radiating to the right groin, anterior thigh and proximal lateral thigh for the past 3 months. His pain was markedly worse with standing or walking, and better with lying down. Pain was a sharp 10/10 discomfort, getting worse over time. He complained of right leg weakness, but denied paresthesias. His family also noted a decrease in overall functioning, with progression from a cane to walker to a wheelchair in a very short time period. He denied bowel or bladder issues. Physical examination revealed painful lumbar flexion and extension. He