S223 S290
Poster 288:
Simultaneous Bilateral Valgus Slipped Capital Femoral
Epiphysis in an 11-Year-Old Girl: A Case Report
James B. Meiling (University of North Texas Health Sci Cen, Fort
Worth, TX, USA), W Paul Bowman, MD, Matthew Mayfield, MD
Disclosures:
James Meiling: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
Slipped capital femoral epiphysis (SCFE)
is a unique emergent hip disorder that afflicts children and teenagers.
The most common presentation of SCFE is varus slip, a posterior and
inferior displacement of the proximal femoral epiphysis on the femoral
metaphysis; however, SCFE also presents less frequently as a valgus
slip, a posterior and lateral displacement. Bilateral SCFE happens even
less often than unilateral SCFE, so a case of simultaneous bilateral
valgus SCFE is unique.
Setting:
Outpatient Primary Care, Outpatient Pediatric Specialty
Clinic.
Results:
An 11-year-old normal weight girl presented with simulta-
neous bilateral valgus SCFE. She underwent bilateral in situ pinning
to prevent further slippage, but post-surgery rapidly developed
acute right hip pain caused by retained hardware that inadvertently
entered the acetabulum and protruded into the inner wall of the
pelvis. An additional operation took place where surgeons dis-
located her right hip to remove the retained screw and revised
pinnings of both hips. She faced numerous complications, including
decreased sensation and numbness on the dorsum of her right foot
and decreased peroneal distribution. Almost 2 years later she con-
tinues to experience progressive right hip pain, pinpointed to the
tip of the greater trochanter on the lateral aspect of her right hip.
The hardware irritation pain resolved after the removal of symp-
tomatic hardware in the right hip. However, she still complains of
severe radiating right hip pain on the anterior aspect of her hip,
which displays significant acetabular dysplasia and a small cystic
area on MRI.
Discussion:
Valgus SCFE is infrequent, but important. Limited avail-
able cases for review.
Conclusions:
Valgus SCFE is a rare presentation of an uncommon
musculoskeletal condition. According to the literature, simultaneous
bilateral valgus SCFE in a female might be anticipated, but because of
the infrequency of such cases the nature of both the presentation and
demographics are still being discovered and understood.
Level of Evidence:
Level V
Poster 289:
Utility of Dynamic Sonographic Examination and Intervention
in the Management of Proximal Tibiofibular Joint
Osteoarthritis in the Context of Partial Fibulectomy:
A Case Report
Allison N. Schroeder (University of Pittsburgh Medical Center),
Kentaro Onishi, DO, FAAPMR
Disclosures:
Allison Schroeder: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 56-year-old woman with a remote his-
tory of a partial fibulectomy and recent arthroscopic partial lateral
meniscectomy presented with 6 months of vague right proximal pos-
terior fibular area pain. Her pain was a 7/10, constant, worsened with
plantarflexion or weight bearing, and reliably reproduced with
compression of the proximal lateral gastrocnemius. Examination
findings were consistent with her history. A knee MRI revealed a likely
ganglion cyst of unknown origin in the proximal lateral gastrocnemius.
She was referred to our clinic for aspiration of the cyst. The multi-
lobulated cyst (4.35 cm by 0.79 cm by 1.78 cm) in the right proximal
lateral gastrocnemius and the surrounding neurovasculature were
identified on sonographic examination. Aspiration and corticosteroid
injection were completed under sonographic guidance.
Setting:
Outpatient musculoskeletal/sports ultrasound clinic.
Results:
One week post-procedure, she reported
>
70% improvement
in pain and a limited sonographic examination showed a 40% decrease
in cyst size. However, her pain returned 8 days after aspiration and
injection. Further sonographic examination revealed cyst communi-
cation with the proximal tibiofibular joint (PTFJ), hypermobility of the
joint with reproduction of pain with palpation of the mid-fibula, and
sonopalpation tenderness at the PTFJ. Sonographically guided PTFJ
steroid injection resulted in longer term relief, managing her pain to
date (8 months).
Discussion:
Our case highlights the utility of sonographic examination
to evaluate patients with posterolateral knee pain, and brings the
importance of evaluating the PTFJ to our attention, especially in the
setting of partial fibulectomy. Furthermore, due to its proximity to
vital structures, sonographic guidance is indicated for treating pa-
thology in this region of the knee.
Conclusions:
Musculoskeletal ultrasound can be a valuable tool in
evaluating and treating posterolateral knee pain with or without an
associated cyst in the context of partial fibulectomy.
Level of Evidence:
Level V
Poster 290:
Intramuscular Steroid Injections for the Treatment of
Wrist Drop Due to Excessive use of Muscle
Enhancement Oil Site Injections: A Case Report
Daniel Leary, Medical Student (Nova Southeastern University, Hobe
Sound, FL, United States), Michael D. Smith, OMS-III, Robert E. Kent,
DO, MHA, MPH, FAAPMR
Disclosures:
Daniel Leary: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
Patient is a 36-year-old male bodybuilder
who has been under our care for chronic low back pain who presented
for new onset left upper extremity pain/wrist weakness. He describes
the pain as constantly fluctuating from moderate to severe mostly in
his left wrist. Pain is described as aching and sharp in nature. Physical
exam demonstrated 2+ strength in his left wrist extensors (C7-C8). A
nerve conduction study demonstrated slowing in the left radial nerve.
This was managed with a steroid injection into his bicep to decrease
any inflammation compressing the radial nerve.
Setting:
Outpatient Clinic.
Results:
Patient tolerated procedure without complications. Patient’s
wrist extensor muscle strength went from 2/5 to 4/5.
Discussion:
Site Enhancing Oil Injections: Method for bodybuilders to
increase muscle mass appearance by injecting “synthol” into partic-
ular muscle heads, most commonly the bicep/tricep, to stretch the
fascia and give the appearance of a bigger muscle. “Synthol” is
composed of 85% sesame oil (filler), 7.5% lidocaine (pain management)
and 7.5% benzyl alcohol (sterilizing). Injections are necessary daily to
maintain volume in the muscle and injection site infections are a
common. Side effects are sclerosis, abscesses, cyst formation, halting
of muscle regeneration, fibrosis and skin rupture with extreme use.
Features of Site Enhancing Oils: Deformed muscles, Cysts (100’s with
chronic use) filled with oil, Arm filled with fibrotic tissue instead of
actual muscular tissue. In this situation we assumed chronic inflam-
mation from daily use of “Synthol” oil may have created a pseudo-
compartment syndrome in the bicep muscle leading to radial nerve
compression and the sequela of wrist drop.
Conclusions:
Steroid injections for potential nerve compression
associated with bicep oil enhancement injections are a safe and
effective option to reduce inflammation and restore nerve function for
the patient.
Level of Evidence:
Level V
S223
Abstracts / PM R 9 (2017) S131-S290