S266 S290
does not correlate with imaging studies. Astute analysis of clinical
presentation provided patient with the correct surgical plan to
improve his symptoms.
Level of Evidence:
Level V
Poster 420:
A Ganglion Cyst in the Forearm Mimicking Cervical Radiculopathy:
A Case Report
Teresa C. Bianchi, DO (Rusk Inst of Rehab Med), Peiti Cai, MD
Disclosures:
Teresa Bianchi: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 61-year-old woman with history of
cervical spine surgery (C5-C7 in 2008) complained of intermittent neck
pain with radiating symptoms from her left shoulder to hand for
several months. An MRI of the cervical spine was ordered by Neurology
which showed multilevel degenerative changes with limited evalua-
tion of C5-C7 due to hardware. The patient was then referred to
Physiatry for pre-surgical workup for cervical radiculopathy. Physical
examination showed limited range of motion of the cervical spine.
Spurling’s Test was equivocal on the left. On palpation along the
distribution of pain, a soft, rubbery, palpable mass was identified in
the middle of her left forearm dorsally. Deep palpation of the mass
reproduced her radiating symptoms. Per patient, the severity and
exact location of her symptoms varied based on the degree of swelling
in the middle of her forearm. Electrodiagnostic studies were within
normal limits.
Setting:
Tertiary care veterans affairs medical center.
Results:
Ultrasound imaging of the mass site showed a ganglion cyst
within the flexor digitorum superficialis. Among the various treatment
options discussed, the patient opted to monitor the cyst without
further intervention. On 6 week follow up, the patient had fewer
symptoms which coincided with reduced nodular size.
Discussion:
Our case demonstrates the importance of considering
extraspinal pathologies among the differential diagnoses when work-
ing up radiculopathy. An understanding of anatomy, detailed patient
history, and careful physical examination are essential to identify
extraspinal causes of radiating symptoms. In very rare cases, intra-
muscular ganglion cysts have been reported, which can be detected
with ultrasound imaging. These points will be discussed further.
Conclusions:
Extraspinal pathologies may mimic cervical radiculop-
athy, which is important to uncover early in the workup for efficient
use of time and resources, improved management, and overall patient
satisfaction and well-being.
Level of Evidence:
Level V
Poster 421:
Evaluating and Managing Central Poststroke Pain
(CPSP) within the Acute Rehab Setting
Luis J. Soliz, MD (Rush Univ Med Cntr, Chicago, IL, United States),
Jonathan C. VandenBerg, DO
Disclosures:
Luis Soliz: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
A 57-year-old woman with a history of
uncontrolled hypertension presented to the acute hospital with left-
sided weakness. Subsequent workup revealed a right ganglio-thalamic
intracranial hemorrhage. Patient was admitted to acute rehab and
developed acute onset left foot swelling and pain. The pain in the left
foot was further characterized by allodynia and hyperesthesia. There
were also associated skin and temperatures changes in the left foot.
The pain was so severe that the patient was unable to participate in
any therapy sessions.
Setting:
Tertiary Care Hospital.
Results:
Lower extremity Dopplers in the left leg were negative for a
blood clot. Patient subsequently underwent unsuccessful diagnostic
lumbar sympathetic block thereby effectively ruling out Type 1
Complex Regional Pain Syndrome. Given the previously mentioned
failed workup and the fact that the location of the intracranial bleed
affected the thalamic area, the patient was finally diagnosed with
Central Poststroke Pain (CPSP). Patient was started on amitriptyline
25 mg three times per day with the dose eventually titrated up to 50
mg. Patient tolerated and responded well to amitriptyline noting a
greater than 50% reduction in her Visual Analog Scale pain score.
Patient was also able to fully participate in all therapy sessions
thereafter.
Discussion:
CPSP is a disabling comorbidity that occurs as a result of
damage to the spinothalamocortical pathway. This type of pain tends
to improve in time but often requires early medical management
particularly within the acute rehab setting. There are few class I and
class II studies examining the effectiveness of various pharmacological
medications with amitriptyline generally considered to be a first-line
agent.
Conclusions:
This case supported the use amitriptyline as an effective
and generally well-tolerated medication in the treatment of CPSP
within the acute rehab setting. Further studies are needed to inves-
tigate additional therapeutic modalities to help manage this debili-
tating condition.
Level of Evidence:
Level V
Poster 422:
Successful Treatment of Cervical Facet Joint Pain
using Platelet Rich Plasma
d
A Novel Case Report
Keziah A. Sully, MD, Yusef A. Sayeed, MD, MPH, MEng, CPH, CMRO,
CME, COHC, Bharat C. Patel, MD
Disclosures:
Keziah Sully: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
The patient presented with a 5-year his-
tory of progressive bilateral cervical pain. She had a history of
advanced multilevel cervical facet spondylosis, as well as non-instru-
mental fusion of C6-7 cervical vertebral body, with anterior osteo-
phytic bridging and dorsal ridging at C3-7. The pain was axial, aching,
throbbing, burning and causing daily headaches. It was aggravated
with driving and overhead activity and minimally relieved with oral
medication, opioid medication and muscle relaxer, as well as cryo-
therapy. Exam was notable for marked facet joint tenderness to
palpation, severe cervicothoracic muscle spasm and decreased ROM.
Prior treatment, including physical therapy, steroid facet joint in-
jections and radiofrequency ablation offered some short term relief
for 6 weeks. The patient elected for cervical facet injections with
platelet rich plasma (PRP) under fluoroscopic guidance. The bilateral
C2-7 facet joints were each injected with 0.5cc of PRP.
Setting:
Multidisciplinary Pain Clinic.
Results:
The patient reported improved pain and function. 4-weeks
post injection the patient experienced 80% relief in pain symptoms. By
3 months post injection, the patient’s pain was completely relieved
(100%) and she no longer required narcotic pain medication. She was
able to drive and complete overhead activities without pain.
Discussion:
PRP has been utilized for treatment of various musculo-
skeletal conditions with success including tendinosis, bursitis, discitis,
and even degenerative joint disease. This is the first reported case, to
the author’s knowledge, of cervical facet joint treatment with PRP.
This case is also notable for improvement in functional outcomes
including improvement in activities of daily living and quality of life
measures.
Conclusions:
PRP may be a good alternative to steroids and radio-
frequency ablation to treat facet mediated pain in the cervical spine.
Level of Evidence:
Level V
S266
Abstracts / PM R 9 (2017) S131-S290