S267 S290
Poster 423:
Posterior Femoral Cutaneous Neuropathy Following
Hamstring Injury: A Case Report
David J. Schwanebeck, DO (Univ of WI Hosp and Clncs, Madison, WI,
United States), Michelle Poliak-Tunis, MD
Disclosures:
David Schwanebeck: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 47-year-old woman presented to pain
clinic for evaluation of chronic right posterior thigh pain that has been
present since she initially injured her hamstring 1.5 years ago getting
out of a car. She describes her pain as constant, sharp, rating 9/10 on a
visual analog pain scale with some radiation into the anterior thigh.
Her pain is worse with walking and sitting with any pressure on the
right hamstring. Her pain has not improved with multiple different
treatments and no etiology had been identified despite extensive
work up.
Setting:
Tertiary care pain clinic.
Results:
The patient underwent ultrasound-guided peripheral nerve
block of the right posterior femoral cutaneous nerve (PFCN) with 2cc
2% lidocaine. She had a 50% reduction in her pain on the visual analog
scale immediately following the procedure with complete resolution
of her pain at 48 hours. Her pain reduction persisted for 2 weeks.
Discussion:
The posterior femoral cutaneous nerve is a sensory nerve
arising from the sacral plexus supplying the posterior thigh and
buttock. Entrapment of this nerve is rare as it does not pass through
any osseous-ligamentous tunnels but can be damaged by hematoma,
prolonged cycling, or compression from tumors. Neuropathies of the
PFCN can cause paresthesias and pain with sitting and walking in a well
localized distribution in the posterior thigh. Peripheral nerve block of
the PFCN may be useful in the diagnosis of posterior femoral cutaneous
neuropathy. Treatment options include therapeutic injections and
neurectomy which have been reported in literature.
Conclusions:
In the setting of chronic posterior thigh pain, posterior
femoral cutaneous neuropathy should be included in the differential
and can be confirmed with peripheral nerve block in clinic.
Level of Evidence:
Level V
Poster 424:
Chronic Pain Confusion: Lymphoma Originally Diagnosed as
CRPS, A Case Report
Jennifer A. Baima, MD, FAAPMR (UMASS Medical School, Worcester,
MA, United States), Mathew J. Most, MD, Amanda Doodlesack, BS
Disclosures:
Jennifer Baima: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 48-year-old woman presented with
right ankle pain and swelling several months following a distal fibula
fracture due to a fall. The fracture was treated non-operatively and
she initially recovered, but then developed pain, hypersensitivity and
swelling 7-8 weeks later. She also developed atraumatic left knee pain
and swelling. A CT scan showed a lucent lesion in the distal fibula and a
bone scan showed increased uptake in the distal fibula, thought to be
from trauma. However, uptake was also seen in her left knee and
bilateral elbows. At the time, she was diagnosed with CRPS. A pain
specialist thought she did not have CRPS and referred her to rheu-
matology. The rheumatologist performed a left knee arthrocentesis
that revealed atypical cells and led to a diagnosis of large B-cell
lymphoma. She was referred to Orthopedic Oncology.
Setting:
Outpatient Orthopedic Oncology clinic.
Results:
On physical exam, her right ankle exhibited profound
swelling, diffuse tenderness to palpation, and limited range of motion.
Her left knee had swelling around the patella and tenderness to
palpation. In addition, there was mild tenderness to palpation over the
olecranon bilaterally. Radiographs showed areas of demineralization in
the olecranon processes of both elbows, profound destruction of the
right distal fibula, and demineralization of the left patella, all likely
indicating lymphoma involvement. PET-CT confirmed multi-focal
osseous involvement. She was treated with a chemotherapeutic
regimen of R-CHOP.
Discussion:
After 3 months of treatment, her right ankle and left knee
symptoms were greatly improved. She no longer had pain or swelling,
was off pain medications, and was ambulating independently. Radio-
graphs demonstrated substantial reossification of the left patella and
right lateral malleolus and post-treatment PET-CT demonstrated sig-
nificant metabolic response to treatment.
Conclusions:
This case illustrates a unique presentation of B-cell
lymphoma and the importance of ruling out other causes before
diagnosis of CRPS.
Level of Evidence:
Level V
Poster 425:
Arm Pain in a 27-Year-Old Paralympic Swimmer
John Franco, MD (Mayo Clinic of Rochester, Rochester, MN, United
States), Lisa Beck, CNS RN, Keith A. Bengtson, MD
Disclosures:
John Franco: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 27-year-old female Paralympic swim-
mer with T10 American Spinal Injury Association Class A spinal cord
injury sustained a fall from a shower bench, striking the ulnar aspect
of her left forearm. She developed dysesthesias and inability to flex
her 4th and 5th digits and wrist. Radiographs and MRI were normal.
After extensive hand therapy, she continued to have pain and impaired
flexion of her 4th and 5th digits. She was unable to participate in
swimming or manually propel a wheelchair. Electromyographic studies
at 3 and 6 weeks post-injury were unremarkable for median, ulnar, or
radial neuropathies. She developed dystrophic changes, coolness to
touch, blotched skin appearance, and heat hypersensitivity of the
hypothenar eminence and 4th and 5th digits at 4 months post-injury.
Setting:
Tertiary Referral Center.
Results:
Due to concern of complex regional pain syndrome (CRPS),
she underwent an ultrasound-guided mid-forearm ulnar and radial
periarterial sympathetic block, which provided her with 8 weeks of
symptom improvement prior to return to previous level of symptoms.
She was able to return to swimming and manually propelling her
wheelchair with ulnar gutter splints. Over the following year, she
would undergo repeat sympathetic blocks 1 week prior to swimming
competitions and was able to successfully compete in Paralympic
competitions.
Discussion:
CRPS is a disorder of the sympathetic and autonomic
nervous systems that results in sensorimotor disturbances, trophic
changes, and pain disproportionate to the original injury. Epidemi-
ology and management has been little-reported in spinal cord injury
and sports medicine literature. Regardless of management strategy,
prognosis can be highly variable, with up to 60% of symptoms persisting
greater than 5 years.
Conclusions:
We present a successful management approach to CRPS
in a Paralympic athlete who had failed conservative measures. While
not cured of her symptoms, she has been able to successfully return to
competition without limitations.
Level of Evidence:
Level V
Poster 426:
Unusual Cause of Rib Pain in a Young Adult Golfer: A
Case Report
Michael J. Slesinski, DO (MI State Univ)
Disclosures:
Michael Slesinski: I Have No Relevant Financial Re-
lationships To Disclose
S267
Abstracts / PM R 9 (2017) S131-S290