S196 S290
Poster 199:
Diffuse Idiopathic Skeletal Hyperostosis Presenting
with Wrist Drop: A Case Report
Matthew Moore (Nassau University Medical Center PM&R Pr, Port
Washington, NY, USA), Walter Gaudino, MD, Lyn D. Weiss, MD,
Robert Andrews, DO
Disclosures:
Matthew Moore: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
The patient originally presented to the
emergency department with a 2-day history of right forearm and hand
numbness and profound weakness in wrist extension. On initial phys-
ical exam, the patient showed an inability to extend the wrist and had
decreased sensation to light touch in the radial nerve distribution of
the forearm and hand. To rule out any acute neurological pathology, a
CT of the cervical spine and head was performed which revealed
extensive diffuse idiopathic skeletal hyperostosis (DISH) involving the
C3-T1 vertebrae. A diagnosis of right wrist drop due to nerve
impingement likely secondary to DISH was made. EMG/NCV revealed
electrodiagnostic evidence of a focal demyelinating neuropathy of the
right radial nerve above the level of the elbow. On further evaluation
by PM&R the patient admitted to progressive dysphagia and worsening
range of motion of the cervical spine for the past year.
Setting:
Outpatient PM&R Clinic.
Results:
The patient is a 63-year-old man diagnosed with right sided
wrist drop likely due to nerve impingement secondary to DISH. The
patient is currently pending evaluation by orthopedics as he may be a
candidate for surgical intervention.
Discussion:
DISH of the cervical spine can present with wrist drop.
Conclusions:
DISH can present with a variety of symptoms; most
commonly neck, back, and extremity pain. In this case, the patient
presented with a chief complaint of wrist drop and later admitted to
an associated decrease in ROM of the cervical spine and dysphagia.
This case emphasizes the need for a thorough history, physical and
workup in patients who present with unusual findings.
Level of Evidence:
Level V
Poster 200:
Meralgia Paresthetica Secondary to the Usage of a
Left Ventricular Assist Device: A Case Report
RyanA. Menard, DO (Temple University Hospital, Philadelphia, PA, United
States), Katie Hatt, DO, Brandon Barndt, OMS-II, Ernesto Cruz, MD
Disclosures:
Ryan A. Menard, DO: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 48-year-old man with history of end
systolic heart failure was admitted to hospital for a LVAD placement and
fitted with a Heartmate GoGear Holster Vest to be worn for trans-
portation of the LVAD components. Later, he was transferred to acute
inpatient rehabilitation for deconditioning. Two weeks into his rehab
stay, he noted left lateral thigh pain and numbness, which he described
as “burning” and worsening throughout the day. Examination of the
extremities noted tight belt portion of the LVAD vest over the anterior
superior iliac spine (ASIS), decreased sensation to light touch over left
upper anterolateral thigh, and a positive Tinel’s sign 2 cm medial and 2
cm inferior to the left ASIS. Deep tendon reflexes were normoreflexic
throughout with negative Hoffmann’s and Babinski. Manual muscle
testing revealed 5/5 strength of bilateral lower extremities. Active
range of motion of his bilateral hips, spine, and SI joints were within
normal ranges. The patient was clinically diagnosed with MP of his left
lateral leg secondary to nerve compression from LVAD belt.
Setting:
Tertiary care hospital.
Results:
Patient reported improvement of his neuropathy after loos-
ening the LVAD belt. Symptoms further improved with gabapentin,
gentle stretching of his anterior thigh and groin, and ice.
Discussion:
To our knowledge, there have been no case reports
describing MP in patients using LVAD devices.
Conclusions:
Physicians should become aware of the various causes of
MP, including LVAD devices. This is especially important as the number
of LVAD procedures and fitting of carrying devices will likely continue
to increase. If not properly diagnosed and treated, MP may cause
considerable pain and distress, leading to long-term disability.
Level of Evidence:
Level V
Poster 201:
Gait Retraining in a Patient with Acquired Absence of the
Left Hip Joint After Surgical Resection: A Case Report
Charles P. Scott, MD (New York Presbyterian Hosp), Nasim Chowdhury, MD
Disclosures:
Charles Scott: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
The patient is a 58-year-old woman with
history of liposarcoma involving the left pelvis and buttock diagnosed
24 years prior to admission. Upon diagnosis, she underwent partial
resection of the left acetabulum and remained disease-free for 23
years. Two months prior to admission, the left hip surgical wound
dehisced and work-up revealed osteomyelitis of the left pelvis and
proximal femur. The infection remained refractory to multiple de-
bridements and intravenous antibiotics, requiring extensive resection
of the left pelvis and proximal femur. A post-operative hip radiograph
demonstrated absence of the entire left acetabulum and the proximal
left femur from the level of the lesser trochanter.
Setting:
In-patient rehabilitation unit of a tertiary care hospital.
Results:
At the time of admission to acute in-patient rehabilitation on
post-operative day 12, the patient required maximum assistance to
ambulate 8 steps using a rolling walker. After a brief inpatient reha-
bilitation course, the patient regained modified independence with
ambulation using a rolling walker.
Discussion:
Prior case reports of ambulation in patients with “flail
hip” have predominantly described cases with either hemipelvectomy
or, less often, proximal femur resection, but not both. We describe a
patient who, after undergoing extensive combined left pelvic and
proximal femur resection, regained modified independent ambulatory
function after a brief acute rehabilitation course.
Conclusions:
Although prior studies have shown that patients with
hemipelvectomy have reduced quality-of-life and functional out-
comes, therapeutic approaches that include gait retraining in patients
with complete surgical absence of a hip joint can result in meaningful
benefits including ambulation with modified independence.
Level of Evidence:
Level V
Poster 202:
A Rare Case of Single Upper Extremity Lymphedema
in a Patient with Systemic Lupus Erythematosus: A
Case Report
Diana Molinares Mejia, MD (Jackson Mem Hosp/Jackson Hlth Sys,
Miami, FL, United States), Tamar Ference, MD
Disclosures:
Diana Molinares Mejia: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
This is the case of a 41-year-old woman
with history of systemic lupus erythematosus (SLE) and kidney trans-
plant secondary to lupus nephritis, who presented with chronic, non-
pitting edema of the left upper extremity. The symptoms started
gradually a year prior and were characterized by progressive edema of
the left upper extremity extending to the ipsilateral breast and chest
wall, without associated symptoms. Computed tomography revealed
moderate pericardial effusion as well as left breast, chest wall and
upper extremity skin thickening with enlarged likely benign left axil-
lary lymph nodes. After a thorough evaluation, vascular abnormalities
and malignancies were ruled out. This is the second case in the
literature of lymphedema secondary to SLE and the first that reports a
single extremity involvement associated to SLE.
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Abstracts / PM R 9 (2017) S131-S290