S212 S290
Poster 251:
A Mixed Martial Arts (MMA) Fighter with a Bleeding
Disorder: A Case Report of the Importance of
Preparticipation History and Physical
Katie M. Fast, MD (Univ of MO-Columbia), Carl E. Giacchi, DO
Disclosures:
Katie Fast: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
A 22-year-old female amateur MMA figh-
ter was scheduled to fight in the 120-pound weight division. Prior to
the fight, thorough pre-fight physical examination and questionnaire
were performed including a full past medical history (PMH) in which
she denoted no significant PMH; her pregnancy test was also negative.
The bout was stopped by the referee in the first round due to unde-
fended strikes, with the final blow ending in profuse epistaxis.
Setting:
Amateur MMA Fight.
Results:
Immediately after the final blow, the onsite physician
entered the ring to evaluate the fighter. She was alert and oriented
x3 and appeared to be in no acute distress. An unprecedented
amount of bleeding was noted; after 5 minutes of unmitigated
bleeding 1:1000 epinephrine swab was applied directly to the nares
and eventually the bleeding ceased. The physician questioned her
about previous nasal fractures. She denied previous fracture but
finally admitted, “I have Von Willy syndrome.” When asked why she
had not disclosed this initially, she stated it was genetic and there-
fore nothing to be done; she also noted her primary-care provider
had cleared her to fight. The physician and MMA association enacted
a life-time ban on her prohibiting any future participation in their
fights again.
Discussion:
Athletes are motivated patients, but sometimes they are
more devoted to their sport than their health. The athlete in this report
did not realize the potential consequences of her disease and therefore
did not report it. A well-directed blow in a patient with Von Willebrand
disease could result in internal or even intracranial bleeding. Event
physicians must be diligent in stressing pre-participation physicals and
obtaining comprehensive PMH, as the athletes may not fully appreciate
the risks involved with their premorbid conditions.
Conclusions:
Preparticipation history and physicals, though seemingly
rudimentary, provide a stop-gap for physicians to prevent serious
medical consequences.
Level of Evidence:
Level V
Poster 252:
An Unusual Presentation of Suprascapular Nerve Palsy
Vivek Kumar, DO (Vidant Rehab Ctr/East Carolina Univ/Brod,
Greenville, NC, United States), Jayveeh D. Navarro, MD,
Matthew W. Wilson, MD
Disclosures:
Vivek Kumar: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 22-year-old man presented to clinic
with left shoulder pain that was present for 3 months. Patient could
not recall any inciting event but the pain had improved since initial
onset. Patient had a job, 10 months prior, requiring him to wear a
heavy weighted backpack while spraying fields. Patient denied asso-
ciated neck pain or history of trauma to the spine. On physical exam,
there was no paresthesia in the left upper extremity but weakness
with shoulder flexion, abduction, and external rotation. There was
atrophy of the supraspinatus and infraspinatus muscles without
winging of the scapula. Patient’s strength was symmetrical bilaterally
and he was able to perform a push up exercise without difficulty. MRI
shoulder indicated mild edema and muscular atrophy in the supra-
spinatus and infraspinatus muscles without a mass lesion in the region
of the suprascapular notch.
Setting:
Nerve conduction study/Electromyography Clinic.
Results:
Electromyography and nerve conduction study were performed
on the patient’s left upper extremity. There was electro-diagnostic
evidence of left suprascapular mononeuropathy. Based off the results,
the lesion was characteristic of axon loss of approximately 60%. Nerve
conduction studies indicated the continuity of the nerve was intact and
there was evidence of partial re-innervation.
Discussion:
Suprascapular nerve injury is commonly associated with
repetitive overhead loading, shoulder pathologies including glenoid
labrum tear, and compression at the suprascapular notch secondary to
cyst formation. Generally, backpack palsy is associated with numb-
ness, paresthesia and paresis. Based off the history with results from
the electromyography and nerve conduction, patient had a supra-
scapular neuropathy secondary to a heavy backpack.
Conclusions:
The chronicity of the suprascapular nerve palsy resulted
in a unique presentation of muscle atrophy and weakness without
sensory symptoms.
Level of Evidence:
Level V
Poster 253:
Obturator Externus Avulsion and Parasymphyseal
Fracture After a Fall: A Case Report
Benjamin J. Bonte, MD (Rusk Rehabilitation at NYU Langone, New
York, NY, United States), Daniel P. Giangrasso, DO, Ronald Shin, DO,
Derek J. Ho, DO, Salvador Portugal, DO, FAAPMR
Disclosures:
Benjamin Bonte: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 68-year-old woman with a past medical
history of osteoporosis and bilateral knee replacements was referred
due to clinical concern for lumbar radiculopathy. She suffered a fall 7
weeks prior to presentation however had no radicular symptoms at that
time. She presented with 1 week of left-sided radiating groin pain and
weakness of the left leg. She was unable to bear weight without pain and
pain worsened with prolonged walking and improved with rest. She had
previously been prescribed oxycodone and oral steroids. Her previous
imaging included hip radiographs which revealed no evidence of frac-
ture andMRI of the lumbar spinewhich revealedmoderate canal stenosis
at L4-5 and multilevel neuroforaminal stenosis without compromise.
Sacral insufficiency fractures were seen on the right greater than left,
but incompletely evaluated. Her exam was notable for pain with hip
flexion, internal and external rotation, Stinchfield test, log roll test, and
Patrick’s test. Occult hip fracture and lumbar radiculopathy were
considered as possible explanations for her symptoms. A left hip MRI was
ordered to better characterize her injury.
Setting:
Quaternary care hospital.
Results:
Left hip MRI revealed a left obturator externus avulsion as
well as bilateral sacral alar fractures and left parasymphyseal frac-
ture. She was given oxycodone for pain management, and a manual
wheelchair until she was able to bear weight without pain. She began a
physical therapy program and 9 weeks after her injury she was able to
walk with a rollator. Her osteoporosis treatment was addressed.
Further developments will be discussed.
Discussion:
Pelvic ring fractures involving the sacral ala and the
parasymphyseal region can be managed nonoperatively, and may
present similarly to radiculopathy. In addition, this is the first reported
case, to our knowledge, of obturator externus avulsion.
Conclusions:
Obturator externus avulsions should be considered in
the setting of presumed occult hip fracture.
Level of Evidence:
Level V
Poster 254:
Sacroiliitis Presenting as Hip Pain in an Elite Hockey
Player: A Case Report
John Evans, DO (Mayo Clinic of Rochester), Brennan Boettcher, DO,
Steve J. Wisniewski, MD
Disclosures:
John Evans: I Have No Relevant Financial Relationships
To Disclose
S212
Abstracts / PM R 9 (2017) S131-S290