S213 S290
Case/Program Description:
A 19-year-old male hockey player pre-
sented with a 2-week history of bilateral hip and pelvic stiffness and
pain localized to the posterior and lateral hips. His symptoms started
during the hockey season, but were not associated with acute trauma.
He continued to compete at a high level despite the pain and stiffness.
Physical exam revealed mild tenderness to palpation over the sacro-
iliac joints, gluteal muscles, and lower lumbar paraspinal muscles. Hip
range of motion was full, with a mild familiar pain in the lateral hips
and buttocks with hip internal rotation and Patrick’s test. Lumbar
spine range of motion was normal. His gait was somewhat stiff. Hip and
pelvis radiographs were normal, and a subsequent MRI of the pelvis
revealed edema and cortical irregularities of both sacroiliac joints,
consistent with sacroiliitis. Inflammatory markers and HLA-B27 were
negative. The patient was referred to rheumatology for a second
opinion. He was diagnosed with a seronegative spondyloarthropathy,
and treated with scheduled Meloxicam.
Setting:
Outpatient Sports Medicine Clinic.
Results:
The patient’s pain subsided, and he was able to resume high
level competition within 2 weeks of starting non-steroidal anti-
inflammatories.
Discussion:
Sacroiliitis is a relatively uncommon cause of hip pain in
athletes, and inflammatory markers can be negative in 10% of affected
individuals. In sportspeople, the diagnosis can be elusive given the
prevalence of both acute and overuse injuries. In hockey players,
femoroacetabular impingement, acetabular labrum tears and gluteal
tendinopathy are common causes of hip pain. Accurate diagnosis and
prompt treatment may allow athletes to return to play and to prevent
disease progression.
Conclusions:
Early diagnosis and treatment of spondyloarthropathy in
young athletes may allow rapid return to high level sporting activities.
Level of Evidence:
Level V
Poster 255:
Ultrasound-Guided Radiofrequency Ablation of Amputation
Related Neuromas: A Case Report
Jennifer Windsor (North Bethesda, MD, USA), Yin-Ting Chen, MD,
Matthew E. Miller, MD, Michael Jacobs, MD, David Reece, DO,
William J. Kroski, DO
Disclosures:
Jennifer Windsor: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
Case 1: A 31-year-old man injured by an
improvised explosive device (IED) resulted in severe ankle injuries which
led to an elective left transtibial amputation (TTA). He presented 3-
months post TTA with shooting electric like pain in his residual limb,
rated 8-10/10, inhibiting prosthesis usage. Ultrasound (US) evaluation
demonstrated a well-circumscribed hypoechoic spherical mass termi-
nating at normal nerve tissue, consistent with a neuroma. US-guided
radiofrequency ablation (RFA) of the peroneal neuromawas performed 4
weeks following a diagnostic lidocaine injection. Case 2: A 25-year-old
man injured by an IED sustained multisystem trauma, notably bilateral
transfemoral amputations (TFA). He presented to the clinic 12-months
post injury, complaining of a sharp, shooting pain of his left lower re-
sidual limb, 10/10, unable to ambulate in his prosthesis, unrelieved with
oxycodone, with functional limitations. US exam revealed a neuroma
originating from the sciatic nerve. One week following the diagnostic
injection, RFA was completed without complications.
Setting:
Tri-service military medical center.
Results:
Case 1 Results: At the 2 and 9 month follow up, he reported
decreased pain at 2-3/10, with complete resolution of the electric-like
pain and ambulation in prosthesis for over 7 hours a day, as well as a
decrease in medications. Case 2 Results: Patient reported complete
pain cessation at his 2 week and 5 month follow up, all day use of his
prosthesis, decreased medication use, and obtained snowboarding and
running prostheses.
Discussion:
Continuous RFA successfully treated amputation-related
neuromas in these two patients. Several case reports and studies on RFA
have been published among other pain processes, but very little research
has been produced in regards to neuromas. It is clear from these limited
results further research is needed for post amputation neuromas.
Conclusions:
RFA remains a good treatment option for those re-
fractory to routine treatments for patients with amputation-related
neuromas.
Level of Evidence:
Level V
Poster 256:
An Unusual Cause of Chest Pain in a Female Boxer: A
Case Report
Rachel Welbel, MD (NY Presby Hosp/Columbia/Cornell, New York, NY,
United States), Leroy Lindsay, MD
Disclosures:
Rachel Welbel: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 35-year-old female boxer with no PMH
presented with 4 months of insidious right sided chest pain which
radiated to the neck and right arm. The pain was reported as sharp,
sore, aching and shooting. It was worse with movement of the arm and
changing positions. ADLs became challenging. Prior work-up included
unremarkable right shoulder and c-spine x-rays. A chest x-ray revealed
possible subluxation of the right AC joint. Prior treatments included
oral and topical NSAIDs with no relief. Physical exam was significant for
decreased right shoulder external rotation, and reproduction of pain in
the right pectoralis with shoulder impingement testing. She was ten-
der to palpation along the medial aspect of the sternal head of the
right pectoralis major muscle. She had full strength, normal sensation
and reflexes in the right upper extremity.
Setting:
Tertiary Care Outpatient Clinic.
Results:
An MRI of the chest without contrast revealed a T2 hyperin-
tense marrow edema involving the right aspect of the manubrium with
superimposed linear low signal suspicious for a stress fracture. The
pectoralis musculature and tendinous insertions were normal. She was
treated with physical therapy and pain control.
Discussion:
Overuse injuries resulting in a stress fracture to the ma-
nubrium are rare. The handful of reported cases have been with
weight-bearing activities such as body-building or sports with
abnormal torso movement. There have been none reported with
boxers, nor with associated AC joint abnormalities. It is postulated
that abnormal biomechanics of the pectoralis major lead to increased
pull and therefore stress on the manubrium. Concomitant AC joint
subluxation or instability can lead to further biomechanic malfunction
and poor activation of the surrounding musculature.
Conclusions:
When evaluating chest pain in an athlete, it is important
to consider the biomechanics of a specific sport and the possible
consequences of abnormal movement and function.
Level of Evidence:
Level V
Poster 257:
Radial Nerve Compression by a Cyst at the Elbow: A Case Report
Liza Hernandez, MD (San Juan VA Medical Center), Rafael A. Romeu-
Mejia, MD, Luis B. Varela, MD
Disclosures:
Liza Hernandez, MD: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 39-year-old patient presented to
ambulatory clinics with a 3-month history of a painful lump in the right
anterolateral elbow associated with sudden, transient, electric-like
sensation over the radial side of the distal forearm. There was no
history of trauma, however symptoms are exacerbated with grip and
lifting movements. Physical exam showed dysesthesia on a small area
over the radial side of the distal forearm. A positive Tinel’s sign was
reproduced over the lateral aspect of the soft, round, fluctuating lump
of the elbow joint. The remainder of the musculoskeletal and neuro-
logic exam was unremarkable.
Setting:
Outpatient-based private practice.
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Abstracts / PM R 9 (2017) S131-S290