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scrotal swelling 4 days prior after landing from a jump. He was evaluated
in the emergency department where a groin and testicular ultrasound
were normal. His pain was sharp, worse with activity, rated from 0-6/10
but not increased with cough/Valsalva. Exam revealed full strength,
normal and pain free passive hip range of motion, and normal neuro-
vascular exam. Pain was reproduced with resisted adduction, supine heel
lifts and palpationover thepubic bone/proximal adductor tendons. There
was visible swelling in the left inguinal/pubic region. An MRI of the pelvis
revealed a full-thickness tear of the left rectus abdominis/adductor
longus (AL) aponeurosis with 3.5 cm AL retraction and a large hematoma
extending into the left hemiscrotum. The patient was presented with the
option of surgical consultation vs conservativemanagement. Hewished to
return to sport this season, as he was being scouted for the NFL, and thus
elected rehabilitation with Physical Therapy.
Setting:
Sports Medicine Center.
Results:
The patient was able to return to high level competition 5
weeks post injury.
Discussion:
Definitive guidance on the management of AL tendon
avulsion is lacking. Case reports/series describe both operative and
non-operative management in high level athletes. Schlegel et. al.
report return to National Football League (NFL) play at 6 weeks for
non-operative management vs 12 weeks for operative management.
Our athlete desired to return to his season for NFL scouting reasons. He
successfully returned to play at 5 weeks.
Conclusions:
Conservative management of acute AL avulsion in the
setting of subacute athletic pubalgia can rapidly return athletes to
high level sporting activities.
Level of Evidence:
Level V
Poster 265:
Multiple Sclerosis Diagnosed in an Athlete with Gait
Abnormality: A Case Report
Rondy M. Lazaro, MD (Virginia Commonwealth University),
Katherine Dec, MD
Disclosures:
Rondy Lazaro: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 30-year-oldwoman presentedwith a 1.5-
year history of progressively worsening right leg weakness that started
while training for a 10K. She demonstrated mild weakness in gait on the
right with decreased forefoot clearance. Lumbar spine magnetic reso-
nance imaging (MRI) revealed a small central L5-S1 disc protrusion. She
was prescribed a course of diclofenac and physical therapy. She noted
slight symptom improvement on follow-up, but physical examination
showed steppage gait without foot drop, mild hip weakness with stance
change, 4/5 right hip flexion strength, and no upper motor neuron signs.
Because her prior imaging findings (including lumbar spine MRI and ra-
diographs of the lumbar spine, right knee, and right hip) were incon-
sistent with her gait issues, and since she recalled a history of “spastic
bladder,” a non-contrast brain MRI was ordered to investigate demye-
lination, mass, ischemia, or hydrocephalus.
Setting:
Academic sports medicine clinic.
Results:
Non-contrast brain MRI showed several scattered hyper-
intensities in white matter, periventricular regions, subcortical areas,
and brainstem suspicious for a demyelinating process. The patient was
referred to Neurology clinic. Cerebrospinal fluid analysis revealed 12
oligoclonal bands and an elevated IgG index. Contrast MRI of the brain
and spine displayed several frontal lobe enhancing lesions and multi-
ple signal intensity abnormalities in the cervical and thoracic cord
without contrast enhancement, consistent with multiple sclerosis
(MS). She was started on oral prednisone for her acute MS flare and
natalizumab for chronic MS treatment.
Discussion:
MS is an immune-mediated multifocal demyelinating dis-
ease of the central nervous system demonstrated by lesion dissemi-
nation in time and space. Acute MS exacerbations are typically treated
with glucocorticoids. Various disease-modifying agents are available
for relapsing-remitting MS.
Conclusions:
Sports medicine clinicians should consider demyelin-
ating processes such as MS in the differential diagnosis for gait ab-
normality, particularly if history and physical examination do not
correlate with other diagnoses or imaging findings.
Level of Evidence:
Level V
Poster 266:
Parsonage-Turner Syndrome Following Influenza
Vaccination: A Case Report
Anupam Sinha, MS DO (Rothman Inst, Mount Laurel, New Jersey,
United States), Shivani Gupta, DO
Disclosures:
Anupam Sinha: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
An 85-year-old man presents with com-
plaints of left shoulder weakness after having had a flu shot in the left
deltoid 1 year ago. He complains of inability to move his left shoulder
above the horizontal plane. He has done physical therapy for about 3
months without progress. He currently does take some herbal medications
for pain relief. He denies any paresthesias. Denies weakness in the distal
upper extremity. Prior to the flu vaccine, he was playing golf and staying
very active physically. One week after the injection, he described acute
onset of shoulder pain and weakness. Physical examination is unremark-
able except for reduced active range of motion of the left shoulder, and 4
out of 5 strength in the left deltoid and left shoulder external rotators.
Setting:
Outpatient orthopedic practice.
Results:
MRI of the left shoulder shows evidence of an old rotator cuff
injury. MRI of the cervical spine shows cervical spondylosis without
evidence of nerve or cord impingement. Electromyography of the left
upper extremity confirms the presence of left axillary nerve and
suprascapular nerve injury.
Discussion:
We present a case of shoulder weakness due to supra-
scapular andaxillary nerve injury followingflu vaccination. Although rare,
there are well documented reports of brachial neuritis or Parsonage-
Turner syndrome (PTS) following vaccinations. The cause is considered to
be a postinfectious reaction or a reaction secondary to a hypersensitivity
response. The prognosis for clinical improvement is good, although a
number of patients demonstrate residual weakness and atrophy.
Conclusions:
Parsonage-Turner syndrome is a rare but distinct disor-
der with an abrupt onset of shoulder pain, followed by weakness and
atrophy of the upper extremity musculature, and a slow recovery
requiring months to years. We present a rare case of PTS following
influenza vaccination. Clinicians should consider this diagnosis in pa-
tients with upper extremity weakness following vaccination.
Level of Evidence:
Level V
Poster 267:
Rapid Recovery from Bilateral Upper Extremity
Neuralgic Amyotrophy in a Previously Healthy Male
Adult: A Case Report.
Tomasz K. Podobinski, DO (Univ of TX-UT Houston, Houston, Texas,
United States)
Disclosures:
Tomasz Podobinski: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
This right-hand dominant man presented
for evaluation of 1 month history of progressive bilateral arm pain, first
and second finger numbness as well as anterior interosseous nerve and
posterior interosseous nerve dysfunction. The patient described his
discomfort as aching, tingling, shooting which was worse with move-
ment. He has completed a course of methylprednisolone and gaba-
pentin trial, but both did not provide any relief. The patient’s imaging
included cervical MRI which showed mild degenerative changes, but
without any disc herniation. His bilateral brachial plexus MRI did not
show any masses or other abnormality. The patient had also undergone
a bilateral upper extremity EMG which showed mild to moderate
brachial plexopathy, involving the upper trunk, AIN and PIN in bilateral
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Abstracts / PM R 9 (2017) S131-S290