S218 S290
surgery in all patients. Furthermore, structural instability and changes
in surrounding tissue due to nature of surgery may contribute to pain
symptomatology. Manual medicine acts to align structures, correct
reflexive changes, and improve mobility in patients.
Conclusions:
The use of manual medicine can improve pain and
functional disability in patients suffering from LBP which persists post
lumbar laminectomy.
Level of Evidence:
Level V
Poster 272:
Sacral Pedicle Stress Fracture in a Male, Adolescent,
Competitive, Dual-Sport Athlete with Prior Physeal
Injury: A Case Report
Andrew P. Creighton, DO (WA Univ/BJH/SLCH Consortium, St. Louis,
MO, United States), Craig Ziegler, MD, Heidi Prather, DO
Disclosures:
Andrew Creighton: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
This 15-year-old dual-sport athlete pre-
sented with 4 months of left lower back pain. It started during a relay
race while reaching for a baton pass with his right hand while striking
the ground with his left knee fully extended, resulting in a painful
jarring sensation at his left lower back. His pain was 8/10 when pro-
voked and located near the left PSIS. The pain was better with
ibuprofen and heat/ice application. It was worse with extension,
running, and jumping. He had previously experienced minimal relief
with three rounds of physical therapy. Past medical history includes a
left distal femur physeal injury 18 months prior and subtle lumbar
scoliosis. During the 6 months prior to our initial evaluation, he had
experienced a growth spurt of 3 inches and worsening scoliosis, which
prompted referral to our pediatric sports medicine clinic. Examination
revealed an elevated right iliac crest and right PSIS, positive left-sided
standing flexion test, positive FABER test bilaterally reproducing pos-
terior pelvic pain, and left leg length 1.5cm shorter than right. MRI
revealed a small non-displaced extra-articular stress fracture at the
left S1 pedicle. He was restricted from sports participation for 8 weeks
and was prescribed an orthotic for his leg length discrepancy.
Setting:
Academic Sports Medicine Clinic.
Results:
At 8-week follow-up he was pain-free and able to hop and
skip flat-footed without pain. He was then referred for gait analysis to
improve running mechanics and allowed to return to basketball prac-
tice, with plans to gradually return to full activity.
Discussion:
Fatigue-type sacral stress fractures are being reported
with increasing frequency in the literature; however, the incidence of
these fractures in patients with leg length discrepancies is unknown.
Conclusions:
Sacral pedicle stress fracture can be an unusual source
of unilateral low back pain in a patient with a leg length discrepancy.
Level of Evidence:
Level V
Poster 273:
Ischial Bursitis with Sciatica Like Symptoms and
Fluoroscopic-Guided Steroid Injection as a Successful
Treatment Option: A Case Report
Diana Molinares Mejia, MD (Jackson Mem Hosp/Jackson Hlth Sys,
Miami, FL, United States), Andrew L. Sherman, MD, FAAPMR,
Yevgeniya Sergeyenko, MD/MPH Candidate
Disclosures:
Diana Molinares Mejia: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
This case reports a patient with 4-year
history of sciatica-like symptoms as a result of ischiogluteal bursitis.
The patient is an active young female who presented with posterior
left lower extremity pain, and MRI with degenerative changes of the
lumbar spine as possible source of her symptoms. Patient underwent
multiple treatments for lumbar radiculopathy without success.
Setting:
Outpatient.
Results:
MRI of the lumbar spine showed a bulging L4-L5 disk with
left lateral recess stenosis. Patient underwent transforaminal
epidural injection with no improvement. Patient failed conservative
treatment for the treatment of degenerative disc disease. She
continued to report sharp pain in the inferior aspect of her left
gluteus. Pain was exacerbated by hamstring stretching and palpation
of the proximal aspect of the muscle. MRI of the hamstring revealed
small tear and tendonitis. She tried conservative treatment for
approximately 12 months without improvement, including ultra-
sound-guided PRP injections without success. Finally, a fluoroscopic-
guided injection in the left ischial bursa was performed with com-
plete resolution of her pain.
Discussion:
Positioned between the proximal hamstring origin on the
ischial tuberosity and the gluteus maximus, the ischiogluteal bursa is
in close contact with the sciatic nerve. Ischial bursitis is an inflam-
mation of the ischial bursa that can develop with repetitive minor
trauma from prolonged sitting. In this case, the symptoms of ischial
bursitis resembled those of sciatica either due to irritation of the
sciatic nerve or to referred pain to the hamstring muscle. Although
some patients may improve with conservative measure, our patient
only obtained relief with a corticosteroid injection of the ischial
bursa.
Conclusions:
Ischial bursitis is a rare disorder, however it should not
be overlooked as a cause of buttock pain. In cases refractory to con-
servative management, fluoroscopic-guided steroid injections into the
ischial bursa should be considered as a treatment option.
Level of Evidence:
Level V
Poster 274:
Repair of Large, Retracted Rotator Cuff Tear Using an
Extracellular Matrix Scaffold: A Case Report
Adil S. Hussain, DO (Wayne State University / Beaumont, Dearborn
Heights, Michigan, United States), Marc J. Milia, MD
Disclosures:
Adil Hussain: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
The patient presented with a chief
complaint of progressive right shoulder pain and weakness. Physical
exam findings were consistent with a shoulder impingement syndrome.
Radiograph imaging revealed a type 2 acromion along with proximal
migration of the humerus. Magnetic resonance imaging (MRI) of the
shoulder confirmed a large, full-thickness rotator cuff tear involving
the supraspinatus tendon. The patient failed conservative measures
and elected for surgical management. Intraoperatively, his supra-
spinatus tendon was noted to be fully retracted and thus could not be
repaired by simply anchoring the tendon to the humeral head. Utilizing
a specialized surgical technique, an extracellular matrix (ECM) scaf-
fold was used to bridge the gap between the torn rotator cuff and the
head of the humerus. The patient did well with no post-operative
complications.
Setting:
Outpatient Surgery Center.
Results:
At 2 weeks post repair, the patient reported a significant
reduction in his shoulder pain. He began physical therapy for
strengthening and range of motion after 1 month post repair.
Discussion:
The patient suffered chronic pain and weakness due to a
large rotator cuff tear that was not amenable to standard operative
management. The rotator cuff was able to be repaired using an
extracellular matrix scaffold. This case is a prime example of when a
rotator cuff augmentation procedure can and should be used to repair
a large rotator cuff tear.
Conclusions:
In patients with large, retracted rotator cuff tears, a
total shoulder arthroplasty is not the only option. Using a rotator cuff
augmentation technique with an ECM scaffold, the rotator cuff can be
repaired with a high success rate. This can lead to greater pain
reduction, enhanced strength, increased longevity, and overall
improved quality of life.
Level of Evidence:
Level V
S218
Abstracts / PM R 9 (2017) S131-S290