S221 S290
pain while running a race. Shortly after completing the race at her
typical pace, she began to have sudden onset vertigo with nausea and
emesis causing her to collapse. Emergency medical staff was imme-
diately called and she was transported to the hospital. On work up in
the emergency department, CT angiography of the neck revealed an
acute focal right vertebral artery dissection at C2-C3. MRI of the brain
additionally showed a right cerebellar vermis stroke.
Setting:
Academic Medical Hospital.
Results:
The mechanistic cause of the patient’s dissection and stroke
remained cryptogenic. The patient was started on a heparin drip with
transition to warfarin for anticoagulation and secondary stroke pre-
vention. She was admitted to inpatient stroke rehabilitation and dis-
charged to home after 5 days of rehabilitation at an independent
level. While at inpatient rehabilitation, she was started on Clonaze-
pam 0.5mg three times daily as needed for vertigo, which controlled
her symptoms. She is enrolled in vestibular outpatient physical ther-
apy. The patient plans to run the Boston marathon in 2017 which she
has already qualified for.
Discussion:
Vertebral artery dissection with stroke in sports is a rare
condition but should be considered in those with neck pain as this is the
most common presenting feature. This condition remains difficult to di-
agnose as clinical presentations commonly involve minimal trauma to the
neck. The mechanistic cause of this condition in sports remains poorly
understood as individuals often do not have vascular risk factors. Intra-
venous heparin followed by warfarin is usually recommended for anti-
coagulation treatment to prevent further thromboembolic complications.
Conclusions:
As vertebral artery dissection with stroke can be
severely disabling, physicians caring for athletes should be aware and
educated on this condition.
Level of Evidence:
Level V
Poster 282:
A Case Report of a Recurrent Gastroc Strain Treated
with Platelet Rich Plasma Injections
Thomas S. Nabity, MD (Michigan Neurology Associates)
Disclosures:
Thomas Nabity: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
After failing conservative care with
NSAIDs, rest, ice, modalities including therapeutic ultrasound and
TENS, 6 weeks of physical therapy and dedicated home exercises, a 38-
year-old suffering from chronic recurrent bilateral gastroc strains with
visible tears on ultrasound was injected with platelet rich plasma
(PRP) injections.
Setting:
Outpatient Private Practice.
Results:
Patient felt pain improvement within 2 weeks and was able
to resume competitive activities within 4 weeks. Repeat ultrasound
imaging demonstrated resolution of tears at 6 weeks.
Discussion:
PRP injections offer a safe and effective treatment for a
multitude of musculoskeletal conditions including chronic strains
involving the musculotendinous junction. PRP should be considered
sooner in the treatment algorithm when athletes do not heal within
the anticipated timeline for their injury or suffer from a recurring
injury.
Conclusions:
This patient demonstrated a remarkably quick recovery
and ability to return to competition after failing multiple attempts of
the traditional conservative treatments. PRP should be considered not
only a reasonable and safe treatment for strains of the muscu-
lotendinous junction, but a very cost effective treatment as well.
Level of Evidence:
Level V
Poster 283:
Hydraulic Capsular Distension for Treating Adhesive Capsulitis
in an Individual with Tetraplegia: A Case Report
Ajax Yang, MD, MPT (Icahn School of Medicine at Mount Sinai, New
York, NY, United States), Anokhi Mehta, MD, Thomas n. Bryce, MD
Disclosures:
Ajax Yang: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
Adhesive capsulitis (AC) often develops
after prolonged shoulder immobilization. In our experience, we
observed more cases of AC in individuals with tetraplegia than para-
plegia as a result of spinal cord injury (SCI). Hydraulic capsular
distension (HCD) is an accepted method for treating AC in able-bodied
individuals. However, HCD has not been described in SCI literature. We
propose that HCD therapy as an option to mitigate AC in individuals
with SCI. This is a 38-year-old man with incomplete tetraplegia since
2015. He was admitted to our inpatient rehab service in October 2016.
A notable complication that ensued since his injury included left
shoulder. Extensive left shoulder heterotopic ossification was initially
considered due to nearly absent glenohumeral joint ROM. However,
left shoulder radiography was normal. The diagnosis of AC was made.
Setting:
Inpatient SCI Rehabilitation.
Results:
Under ultrasound visualization, we performed glenohumeral
intra-articular injection of 4cc 1% lidocaine, 1cc kenalog and 18cc 3%
hypertonic saline. Afterwards, the left shoulder was routinely mobi-
lized in all planes of motion. The following passive ROM were obtained
on day 7 post injection- flexion: 0-40 , extension: 0 , abduction: 0-55 ,
external rotation: 0-25 and internal rotation: 0-40 . Patient also re-
ported moderately decreased discomfort during stretching exercises.
Repeated injection on day 8 of 4cc 1%-lidocaine and 20cc 3%-hyper-
tonic saline followed by routine stretching yielded additional signifi-
cant ROM gain in all directions on day 15.
Discussion:
Unrestricted shoulder movement plays an integral part of
placing hand in space that allows an individual tomanipulate and interact
with one’s surroundings. This is particularly important in individuals with
SCI that often rely on their upper extremities for mobility and self-care.
The ability to transfer and drive a wheelchair could mean the difference
between living independently versus needing an attendant.
Conclusions:
HCD is effective in improving shoulder passive ROM
caused by AC in an individual with tetraplegia.
Level of Evidence:
Level V
Poster 284:
Deep Vein Thrombosis Presenting as Posterior Knee
Pain After Playing Soccer: A Case Report
Amit Bhargava, MD, MS, RMSK (Advanced Interventional Pain and
Sports, Owings Mills, Maryland, United States)
Disclosures:
Amit Bhargava: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 32-year-oldmanpresentedwith right knee
pain. 2 weeks earlier, he had twisted left ankle following which he played
soccer. Two days later he developed right knee pain. He felt he was putting
more stress on the right knee due to left ankle injury. Right knee felt stiff.
There was tenderness at the popliteal fossa and posteromedial aspect of
right thigh. There was no swelling. Varus, valgus and Lachman test was
negative. Right ankle dorsiflexion increased pain in popliteal fossa and
stretching sensation in the calf. MRI was ordered as patient was leaving for
trekking in another country for 3 weeks. MRI findings were consistent with
DVT involving the popliteal vein and low grade anterior cruciate ligament
sprain. On further evaluation patient was found to have factor V Leiden.
Setting:
Private medical office.
Results:
The patient stopped taking warfarin after 11/2 years.
Following that, he was recommended to take aspirin for long journey.
Discussion:
This is the first reported case, to our knowledge, of DVT
presenting as posterior knee pain after playing soccer. We do not
recommend MRI immediately for knee pain. MRI was obtained to rule
out any internal derangement of the knee before patient left for
another country for trekking.
Conclusions:
DVT can present as posterior knee pain after playing.
There should be a high suspicion for DVT if a patient presents with
posterior knee pain.
Level of Evidence:
Level V
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Abstracts / PM R 9 (2017) S131-S290