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Abstracts / PM R 8 (2016) S151-S332

Design: Data regarding purchase of new ultrasound devices in the

southeastern United States was obtained from the leading ultrasound
device manufacturer, Sonosite Fujifilm, during the period of January
2014 to December 2015. We included outpatient musculoskeletal
practices in the southeastern United States, specifically covering the
states of Georgia, Alabama, Florida, and South Carolina. Hospitals and
inpatient services were excluded, as was the purchase of used ultrasound devices. Data were collected from the practices on whether
they had received manufacturer training, loaned a device, or were
trained in ultrasound during residency, fellowship, or in a prior job.
Setting: Primary investigators all from academic setting.
Participants: Fifty-two outpatient musculoskeletal practices were
included in this study.
Interventions: Not applicable.
Main Outcome Measures: Percentage of musculoskeletal practice
which received manufacturer training, loaned a device, or were
trained in ultrasound during residency, fellowship, or in a prior job.
Results: Thirty-six devices (61%) were bought by practices where the
physicians were trained to use ultrasound during residency, fellowship,
or a prior job. Ten devices (17%) were bought by practices where the
manufacturer trained physicians, and 7 of these devices were also
loaned to the practices after training. Fifteen devices (25%) were
bought by practices where the physicians had no prior training with
ultrasound nor loaned a device before purchase. Only 12% of practices
loaned a device before purchase, and this was not associated with an
increased likelihood of purchasing an ultrasound device (P>.05).
Conclusions: Our data suggest that ultrasound training during residency, fellowship, or a prior job is more strongly associated with the
purchase of new ultrasound devices in outpatient musculoskeletal
clinics than other factors, including training by the manufacturer or
loaning the device. Thus, earlier exposure to ultrasound seems to
promote continued use of ultrasound later in a physiatrists career.
Level of Evidence: Level III
Poster 197-C
Epidemiology of Cervical Spine Injuries in High
School Athletes
Adele Meron, MD (University of Colorado School of Medicine, Denver,
Colorado, United States), Christopher W. McMullen, MD,
Scott R. Laker, MD, R. Dawn Comstock, PhD
Disclosures: Adele Meron: I Have No Relevant Financial Relationships
To Disclose
Objective: To describe and compare cervical spine injury rates and
patterns among high school athletes across 20 sports over a 10-year
Design: Retrospective analysis of the rates of cervical spine injuries
sustained by high school athletes from a representative sample of high
schools across the United States. Injury data are collected by athletic
trainers and input into a national database. This study compares injury
setting, type and mechanism as well as characteristics of athletes who
sustained these injuries and how injury rates changed over time.
Setting: Representative and convenience sample of high schools
across the United States via High School Reporting Information Online
Participants: High school athletes injured in a school sanctioned
practice, competition or performance over a 10-year period from the
2005/06 season through the 2014/15 season.
Interventions: Not applicable.
Main Outcome Measures: Cervical spine injury rates, diagnoses,
mechanism and severity.
Results: Over the 10-year collection period from 2005/6 through 2014/
15, there were 1080 recorded cervical spine injuries in 35,581,036
athlete exposures (AE) for an injury rate of 3.04 cervical spine injuries
per 100,000 AE. Injury rates per 100,000 AE were highest in football
(10.1), wrestling (7.42) and girls gymnastics (4.95). Muscle injuries were
the most common (63%), followed by nerve injuries (21%), ligamentous


injuries (10%), and fractures (3%). The most common etiology of severe
injury (season ending or athlete missed more than 22 days) was nerve
injuries (42%), followed by fracture (22%) and muscular injuries (17%).
Conclusions: High school cervical spine injury rates and severity vary by
sport. Continued surveillance, study and education are warranted to further
understand trends and develop evidence based prevention guidelines.
Level of Evidence: Level III

Poster 197-D
Ultrasound-Guided Lidocaine Injection Directs
Successful Talus Os Trigonum Resection: A
Case Report
Elizabeth A. Barton, MD (University of Missouri-Columbia, Columbia,
MO, United States), Jane Anne Emerson, MD, Mohammad Agha, MD
Disclosures: Elizabeth Barton: I Have No Relevant Financial Relationships To Disclose
Case/Program Description: A 15-year-old overweight female was
referred to PM&R by orthopedics due to unilateral ankle pain and gait
abnormality noted since childhood. Examination demonstrated point
tenderness inferior and posterior to the lateral malleolus and sharp
pain with plantar flexion, dorsiflexion, inversion and weight bearing.
Range of motion, strength and neurological examination were normal.
The affected foot was markedly pronated and everted in weight
bearing and gait was antalgic. MRI revealed os trigonum of the talus
with subcutaneous peroneal tendon edema.
Setting: Physical Medicine & Rehabilitation clinic.
Results: Using a posterolateral, in-plane long axis approach, diagnostic
ultrasound-guided injection of lidocaine was performed directly to the os
trigonum. Patient reported immediate pain relief and gait normalized
briefly. Steroid injection was considered, but surgical excision was elected. Two months following successful surgery, the patient reported pain
relief and demonstrated neutral foot positioning with gait.
Discussion: Typically, os trigonum is an incidental finding with an incidence estimated to be between 3-15%. Extreme plantar flexion can
impinge the posterior talus between the tibia and calcaneus, causing
painful symptoms and is frequently used in the diagnosis of Os Trigonum
Syndrome. In this case, ultrasound-guided injection allowed accurate
diagnosis and foot position was corrected with surgical excision.
Conclusions: The presence of symptomatic os trigonum, though
infrequent, can negatively affect foot positioning, comfort, and gait
mechanics. Ultrasound-guided lidocaine injection can be a useful
diagnostic tool that can direct definitive treatment.
Level of Evidence: Level V
Poster 197-E
Hip Pain Secondary to Intramuscular Lipoma of
Tensor Fascia Lata: A Case Report
Alexander Feng, MD (Temple University Hospital, Philadelphia,
Pennsylvania, United States), Ilya Igolnikov, MD, Cora H. Brown, MD,
Michael M. Weinik, DO
Disclosures: Alexander Feng: I Have No Relevant Financial Relationships To Disclose
Case/Program Description: A 69-year-old man presents for evaluation
of chronic hip pain. He describes the pain as sharp, non-radiating.
Exacerbating factors include long walks and internal rotation. On
manual muscle testing, he had bilateral hip flexion and abduction
weakness but normal hip adduction without notable muscle atrophy or
fasciculation. Functionally, he had a non-antalgic gait, normal limb
advancement, stability, and clearance, but was unable to perform
heel/toe walk. The spinous processes, paraspinal musculature, PSIS,
piriformis and greater trochanteric regions are non-tender. Hip range
of motion is full. Femoral nerve stretch test, Patricks test, Kemps
test were negative. Obers test was positive. There was a palpable left
anterior hip mass.


Abstracts / PM R 8 (2016) S151-S332

Setting: Musculoskeletal Clinic.

Results: Initial work up included electrodiagnostic studies, x-ray of
the hip, and targeted ultrasound of the lateral left hip. US demonstrated a mildly heterogeneously solid soft tissue mass that extends
from the superficial subcutaneous soft tissues very close to/abutting
the skin to the region of the deep fascia overlying the musculature.
MRI was obtained for clarification and showed a 10 cm x 7.1 cm x 10 cm
encapsulated intramuscular lesion in the left tensor fascia. Subsequently the patient improved in physical therapy with a focus on
myofascial release techniques, assisted stretching including ART and
PNF techniques, and core and hip girdle stabilization exercises.
Discussion: Intramuscular lipomas are rare, deep seated lipomas that
originate within the muscle. MRI can identify and localize these tumors
and differentiate lipomas from lipo-sarcomas. Clinically, dysfunction of
the engaged muscle due to extensive infiltration has been reported. In
our case, the large size of the mass led to mechanical dysfunction that
likely lead to his hip pain. Further developments will be discussed.
Conclusions: This is the first reported case, to our knowledge, of an
intramuscular lipoma within the tensor fascia lata, leading to muscle
dysfunction and subsequent hip pain.
Level of Evidence: Level V
Poster 197-F
A Comparison of Popliteal Arteries Between
Fractured and Sound Legs by Ultrasound in Patients
with Femur Fracture
Yong-Soon Yoon, MD, PhD (Presbyterian Medical Center, Jeonju,
JeonBuk, Korea, Republic of), Kwang-Jae Lee, MD, Jung-Hoo Lee,
Seung-Kyu Lim, MD
Disclosures: Yong-Soon Yoon: I Have No Relevant Financial Relationships To Disclose
Objective: Reduced physical activity and muscle atrophy is common
in patients with femur fracture. The aim of this study is to assess
whether immobilization after femur fracture surgery leads to
atherosclerotic change in popliteal artery.
Design: Case-control study.
Setting: OPD clinic in Presbyterian Medical Center.
Participants: Patients with femur fracture.
Interventions: Duplex sono.
Main Outcome Measures: Intima-media thickness (IMT) of popliteal
artery bilaterally using ultrasound.
Results: Mean IMT of popliteal artery was thicker in the fracture side
than in the non-fracture side (1.370.39 mm vs 1.110.52 mm)
significantly (P<.05). And mean PSV of that was increased in the
fracture side than in the non-fracture side (52.4418.55 cm/s vs
44.4714.27 cm/s), but there was no statistical significance (P>.05).
Conclusions: Femur fracture and consequential immobilization
affected popliteal artery IMT, and it was highly related to progression
of atherosclerotic plaque formation.
Level of Evidence: Level IV

Poster 373-A
Immunoglobulin Treatment of Miller Fisher Variant of
Acute Demyelinating Inflammatory Polyneuropathy
with Underlying Chronic Inflammatory Demyelinating
Polyneuropathy: A Case Report
John W. Hawkins, DO (William Beaumont Hospital, Royal Oak, MI,
United States)
Disclosures: John Hawkins: I Have No Relevant Financial Relationships
To Disclose

Case/Program Description: A 62-year-old woman with history of a sensory dominant variant of chronic inflammatory demyelinating polyneuropathy (CIDP) presented to the emergency center as a transfer from
an outside hospital with fevers, headache, myalgia, oral paresthesia,
double vision, and generalized weakness. On laboratory testing she was
influenza B positive. Her neurologist was consulted and she was diagnosed
with the Miller Fisher variant of acute inflammatory demyelinating polyneuropathy (AIDP). Intravenous immunoglobulin (IVIG) was prescribed
and she received pretreatment of acetaminophen, methylprednisolone,
and diphenhydramine. Prior to treatment the patient had no sensation in
her bilateral lower extremities below the knee for two years. The day
after her first treatment of IVIG, the patients strength had slightly
improved and she was also having paresthesias bilaterally below the knee.
As she became medically stable, she began to participate in therapy and
was eventually transferred to the inpatient rehabilitation floor (IPR).
Setting: Tertiary Care Center.
Results: Upon initial evaluation by the physical medicine service, the
patient had no anti-gravity movement of the bilateral lower extremities. In the upper extremities she did have anti-gravity strength of the
deltoids and elbow flexion. She was unable to ambulate. After two
treatments with IVIG and one month with IPR she achieved dramatic
improvements. She regained sensation in the lower extremities and
was able to ambulate 170 feet with standby assistance and no assistive
device. The patient was also independent with all activities of daily
living and she was discharged home with her husband.
Discussion: With IVIG and IPR, this patient was able to reach a functional status even better than her baseline.
Conclusions: While recovery of baseline function is almost always a
logical goal, there are instances when a patient could improve even
beyond that baseline. With proper medical and physical treatment
patients can often achieve a quality of life that is better than they
have experienced in several years.
Level of Evidence: Level V
Poster 373-B
Demographic and Clinical Features of Children and
Adolescents with Spinal Cord Injury: A Turkish
Hospital-Based Study
Umut Guzelkucuk, MD (Turkish Armed Forces Rehabilitation Center,
Ankara, Turkey), Yasin Demir, MD, Koray Aydemir, Assistant Professor
Disclosures: U
t Gu

k: I Have No Relevant Financial Relationships To Disclose

Objective: To determine the demographic and clinical characteristics
of children and adolescents with spinal cord injury (CASCI) admitted to
a single center.
Design: Retrospective study.
Setting: Rehabilitation Center.
Participants: 222 spinal cord injured patients equal or younger than
21 years old.
Interventions: Not applicable.
Main Outcome Measures: Variables of each patient such as age at the
time of injury, gender, mechanism of injury, degree and level of
neurological impairment, bladder management methods, and surgical
stabilization were analyzed.
Results: In all, there were 1045 patients with spinal cord injury (SCI)
during the 6-year study period, of which 222 (21.2%) were children and
adolescents and were included in the study. Among these patients, 75.2%
were male (male-female ratio: 3.03:1), mean age at the time of injury was
16.78  3.94 years (range: 3-21 years), the largest age group was 16-21
years (n163, 73.4%), followed by 13-15 years (n34, 15.3%), 6-12 years
(n20, 9%) and 0-5 years (n5, 2.3%). 90.1% of the patients had traumatic
etiology and motor vehicle accident (MVA) was the most common cause of
injury (37.8%). Of all patients 46.8% had cervical level of injury, 39.6%
thoracic, 13.5% lumbo-sacral. The distribution of American Spinal Injury
Association Impairment Scale grades was, as follows: A: 49.5%; B: 26.1%;
C: 11.7%; D: 12.2%; E: 0.5%. The most common bladder management