Berke Aras

Efficacy of Ultrasound in the Diagnosis of Biceps Tendon Dislocation.

A 25-yr-old man presented with pain and weakness secondary to posttraumatic anterior shoulder dislocation from a traffic accident 3 mos earlier. The patient received 15 sessions of physical therapy but no improvement was observed. On physical examination, minimal swelling of the anterior aspect of the right shoulder and tenderness with palpation were detected. Speed and Yergason tests yielded positive results, and a 2-cm reduction in circumference was determined on the right arm. Muscle strength of right elbow flexion and forearm supination was 4/5. Shoulder internal rotation was restricted by 50%. All laboratory findings, including erythrocyte sedimentation rate, C-reactive protein, and X-ray examination were normal. Musculoskeletal ultrasound (US) revealed that the bicipital groove was empty and the long head of the biceps tendon (LHBT) had dislocated anteromedially with surrounding edema (Fig. 1). The supraspinatus tendon was observed to be intact and a full-thickness tear of the subscapularis tendon was seen (Fig. 2). Despite a trial of conservative treatment including physical therapy and nonsteroidal anti-inflammatory agents, the condition did not improve and the patient was referred to an orthopedic service for surgery. Dislocation of the LHBT out of the bicipital groove is usually linked with tears of the subscapularis tendon or massive rotator cuff tears. It has been stated that there is no specific clinical test correlated to the presence of medial dislocation of the LHBT. Thus, imaging methods such as US, magnetic resonance imaging, and magnetic resonance imaging arthrography are of paramount importance. Magnetic resonance imaging has long been the primary mode of evaluating shoulder pathologies, but US has rapidly assumed a similar role as an imaging modality in the past few years. When compared with other imaging tools, US imaging is practical, noninvasive, inexpensive, and portable. In addition, US has been found to have 100% specificity and 96% sensitivity for subluxation or dislocation. It is important to detect the position of the LHBT on US particularly after traumatic shoulder dislocation, because pathology of the LHBT may have a part in the development of shoulder pain and long-term dysfunction. FIGURE 1 Bicipital groove (BG) and long head of the biceps brachii tendon. The star indicates empty bicipital groove, and the arrow denotes biceps brachii tendon. l, lateral; m, medial.

The effectiveness of cervical transforaminal epidural steroid injection for the treatment of neck pain due to cervical disc herniation: long-term results

AIM To investigate the long-term effect of fluoroscopy guided cervical transforaminal epidural steroid injection on neck pain radiating to the arm due to cervical disc herniation. MATERIALS & METHODS 64 patients (26 women [40.6%], 38 men [59.4%]; mean age, 44.9 ± 12.1 years) who had received fluoroscopy guided cervical transforaminal epidural steroid injection for neck pain due to cervical disc herniation at least 1 year before were included in the study. The effectiveness of transforaminal epidural steroid injection was assessed using data obtained by medical records and a standardized telephone questionnaire. Multiple linear regression analysis was applied to evaluate the factors affecting the pain reduction after injection and the duration of treatment effect. RESULTS The mean duration of neck pain symptom was 23.3 ± 23.9 months. Most of the patients received a single injection (50 patients, 78.1%). The mean time since injection at the time of interview was 21.4 ± 9.4 months. There was a significant reduction in mean pain visual analog scale (VAS [10 cm]) score, from 8.6 ± 1.4 at baseline to 3.2 ± 2.5 at check visit two weeks after injection (p < 0.001). 52 patients (81.2%) reported pain relief of more than 50%. The mean duration of treatment effect was 13.3 ± 9.44 months. Greater pain on the VAS was found to predict strongly the higher pain reduction and longer treatment effect (p = 0.042 and 0.011, respectively). CONCLUSION The results suggested that cervical transforaminal epidural steroid injections might be an effective treatment for neck back pain radiating to the arm due to cervical disc herniation.

Rotator manşon tendinopatisine bağlı hemiplejik omuz ağrısında proloterapinin etkinliği: pilot çalışma

Amac: Rotator manson tendinopatisine bagli hemiplejik omuz agrisi bulunan inmeli hastalarda proloterapi uygulamasinin agri ve omuz eklem hareket acikligi uzerine etkisini arastirmak. Gerec ve Yontem: En az 6 ay once inme gecirmis hemiplejik omuz agrisina yonelik proloterapi uygulanan 10 hastanin (ortalama yas, 64.2±11.6 yil) verileri retrospektif olarak toplandi. Tedavide rotator manson tendonuna yonelik 3 seans dekstroz proloterapi enjeksiyonu icermekteydi. Hastalarin tedavi oncesi ve tedavi bitiminden iki hafta sonraki vizuel analog skala omuz agrisi skorlari ve omuz eklem hareket acikliklari degerlendirildi. Bulgular: Hastalarin proloterapi oncesi vizuel analog skala omuz agrisi degerleri (8.2±1.1 cm) proloterapi sonrasi kontrolde (4.8±1.9 cm) istatistiksel olarak anlamli derecede azaldi. Omuz fleksiyonu ve abduksiyonu derecelerinde tedavi sonrasi gorulen artis istatistiksel olarak anlamli bulundu.. Sonuc: Bu pilot calismada elde edilen ilk bulgular hemiplejik omuz agrisi tedavisinde proloterapinin faydali etkisi oldugunu onermektedir

Poster 457-B Complex Regional Pain Syndrome Type 1 in Young Male Adults

Disclosures: Lynne Turner-Stokes: no disclosure on file Objective: To describe the methodology for the Upper Limb International Spasticity study (ULIS) III, and describe an initial evaluation of goal-setting. Design: Non-interventional 2-year longitudinal cohort study. Setting: International, multicenter. Participants: Patients with upper limb spasticity (ULS) receiving botulinum toxin A (BoNT-A). Interventions: Repeated botulinum toxin A injections as part of integrated upper limb spasticity management in real-life clinical practice. Main Outcome Measures: ULS Index and Goal Attainment Scaling— Evaluation of Outcome for ULS (GAS eous) tool will be utilized to evaluate functional changes following BoNT A treatments. GAS eous provides a structured framework for application alongside standardized outcome measures in a clinical setting. Economic, quality of life data, and concomitant therapy use will also be recorded. Results: Recruitment began in January 2015; by 01 November 2015, initial goal-settingdata hadbeen collected for 242patients across 29 sites in 8 countries. Centers were awarded a rating based on the quality of goal statements set. Overall, 20/28 centers achieved the highest rating (A++) (one site was not accessible). One primary goal and 1 secondary goals were set for eachpatient. 236patientshad setprimarygoals anda total of 201 secondary goals were also set; 88 patients had only the primary goal set, 95 patients had set two goals (oneofwhichwasa primary goal) and 53 patients had set three goals (one of which was the primary goal). The commonest primary goal areas identified were passive function (40 patients) and active function (25 patients) followed by pain and range of movements/prevention of contractures (17 patients each). Conclusions: ULIS-III will implement novel approaches for evaluating patient centered goal attainment and a structured and consistent method of recording data. High-quality goal-setting was demonstrated in the majority of centers. Study results will be reported in peerreviewed journals and at international meetings. Level of Evidence: Level II

Poster 327 Role of Ultrasonography in the Detection of Biceps Tendon Dislocation: A Case Report

Disclosures: Y. Demir: I Have No Relevant Financial Relationships To Disclose. Case Description: A 36-year-old man was admitted to our department with pain of the right knee. He specified that his pain had started eight months ago and the pain had been occurring while running and bending the knee. He was diagnosed with chondromalacia patella before. Medical treatment and exercise training program were prescribed according to this diagnosis but his symptoms didn’t regress after the treatment. On physical examination, right knee joint ranges of motion and muscle strength were normal. Popliteal fossa was tender on palpation. Setting: Tertiary care hospital. Results or Clinical Course: Routine laboratory tests and X-ray evaluation were normal. Magnetic resonance imaging (MRI) revealed synovial chondromatosis in the popliteal fossa. Surgical resection was performed and his symptoms regressed after the surgery. Conclusion: Synovial chondromatosis is a rare clinical disorder which consists of metaplastic cartilage formation. Clinicians should take into consideration this pathology in patients who have tenderness in popliteal fossa. The MRI should be done to confirm the diagnosis.