Cyrus Kao

Ultrasound-Guided Intercostobrachial Nerve Block for Intercostobrachial Neuralgia in Breast Cancer Patients: A Case Series

This case series describes 3 cases in which ultrasound‐guided intercostobrachial perineural injection was used for intercostobrachial neuralgia, a common cause of postmastectomy pain syndrome. All cases had undergone modified radical mastectomy with axillary lymph node dissection for breast cancer. Two cases developed axillary and unilateral chest wall pain. The third case initially presented with axillary pain and lateral shoulder pain 1 year out from radical mastectomy. After a cervical epidural steroid injection, her lateral shoulder pain resolved, but she continued to have residual chest wall paresthesia. It was at this time, we decided to treat with an intercostobrachial nerve perineural injection. Injury to the intercostobrachial nerve is thought to be a common cause of postmastectomy pain. In our case series, all patients had pain relief after the intercostobrachial perineural injection. There is a relative dearth of published information on the treatment of postmastectomy pain and more specifically intercostobrachial neuralgia. We review the anatomy of the intercostobrachial nerve and its variants, etiologies of intercostobrachial neuralgia, and current indications and methods of an intercostobrachial perineural injection.

Two Cases of Metallosis from Metal-on-Polyethylene Total Hips: An Emerging Problem

This report describes 2 cases of metallosis from metal‐on‐polyethylene total hip replacements. Case 1 involved a Stryker rejuvenate implant, which has since been recalled. This patient had minimal symptoms, an elevated cobalt level, and loosening. The patient in case 2 had a Dupuys Pinnacle system, with symptoms of weakness, rash, and hip pain. Abnormal laboratory values include elevated sedimentation rate, C‐reactive protein, creatinine, cobalt, and decreased hematocrit. Magnetic resonance imaging revealed synovial thickening and extracapsular edema. Although metallosis is a well‐established complication of metal‐on‐metal implants, emerging data reveal that it also may be a problem in non–metal‐on‐metal implants such as either metal‐on‐polyethylene or ceramic‐on‐polyethylene implants, perhaps related to modular corrosion.

Poster 222 Unusual Case of Motor Neuropathy Secondary to Herpes Zoster: A Case Report

materials in addition to rapid prototyping and design. Over the past five years, major advancements in 3-D printing have been made in the field of prosthetics. Although there is a paucity of high-level research in the literature, proof-of-concept studies have displayed the ability to fabricate passive and body-powered upper extremity prosthetics at a fraction of the cost of traditional prosthetics. Design: A literature review was conducted to perform a cost-comparison of traditional vs. 3-D printed upper extremity prosthetics. Case Description: Not applicable Program Description: Not applicable Setting: Academic medical center. Participants: Not applicable as this abstract represents a review of current literature and addresses its theoretical global impact. Interventions: Not applicable. Main Outcome Measures: A cost analysis of traditional vs 3-D printed body-powered and myoelectric upper extremity prosthetics was performed. Results or Clinical Course: The estimated cost of a body-powered upper extremity prosthetic costs

Atypical Presentation of Hip Pain and Fever: A Case Report

8,000-12,000, while the average partial hand myoelectric prosthesis is

Ultrasound-Guided Intercostobrachial Nerve Block for Post Mastectomy Pain: A Case Series

18,700. Available 3-D printed prosthetics for partial hand amputations range from

Case Presentation Ultrasound-Guided Intercostobrachial Nerve Block for Intercostobrachial Neuralgia in Breast Cancer Patients: A Case Series

50-200. A current 3-D myoelectric hand prototype exists with an anticipated goal of fabricating this prosthesis for under

Case Presentation Two Cases of Metallosis from Metal-on-Polyethylene Total Hips: An Emerging Problem

1,000. Discussion: Not applicable Conclusion: 3-D printing is a cost-effective method for producing functional upper extremity prosthetics. With an estimated 10 million individuals worldwide without access to prosthetic use, 3-D printing represents a possible solution to increase accessibility to these devices. The literature is lacking in terms of functional comparisons between 3-D printed and traditional prosthetics. Nonetheless, awareness of 3-D printed options for prosthetics must be increased within the rehabilitation community. By doing so, Physiatrists can adopt a more fiscally responsible approach to prosthetic management and increase the availability of prosthetic care globally.

Poster 75 Toxicity from Elevated Cobalt and Chromium Blood Levels after Hip Implant: A Case Report

weakness was noted in right-sided hip abduction, foot inversion, plantarflexion, and toe extension. Right medial ankle and foot arch were atrophied. Linear hyperpigmentation with associated induration was present from the medial groin down to the medial foot arch and the first toe. Setting: Sports Medicine Clinic. Results or Clinical Course: Right foot MRI revealed mild medial muscle atrophy and edema. Bilateral thigh MRI was normal. EMG study showed no foot muscle denervation. ANA and doublestranded DNA antibodies were positive. Dermatology was consulted, and a right medial thigh skin biopsy showed histopathologic evidence of morphea. Discussion: Morphea is a self-limited, localized scleroderma characterized by excessive collagen deposition, leading to dermal and subcutaneous tissue thickening. Considerable morbidity develops from growth interference, joint contractions, limb length discrepancy, and prominent atrophy. Therapy aims to reduce inflammation in early disease. Limited disease can be managed with topical or phototherapy, but disabling linear morphea requires more aggressive therapy with methotrexate, corticosteroids, or TNF-alpha inhibitors. By initiating TNF-alpha therapy for CD, our patient was unknowingly also treating undiagnosed linear morphea. Although this arrested disease progression, years of delayed diagnosis had already resulted in chronic disability. Conclusions: This case shows the importance of considering morphea in the differential diagnosis of a patient with focal atrophy, stiffness, and pain with abnormal skin findings, as earlier treatment may have altered her functional outcome.

Poster 222 Myofascial Pain from Ehlers-Danlos Syndrome Treated with Botox Injections: A Case Report

Disclosures: R. A. Dutton, No Disclosures: I Have Nothing To Disclose. Case Description: The patient presented with chronic posterolateral hip pain for 15 years. He recalled a remote history of hip hyperextension during boot camp training. He described right hip pain, as well as a vibrating sensation (pallesthesia) and weakness involving the right lower extremity. On exam, internal and external right hip rotation elicited severe pain in the posterior hip. Straight leg raise test was unremarkable. There was no palpable bony lesion. Strength of right hip abduction was mildly decreased. Setting: Tertiary care outpatient clinic. Results or Clinical Course: EMG showed no evidence of neuropathy or myopathy. Pelvic X-ray revealed an accessory bone between the ischium and femur. MRI demonstrated a digit-like, non-fractured, non-inflammatory mature bone formation with pseudoarthrosis at the ischium. Oral analgesics and physical therapy failed to control symptoms. Trochanteric bursa steroid injection yielded temporary relief at the lateral hip, but pallesthesia and pain with hip rotation and extension persisted. The patient was referred for surgical resection of the pelvic digit. Discussion: Pelvic digit is a rare, congenital anomaly in which bone develops in soft tissue adjacent to normal skeletal bone. Often, the phenomenon is an incidental finding that does not require intervention. It is important to distinguish from other conditions such as avulsion fracture, myositis ossificans, or heterotopic ossification. To our knowledge, less than fifty cases have been reported, of which only two have been associated with symptoms. Both cases were managed surgically. Here, we report a third case of suspected symptomatic pelvic digit, which failed to respond to conservative measures. Conclusions: Pelvic digit is a rare and mostly asymptomatic developmental anomaly. However, pelvic digit can cause pain. An algorithm for management of symptomatic cases has not been established. Surgical resection may be a viable option for refractory symptoms.