Jackson Liu

Intraarticular Shoulder Injection—Posterior Approach: Ultrasound Guidance

Using ultrasound, the glenohumeral (GH) joint can be accessed from either an anterior or posterior approach. The posterior approach, medial to lateral, described in this chapter, can prevent injury to the labrum. There is also a posterior, lateral to medial approach, which is also demonstrated (Fig. 34B.3E) but not fully described. Fluoroscopic visualization after needle placement and contrast injection can be confirmatory.

Obtaining a Pain History

Taking a pain health history consists of the following sections: Source, chief complaint, history of present illness, past medical history, past surgical history, functional evaluation, social history, allergies, medications, and review of systems. The aforementioned healthy history is confirmed by contacting family members or caregiver, primary care physician or previous opiate-prescribing provider, and pharmacies. Examples of pain scales include the Visual Analog Scale, Numerical Rating Scale, Verbal Descriptor Scale, and the Wong-Baker FACES Pain Rating Scale. Multidimensional pain scales, neuropathic pain scales, and risk assessments for aberrant behaviors, misuse, dependence, abuse, and addiction are also listed.

Massive Hemorrhagic Stroke After Administration of a Local Intraoral Anesthetic Solution During a Routine Dental Procedure: A Case Report

functional outcome. Our patient had excellent prognosis with a combination of medical treatment and rehabilitation. Conclusions: This case demonstrates a favorable outcome in a condition where rehabilitation outcomes are not well documented. Of note, pre-existing HIV did not affect the neurological and functional outcomes of GBS. This patient had devastating symptoms but ultimately returned to baseline functional status after aggressive medical and rehabilitation treatments, demonstrating that despite the severity of GBS along with HIV seroconversion, a favorable outcome is possible.

Simultaneous Bilateral Patellar Tendon Ruptures Associated with Statin Use and Obesity Complicated by Ankle Fracture: A Case Report

Results or Clinical Course: Participants had a mean age of 67.6 years old (SD1⁄46.8) and a disease duration of 7.7 years (SD1⁄46.3). Dynamic balance and automatic postural responses were found to have significant correlations with strength. Dynamic balance showed the strongest correlations with work in extension (0.44, p1⁄4.02) and work in flexion (0.59, p<.01). Strength of automatic postural response in both forward (0.43, p1⁄4.03) and backward large translations (0.41, p1⁄4.03) of the MCT correlated with work in extension. Conclusions: Knee flexion and extension strength do not appear to play a role in static balance but correlated most strongly with dynamic balance and less with automatic postural responses in individuals with PD.

Postpartum Foot Drop Caused by Acute Lumbosacral Radiculopathy Improved After Microdiscectomy, Laminectomy, and Inpatient Rehabilitation: A Case Report

Disclosures: J. Liu, No Disclosures: I Have Nothing To Disclose. Case Description: A 28-year-old woman with no past medical history complained of numbness and tingling in her right lower extremity immediately after spontaneous vaginal delivery of a baby girl under epidural anesthesia. Hours later, she developed a frank right foot drop. Magnetic resonance imaging revealed a L5-S1 right foraminal disc herniation contacting the exiting L5 nerve root. The patient was taken for a microdiscectomy and laminectomy 4 days after onset of symptoms and transferred to an acute inpatient rehab facility on post-op day 2. On admission, she denied any history of low back pain or complications during pregnancy. She had loss of sensation to light touch and pain in the right medial and lateral ankle and sole of her foot. She had 0/5 strength on ankle dorsiflexion, plantarflexion, inversion, and eversion, with trace big toe extension. Setting: Inpatient rehab Results or Clinical Course: The patient initially required minimum assistance for functional transfers, ambulating only 10 feet, and maximum assistance for lower body dressing. Her course was complicated by a deep vein thrombosis in the right peroneal veins. Electrodiagnostic studies (EDS) performed about 3 weeks post-partum revealed normal nerve conduction studies but a needle portion consistent with a L5-S1 radiculopathy. She was eventually discharged home at a modified independent level, ambulating 250 feet with lofstrand crutches. Discussion: Postpartum foot drop is a well-known clinical entity, but to the knowledge of this author, it has not been described in the context of a possible acute intrapartum radiculopathy caused by disc herniation. A possible mechanism of injury is a combination of the lithotomy position and increased abdominal pressure during labor. EDS were helpful in differentiating her findings from other more commonly reported causes such as a peroneal nerve compression or lumbosacral plexopathy. This patient recovered rapidly after immediate surgery and acute inpatient rehab. Conclusions: This case describes a patient with postpartum foot drop secondary to acute lumbosacral radiculopathy that improved after surgery and acute inpatient rehab. The physiatrist should be knowledgeable of the many causes of acute foot drop in the postpartum population and be able to differentiate between them on clinical and electrodiagnostic examination. Poster 448 Feasibility of Using Lumbar Magnetic Resonance Imaging Severity of Disc Protrusion and Foraminal Stenosis in Association with Pain Reduction Following Lumbar Transforaminal Epidural Steroid Injection (LTFESI). Robert E. Moore, MD (MetroHealth Rehab Institute of Ohio, Cleveland, OH, United States); Moeid Khan, MD; Kermit W. Fox, MD; Brian Snitily, MD; Richard D. Wilson, MD.

Poster 283 Autoimmune Cerebellar Ataxia Associated with Glutamic Acid Decarboxylase Antibodies Minimally Responsive to Immunotherapy and Acute Rehabilitation: A Case Report

Disclosures: J. Liu, No Disclosures. Case Description: A 45-year-old woman with no past medical history initially presented to the emergency ward with complaints of vertigo, double vision, and gait instability for 2 months. Physical examination showed no deficits in strength, sensation, or reflexes, but was notable for nystagmus, dysarthria, mild bilateral dysmetria, and severe truncal ataxia. She was functionally bed-bound and unable to ambulate with maximum assistance due to prominent ataxia. Broad medical work-up ruled out infectious, toxic, and metabolic etiologies. Magnetic resonance imaging of the brain revealed no ischemic insults or masses. An autoimmune cerebellar etiology was suspected. The patient was given empiric intravenous immunoglobulin (IVIG) therapy and transferred to the acute inpatient rehab service. Setting: Acute inpatient rehab. Results or Clinical Course: Further serologic work-up revealed that the patient had antibodies to glutamic acid decarboxylase-65 (GAD-Ab). She received plasma exchange (PLEX) therapy, was given oral steroids, and continued to participate in the acute rehab therapy program. Despite these interventions, she had minimal improvement in her functional deficits. A family meeting was held to discuss her poor prognosis. She was eventually discharged home requiring supervision for wheelchair propulsion, moderate assistance for transfers, and variable assistance for activities of daily living. Discussion: Cerebellar ataxia associated with the GAD-Ab is a rarely reported disorder with limited evidence-based treatment options like immunotherapy. To our knowledge, this is the first case that describes its response to both immunotherapy and acute rehab. In this patient, IVIG, PLEX, oral steroids, and acute rehab provided minimal return of function. GAD is a major enzyme of the nervous system that catalyzes the conversion of glutamate to -aminobutyric acid (GABA). It has only recently been implicated in movement disorders. The role of the GAD-Ab and the underlying pathophysiology is unknown. Conclusions: This case highlights the need for further research to define the pathophysiology and therapeutic management of a rarely reported autoimmune cerebellar disorder. Testing for GAD-Ab in patients with sporadic cerebellar ataxia is important as this subset of patients may potentially benefit from immunotherapy.