Joshua Sole

Sonographic Evaluation of the Extensor Carpi Ulnaris in Asymptomatic Tennis Players

To determine the prevalence of structural abnormalities and instability affecting the extensor carpi ulnaris (ECU) tendons of asymptomatic recreational tennis players by the use of high‐resolution ultrasonography.

Clinical Efficacy of an Ultrasound-Guided Greater Occipital Nerve Block at the Level of C2

Background and Objectives The purpose of this prospective open-label study was to investigate the analgesic effects of an ultrasound-guided greater occipital nerve (GON) block at the level of C2, as the nerve courses superficially to the obliquus capitis inferior muscle. Methods Patients with a diagnosis of occipital neuralgia or cervicogenic headache were recruited for the study. Ultrasound-guided GON blocks at the level of C2 were performed by experienced clinicians according to a standardized protocol. Numeric rating scale pain scores were recorded preinjection and at 30 minutes, 2 weeks, and 4 weeks after injection. Results A total of 14 injections were performed with a mean procedure time of 3.75 minutes. Anesthesia in the GON distribution was achieved for 86% of patients at 30 minutes postinjection. Compared with baseline, numeric rating scale scores decreased by a mean of 3.78 at 30 minutes (P < 0.001), 2.64 at 2 weeks (P = 0.006), and 2.21 at 4 weeks (P = 0.01). There were no significant adverse events reported during the study period. Conclusions This prospective open-label study demonstrated successful blockade of the GON at the level of C2 using a novel ultrasound-guided technique. Significant reductions in pain scores were observed over the 4-week study period, and no adverse events were reported. The observations from this study provide important preliminary data for future randomized trials involving patients with occipital neuralgia and cervicogenic headache.

Saphenous Neuropathy Secondary to Extraneural Ganglion Cyst 15 Years After Reconstruction of the Anterior Cruciate Ligament

This case report describes a 43‐year‐old woman with a previous anterior cruciate ligament reconstruction and medial meniscectomy who presented with right knee dysesthesias radiating into her medial ankle with associated allodynia. An extensive work‐up was pursued, without a definitive diagnosis found or improvement in the patients symptoms. Eventually, she was referred to Pain Medicine for an ultrasound‐guided saphenous nerve (SN) block, where a scan before the injection revealed a large cyst anteromedial to the sartorius in the expected location of the SN. Magnetic resonance imaging and surgical pathology confirmed a juxta‐articular ganglion cyst compressing the main SN, just above the take‐off of the infrapatellar branch. The cyst was successfully resected, with improvement noted in the patients neuropathic symptoms postoperatively. Saphenous neuropathy is a rare condition, and to our knowledge this case is the first reported of saphenous neuropathy caused by a knee joint capsule−derived ganglion cyst.

Poster 408 Chronic Thoracic Radiculopathy Secondary to Syrinx Responsive to Ultrasound-Guided Transverse Abdominis Plane (TAP) Blockade: A Case Report

consisting of a physical therapist, occupational therapist, pain management therapist, neuropsychologist, nurse, resident physician and an attending physician. The pain management team saw patients that experienced pain and aided in pain control with a variety of support modalities including medications, physical and occupational therapy. There is a high correlation that can be made between the of presence pain and a cerebrovascular accident in our IRF patient population. Level of Evidence: Level II

Unusual Presentation of Functional Popliteal Artery Entrapment Syndrome in a Collegiate Runner: A Case Report

Disclosures: N. Muraoka, No Disclosures: I Have Nothing To Disclose. Case Description: A 57-year-old man with history of Hodgkin’s lymphoma treatedwith radiation 20þ years ago presented to our clinic for evaluation of intractable left hip pain that started a week prior without inciting event and is made worse with activity. It did not radiate and no associated numbness or tingling. Exam revealed mildly painful and reduced range of motion of the left hip (30 internal and 40 external) and tenderness over the left greater trochanter and left gluteal muscles. Sensation and reflexes intact. There is reduced bulk of the trunk and gluteal muscles without weakness on manual muscle testing. He walks with a Trendelenburg gait. Setting: Tertiary care hospital outpatient clinic. Results or Clinical Course: Left hip MRI showed a partial tear of the left quadratus femoris muscle with 9 x 9 x 3 cm hematoma and full thickness tear of the left quadratus femoris tendon, iliopsoas bursitis, atrophy and fatty infiltration of gluteus maximus, medius, and minimus muscles and hamstrings and edema in left adductor compartment. Patient was referred for aquatic therapy. Follow-up visit was 6 weeks later and in the interim, he developed similar atraumatic right-sided hip pain. Second MRI showed new right quadratus femoris tear with hematoma (7 x 3 x 5 cm), edema in the right adductor compartment, interval improvement of the left hematoma (3 x 2 cm). Discussion: Radiation fibrosis is a pathologic change in any tissue that can result as a late complication of radiation therapy. Radiation exposure can affect the vas vasorum and cause infarction of nerve, with atrophy of the innervated. The muscle fibers themselves can undergo fibrotic changes, leading to structural failure under tension. This patient had spontaneous bilateral quadratus femoris tears inside of six weeks without risk factors like steroids or fluoroquinolones and highlights the significant morbidity that can be a late consequence of radiation therapy. The quadratus femoris muscle acts as an adductor and external rotator of the hip and its failure likely contributed to the adductor strains seen on MRI imaging. Conclusions: Radiation fibrosis can be an early or late consequence of radiation therapy that can result in significant morbidity and functional impairment.