Maria E. Reese

Hormonal Influence on the Neuromusculoskeletal System in Pregnancy

One of the hallmarks of pregnancy is the dramatic change of the hormonal milieu. The primary role of shifting hormones is to maintain and support the growing fetus and to allow the pregnant mother to carry and deliver a full-term, healthy infant. However, many of these hormones also have the potential to impact the mother’s neuromusculoskeletal system. In this chapter, we will discuss the growing body of literature regarding the influence of sex and related hormones on the neuromusculoskeletal system. In addition to focusing on the obstetrics literature, we will also extrapolate from research on nonpregnant women as well as from research on animal models as appropriate. We begin the chapter with background information on each of the hormones that will be discussed. We chose to organize the chapter by hormone-sensitive tissues to provide a framework for the clinician treating peripartum and postpartum females. Lastly, figures and tables throughout the chapter help summarize and provide a ready visual reference for the busy clinician.

Anxiety and Insomnia in Young and Middle-Aged Adult Hip Pain Patients With and Without Femoroacetabular Impingement and Developmental Hip Dysplasia

In young and middle‐aged adults with and without hip deformity, hip pain receives treatment focused primarily related to hip structure. Because this hip pain may be chronic, these patients develop other coexisting, modifiable disorders related to pain that may go undiagnosed in this young and active population, including insomnia and anxiety.

Influence of Menstrual Cycle and Oral Contraceptive Phase on Spinal Excitability.

Rates of musculoskeletal injury differ substantially between the genders, with females more likely to experience conditions such as anterior cruciate ligament (ACL) injuries than males in the same sports. Emerging evidence suggests a significant hormonal contribution. Most research has focused solely on how hormonal fluctuations affect connective tissue, but a direct link between hormonal shifts, ligamentous laxity, and ACL injury has not been borne out. There is also evidence to suggest that sex hormones can modulate the central nervous system, but how this affects neuromuscular control is not well understood.

Poster 117 Self-Reported Hip Problems in Professional Ballet Dancers: The Impact on Quality of Life

Disclosures: Claire Gross: I Have No Relevant Financial Relationships To Disclose Objective: To evaluate the impact of hip related injuries on the quality of life in professional ballet dancers. Design: Retrospective cross-sectional study. Setting: Large urban professional ballet company. Participants: Thirty-seven professional ballet dancers, ages 18-33, who completed a post-hire health screening prior to the start of the company’s season. Interventions: Not applicable. Main Outcome Measures: Participants completed the Hip Disability and Osteoarthritis Outcome Score (HOOS), which assesses level of disability due to a hip problem, and contains five subscales: pain, other symptoms, activities of daily living (ADLs), function in sports, and quality of life (QoL). Subjects were also asked to self-report current or prior history of hip problems/injuries. Unpaired t tests were used to compare the HOOS scores of the dancers with a history of a hip problem to those without such a history. A Bonferroni correction was used to account for multiple comparisons, with P<.010 meeting statistical significance. Results: Dancers with a self-reported history of a hip problem (8 of 37) reported statistically lower HOOS subscores for pain (P1⁄4.006) and QoL (P1⁄4.0001). The remaining subscores were not significantly different between groups: symptoms (P1⁄4.047), ADLs (P1⁄4.047), sports (P1⁄4.016). Conclusions: Hip problems and injuries have a significant impact on quality of life in professional ballet dancers as assessed by the HOOS. This impact persists despite a lack of significant effect of hip problems on ability to perform ADLs or sports-related tasks. The presence of a hip problem should be viewed as a risk factor for worsened quality of life in this population. Level of Evidence: Level III

Transient Osteoporosis of Pregnancy of the Bilateral Hips in Twin Gestation: A Case Series

Transient osteoporosis of pregnancy has been described as a rare, self‐limiting disease of unclear etiology that presents as severe pain, which typically affects pregnant women in their third trimester. We describe 3 cases of primigravid pregnant women with twin gestation who reported unilateral hip pain and who were diagnosed with transient osteoporosis of pregnancy of the hip by magnetic resonance imaging. These women were advised to undergo limited weight bearing and activity modification to minimize the risk of fracture. Each patient was able to proceed through her pregnancy, delivery, and postpartum course without complication, with symptom resolution, and return to unrestricted activity.

Lumbar Intraspinal Spindle Cell Rhabdomyosarcoma as a Rare Cause of Spinal Stenosis: A Case Report

Rhabdomyosarcoma (RMS) represents the most common sarcoma in childhood yet is extremely rare in adults, with only a handful of cases reported. Here we present a case of intraspinal spindle cell RMS in an adult who presented as a typical case of spinal stenosis. To our knowledge, this is the first reported case of lumbar intraspinal spindle cell RMS in an adult patient. Furthermore, RMS phenotypically presents more aggressively in adults compared with children.

Poster 192 Radial Stress Fracture in a Kettlebell Competitor: A Case Report.

gained popularity among clinicians and increased cross sectional area (CSA) of median nerve at carpal tunnel level has been found as the most sensitive parameter for sonographic finding of CTS. Quantitative US (QUS) can be used for demonstrating muscle changes according to denervation. In this study we aimed to find diagnostic utility of quantitative US in patients with CTS. Design: A single blinded pilot study. Setting: Tertiary care hospital, physical medicine and rehabilitation clinic. Participants: The study was completed with 31 hands of 19 patients and 20 hands of 10 healthy controls. Interventions: The study consisted three groups; mild CTS, moderatesevere CTS, and healthy controls. All subjects were assessed clinically by first researcher. Patients with clinical CTS were referred to NCS. Median and ulnar motor, median and ulnar sensory NCS were performed by a blinded electromyographer. Main Outcome Measures: Ultrasonographic assessments were performed by a blinded, well trained specialist with using a 6-18 MHz linear array probe (Esaote Mylab 60, Italy). Nerve CSAs were measured in psiform bone level by tracing the nerve just inside its hyperechoic rim. Abductor pollicis brevis (APB) and adductor digiti minimi muscles were visualized axial and longitudinal with a standardized protocol. BMP images of these muscles were captured and histograms were obtained with free software. Results: Median nerve CSA of patients with CTS was larger than healthy age matched controls (P1⁄4.001). Despite the QUS scores of APB muscle were increased in patients with CTS, there was no statistical significance (P1⁄4.08). Conclusions: Median nerve CSAs were larger than healthy control in patients with CTS. QUS of APB muscle in axial view particularly increased in patients with moderate-severe CTS. QUS may be beneficial to differentiated the severe cases. Level of Evidence: Level II

Poster 151 Impairments in Sleep and Anxiety in Patients with Intra-Articular, Non-Arthritic Hip Pain

Disclosures: Wonkee Chang: I Have No Relevant Financial Relationships To Disclose Objective: To investigate the relationships between biomechanical properties of the glenohumeral joint capsule and clinical factors in adhesive capsulitis (AC) patients with diabetes mellitus (DM), and to compare the biomechanical properties between diabetic (DM group) and non-diabetic patients (non-DM group). Design: A retrospective study. Setting: A tertiary university hospital outpatient clinic dedicated to intra-articular hydraulic distension (IHD). Participants: A total of 154 patients (DM group 30, non-DM group 124) with AC who underwent IHD. Interventions: IHD was performed using a hydraulic distension system designed for constantevolumeespeed fluid infusion with simultaneous intraarticular pressure monitoring. Stiffness of capsule (K_cap) was defined as the slope of elastic phase in Pressure-Volume curve. Capsular capacity (V_max), defined as the total infused volume and the pressure at the maximal volume (P_max) were also recorded. Main Outcome Measures: Correlation coefficients between K_cap and demographic and clinical parameters (including glycemic profile such as HbA1c and DM duration) in DM group. Comparison of K_cap, V_max and P_max between DM group and non-DM group. Results: Duration of DM showed positive correlation with K_cap (r1⁄40.468, P1⁄4.028). HbA1c did not show significant correlation with stiffness of capsule, nor did the type of DM medication (Insulin vs OHA only) show any significant difference in K_cap. Mean age was significantly higher in DM group (n1⁄430) than non-DM group (n1⁄4123) (62.60 9.6 vs 57.33 9.7 P1⁄4.008), otherwise there were no significant differences in demographic data, shoulder ROM and biomechanical properties of glenohumeral joint capsule (K_cap, C_max and P_max). Conclusions: The stiffness of glenohumeral joint capsule had positive correlation with DM duration, suggesting that patients with longer duration of DM had stiffer joint capsule. Other clinical factors including HbA1c had no meaningful relationship with capsular stiffness in DM patients. These findings implicate that the duration of DM may be one of the key factors in the pathogenesis of adhesive capsulitis in DM patients. Level of Evidence: Level IV

Poster 346 The Effect of a Musculoskeletal Ultrasound Course on the Accuracy of Joint Palpation in Physical Medicine and Rehabilitation Residents

increasing age. For females, only stride length were statistically significant (p1⁄4.01), with increasing probability of injury with longer stride lengths. Conclusion: This is the first study that characterizes foot strike and injury rates of ultramarathon runners in a competitive race. Our data suggests that foot strike might not be associated with injuries, while stride length may be a factor influencing injury in females.

Poster 336 Transient Osteoporosis of Bilateral Hips in Twin Pregnancy: Two Case Reports

Disclosures: Richard, No Disclosures. Case Description: Busy pediatric inpatient rehabilitation unit with increasing trend in patient falls. Unit fall trends note 45% of falls occurred while the patient was with a family member and occurred frequently in the evening. When an enclosed bed was used in patient care, family members did not always make sure the bed rails were secured or that enclosure was fully zipped and closed. Additionally 31% of the time falls occurred when the patient was alone in the room when a family member briefly stepped away. Further review of these falls showed a trend with patients who suffered a brain injury that attempted to follow their family member. To improve patient safety our multidisciplinary team comprising physicians, nurses, therapist and family support team conducted an evidence-based literature review to develop a comprehensive fall prevention program. Setting: Tertiary care pediatric hospital. Results or Clinical Course: A fall prevention program consisting of education, communication and ongoing monitoring. The fall education for family members is initiated upon admission, is included in the family orientation manual and reviewed daily during transfer of care. Family members and patients are educated on potential risk for falls and proper use of safety aids. All staff participated in mandatory fall education with a focus on fall prevention. Communication regarding risk for falls was critical. To ensure that all staff were aware of a patient at risk of falling, patients were assessed upon admission and with any change in medical condition. A patient at risk had a Yellow Falling Star sign posted on the door of their room which was later changed to a yellow falls risk arm band. Documentation for fall risk was noted on the patient’s plan of care, verbally communicated during transfer of care report and during team rounds. Monitoring of patient falls and near missed falls is conducted by unit leadership. Outcome data are shared with all staff to ensure awareness of patient safety. Discussion: Our goal is to assist patients in reaching the highest level of independence. Given this we acknowledge that there is the potential for patient falls. Conclusions: Immediate and sustained reduction in patient falls by 70%. Multidisciplinary approach to fall reduction improved patient care, patient safety and satisfaction of our families and staff.