healed pars fracture presumed to be secondary to the footballtrauma. The patient was seen 2 months later and his low backpain resolved. Repeat CT scan ordered to assess healingshowed resolution of the pars fracture.Setting: Tertiary care hospital.Results: Patient is an 18-year-old male with chronic spon-dylolysis, positive radiographs, negative MRI, and positiveCT scan for pars fracture. He responded well to the rehabil-itation treatment of initial reduced activity, bone stimulatorand lumbar brace.Discussion: This is a case report where the CT scan de-tected the chronic spondylolysis which was missed on theMR study. In this case, the MRI may have not demonstratedthe fracture because it was a year old and not associated withedema seen in acute pars fractures.Conclusions: MRI is currently the preferred imagingstudy for the diagnosis of acute spondylolysis, but we believethat for chronic spondylolysis MRI may not be a 100%reliable image modality, and CT should be considered toconfirm the presence or absence of spondylolysis. Actualradiographs and CT films will be included in the posterpresentation.Keywords: Rehabilitation, Low back pain, Spondylolysis.

Poster 143

Musculoskeletal Ultrasound in Diagnosis ofPigmented Villonodular Synovitis of the Hip: ACase Report.Annie Davidson, (Lags Spine and Sportscare,Santa Maria, CA); Francis P. Lagattuta, MD;Joseph P. Purcell, DO; David L. Tashima, MD.

Disclosures: A. Davidson, None.Patients or Programs: A 43-year-old man with left hippain radiating to the groin for 2 years.Program Description: The patient was referred fromprimary care for left hip pain presumed to be due to osteoar-thritis, as seen on plain radiograph. The pain was constant,worse with activity and radiated to the groin. The patientcomplained of the feeling of a mass in his groin, which wasnot visible or palpable on examination. Diagnostic musculo-skeletal ultrasound of the hip and groin were done, revealinga 2-cm soft tissue fluid-filled mass in the groin inferior to theanterior capsule. Due to the ultrasound findings, MRI of theleft hip and pelvis were ordered.Setting: Outpatient musculoskeletal and pain managementclinic.Results: MRI revealed synovial proliferation with joint effu-sion and anterior capsule extension into the left groin, withdecreased T2 signal characteristics consistent with pig-mented villonodular synovitis. The patient was referred toorthopedics for confirmation of diagnosis by biopsy.Discussion: Pigmented villonodular synovitis is an un-common condition that is not correctly identified, on aver-age, until 4 years after presentation. One reason is that plainradiographs usually show findings consistent with osteoar-thritis and MRI, a highly sensitive and specific diagnostic tool

for this condition, is often not considered once the diagnosisof osteoarthritis is given.Conclusions: Musculoskeletal ultrasound is a safe, easilyaccessible diagnostic tool for physiatrists to use in the office.In this case, ultrasound immediately aided in reaching thediagnosis before the patient underwent further ineffectivetreatment for osteoarthritis.Keywords: Rehabilitation, Ultrasonography, Synovitis,Pigmented villonodular, Musculoskeletal system.

Poster 144

Musculoskeletal Ultrasound in the Diagnosisof an Acetabular Labral Tear. A Case Report.Joseph P. Purcell, DO (Lags Spine and Sportscare,Santa Maria, CA); Annie Davidson; Francis P.Lagattuta, MD; David L. Tashima, MD.

Disclosures: J. P. Purcell, None.Patients or Programs: A 23-year-old man with right hippain and clicking.Program Description: The patient was involved in aboating accident 3 years prior during which he sustainedmultiple injuries. Since the incident, he has noticed clickingand a sensation that the right hip “comes out of place” whenplaced in a position of external rotation. Though this initiallydidn’t cause him discomfort, in the past 6 months it hadbecome painful during ambulation. Physical examinationrevealed mild tenderness to palpation of the anterior hipjoint, a positive Patrick’s test and a reproducible audible clickupon flexion and external rotation of the hip.Setting: Outpatient musculoskeletal and pain managementclinic.Results: Radiographs of the hip were normal, with no sign ofdegeneration or dislocation. An MRI of the hip was normal,without alignment abnormality, degenerative change or labralpathology. Based on continued clinical suspicion a diagnosticultrasound examination was performed, which revealed a tear ofthe anterior labrum with capsular inflammation and a mildeffusion. The patient was referred to orthopedics for further careand consideration of arthroscopic debridement.Discussion: Acetabular labral tears are a commonly missedand often untreated source of hip pathology which may lead toearly degeneration of the hip, significant pain and disability.Conclusions: Musculoskeletal ultrasound offers a quickand inexpensive means of accurately diagnosing this acetab-ular labral tears which can be missed with conventional MRI.Keywords: Rehabilitation, Ultrasonography, Hip, Acetab-ular labral tear.

Poster 145

Non-Traumatic Knee Ligamentous Rupture in aPost-Partum Woman Resulting in AmbulatoryDysfunction: A Case Report.Robert Rankin, MD (Temple University Hospital,Philadelphia, PA); Carmen Angles, MD; KarenJ. Gisotti, DO; Sidra Sheikh, MD.

S166 POSTER PRESENTATIONS

Disclosures: R. Rankin, None.Patients or Programs: A 33-year-old woman, 8 weekspostpartum, who suffered a left knee multi-ligamentous rup-ture (anterior cruciate ligament [ACL], posterior cruciateligament, lateral collateral ligament, medial collateral liga-ment), lateral meniscal tear, and popliteal artery rupturesecondary to a hyperextension injury while getting out of hercar.Program Description: During acute care the patient de-veloped compartment syndrome and required a fasciotomyand femoro-popliteal artery bypass. She also had soft tissueinfections requiring several debridements, skin grafts andhyperbaric oxygen treatments. She subsequently developed aleft foot drop with neuropraxia. She was admitted to acuteinpatient rehabilitation 5 months post-injury. Physical exam-ination on admission was significant for dysesthesia of the leftfoot, left equinavarus contracture, and limited range of mo-tion at the knee (0 to 30°). This patient had a history signif-icant for obesity and an ACL reconstruction in 2001. Theremainder of her history is non-contributory. The patient wasfitted with a knee brace and short leg brace, and was referredto orthopedic surgery for Achilles tendon release.Setting: Acute inpatient rehabilitation.Results: The patient was advanced to independent ambula-tion with a rolling walker.Discussion: This is the first reported case, to our knowl-edge, of multiple non-traumatic ligamentous tears in a post-partum female.Conclusions: Several studies have shown a correlationbetween serum relaxin levels during the menstrual cycle withincreased incidence of ACL rupture in female athletes. Pre-ventative measures and patient education focusing on thereduction of risk factors could include target musclestrengthening pre- and post-partum, activity modificationand possibly prophylactic bracing. Further studies couldinvestigate a correlation between risk of injury with peri-partum hormone changes in various populations, includingthe general population, those with previous ACL reconstruc-tion, and in hypermobile patients.Keywords: Rehabilitation, Knee, Postpartum, Ligaments.

Poster 146

Non-Traumatic Stress Fracture of the TibialPlateau: A Case Report.Simonetta Sambataro, MD (St. Vincent's CatholicMedical Center, New York, NY); Christina M.Gonzaga, DO.

Disclosures: S. Sambataro, None.Patients or Programs: A 60-year-old woman with amedical history of HTN, OA, osteoporosis,and hypothyroid-ism presents with right knee pain � 2 days.The pain waslocated at the medial joint line.The week prior, she had beenon a 7-day bus tour where she walked much more than shewas accustomed.Two days after returning home she stood upfrom a bench and the right knee suddenly became verypainful. She tried ibuprofen for pain control with no relief.

The pain was worse with rest and long periods of sitting. Itdid not radiate nor did it wake her up at night.On examina-tion, the patient’s right knee medial joint line was swollenand tender.The active range of motion was decreased at endrange of flexion secondary to pain. Knee extension was full.Muscle strength and sensation were intact. Lachman’s andanterior drawer tests were negative. Positive McMurraytest.The impression was that of knee osteoarthritis with me-dial meniscal tear.Setting: Office.Results: MRI (non-contrast): Stress fracture of the medialaspect of the tibial metaphysis; no displacement.Discussion: Tibial plateau fractures have a variety of pre-sentations depending on the severity of the traumatic event.In many cases of knee pain, radiographs are the first diagnos-tic test ordered. Initial films often reveal osteoarthritis and areoften negative for fracture. Fractures can be detected moreeasily 3 to 6 weeks after the initial presentation. In olderpatients with osteoporosis, if the initial films are negative andclinically they continue to have pain, other diagnostic testingshould be considered. Clinicians should consider risk factorsfor developing stress fractures, including osteoporosis,chronic steroid use, rheumatoid arthritis, and spinal cordinjury.These risks leave bone prone to morphologic weaken-ing leading to a medial tibial plateau stress fracture withoutan acute traumatic event. Bone scan, MRI, or multi-slice CThave been studied and proven to be beneficial for diagnosticpurposes as well as in guiding treatment.Conclusions: Multiple risk factors leave older patients’bones more prone to fractures from non-traumatic stresses.Clinicians should consider the possibility of a tibial plateaufracture, even in the context of negative radiographs. Avariety of diagnostics can help stage these fractures and guidetreatment.Keywords: Rehabilitation, Tibial fractures, Osteoporosis,Age-related fracture, Compression.

Poster 147

Novel Use of Ultrasound Imaging toInvestigate Myofascial Trigger Points and theEffects of Dry Needling: A Case Series.Ru-Huey Yen, (National Institutes of Health, Be-thesda, MD); Jerome Danoff, PhD; Tadesse M.Gebreab, BS; Naomi Lynn H. Gerber, MD;Jay P. Shah, MD; Siddhartha Sikdar, PhD.

Disclosures: R. Yen, None.Patients or Programs: Two subjects, presenting withrecent onset neck and shoulder pain and decreased range ofmotion.Program Description: Several sites were identified in theupper trapezius and superficially marked as having an activemyofascial trigger point (A-MTrP), latent myofascial triggerpoint (L-MTrP), or no MTrP (normal tissue). Both subjectsrated their pain on a visual analog scale (VAS) from 0 (nopain) to 10 (worst pain imaginable). Pain pressure thresholds(PPTs) were accessed over each site. The sites were imaged

S167PM&R Vol. 1, Iss. 9S, 2009