with normal flexor hallucinus longus, but concurrent cysts andedema within the anterior calcaneus. The patient was prescribedphysical therapy with an occupation/ballet-focused therapist andtold to follow-up as an outpatient.Setting: Quaternary care academic hospital.Results: The patient had an isolated posterior tibialis tenosynovitiswithout concurrent flexor hallucis longus injury that improved withfocused therapy to strengthen her kinetic chain through strength-ening of ankle inversion, intrinsic foot muscles, and external hiprotation to prevent pronation or “rolling out of foot.”Discussion: In ballet, posterior tibialis tendinopathy often arisesfrom a combination of excessive pronation during jumping/propul-sion and decreased peroneus longus strength which leads to “rollingout of foot.” Ballet dancers are classically known to have FHL“dancer’s tendinitis” injuries secondary to repetitive plantar flexionpush-off maneuvers of the forefoot.Conclusions: To our knowledge, this is a unique case of anisolated posterior tibialis tenosynovitis causing the ballerina’s symp-toms instead of the more common flexor hallucis longus injury withrelief with focused therapy.

Poster 157Evaluation of the Role of Ultrasonography in theDiagnosis of the Myofascial Neck Pain.Antonio Stecco, MD (University of Padua, Padua, Italy);Marta Imamura, MD, PhD; Carla Stecco, MD.

Disclosures: A. Stecco, No Disclosures.Objective: Myofascial pain is a very common pathology and themost frequent localization of this pain is the neck region. Thediagnosis is actually only clinical. With this study, we tried toobjectify the diagnosis of myofascial pain with ultrasonography.Setting: We compared the morphometric and clinical data of 25healthy subjects and 28 patients with chronic neck pain. We analyzedwith 10Mhz ultrasonography the fascia thickness of sternal ending ofthe SCM and of scalene medio muscle. Some authors have describedthe deep fascia as a multilayer structure. These sub-layers are possible torecognize in most regions of the body, but not in the SCM. All subjectswere analyzed also with the goniometer (for the active and passivecervical ROM) and administered the Neck Pain Questionnaire beforetreatment, after physiotherapy and at 3- and 6-month follow up.Results: In the patients, the mean value of the fascial thickness inthe upper and lower side were respectively, 0.157 cm and 0.124 cmin the left SCM; in the left scalene were respectively, 0.1 cm and0.105 cm; in the right SCM were respectively, 0.151 cm; 0.114 cm;in the right scalene were respectively, 0.118 cm; 0.130 cm. Therewere significant statistical differences with the normal subject in thethickness of the upper side of the SCM fascia (P value .06 lf; .035 rt)and of the lower and upper side of the rt scalene fascia (P�.031;P�.031). At the end of the treatment and at 3- and 6-month followup, the patients refer a significant decrease of the pain. We observeda significant decrease in the thickness of the fascia at the end of thetreatment (P�.05) and at 3 (P�.005) and 6 months (P�.005). Theanalysis of the thickness of the sub-layers of the fascia showed astatistical decrease of the loose connective tissue at the end of thetreatment (P�.0001) at 3 months (P�.0003) and at 6 months(P�.0003). There wasn’t any variation in the thickness of thecollagen layers of the fascia.Conclusions: Ultrasonography is helpful in the diagnosis ofmyofascial pain. Visualizing a thickness of the SCM fascia bigger

then 0.15 cm is correlated with stiffness and myofascial etiology ofchronic neck pain. The increase of the fascia thickness is correlatedonly at the thicker layer of loose connective tissue.

Poster 158Isolated Teres Minor Atrophy in QuadrilateralSpace Syndrome: A Case Report.Anupam Sinha, DO (Rothman Institute, Philadelphia,PA, United States); Madhuri Dholakia, MD.

Disclosures: A. Sinha, No Disclosures.Case Description: A 56-year-old man presented with a 2-yearhistory of neck and right shoulder pain. He denied any upperextremity radicular pain but did report mild paresthesias in hishands. He denied any bowel, bladder, or balance disturbance. Onexamination, the patient was neurologically intact without evidenceof upper motor neuron signs. He did have mild weakness in rightshoulder strength along with positive shoulder impingement signs.MRI of the cervical spine showed evidence of C6-7 foraminalstenosis. The patient had undergone physical therapy and cervicalepidural injections with marginal improvement of his symptoms.MRI of the right shoulder revealed mild supraspinatus tearing andfatty atrophy of the teres minor.Setting: Outpatient orthopedic practice.Results or Clinical Course: Electrodiagnostic testing of theright upper extremity showed normal nerve conduction and needlestudies, except for denervation found only in the teres minor; therewas no denervation noted in the cervical paraspinals or remainder ofthe right upper extremity.Discussion: Quadrilateral space syndrome (QSS) is caused bycompression of the posterior humeral circumflex artery and axillarynerve or one of its major branches in the quadrilateral space.Symptoms include a dull intermittent ache localized in the posteriorand lateral shoulder. These symptoms are exacerbated by active andresisted abduction and external rotation of the humerus. Paresthe-sias may occur in the cutaneous sensory distribution of the axillarynerve, overlying the deltoid muscle. Diagnosis can be made by MRIof the shoulder, electrodiagnostic studies, and CT arteriogram.Treatment includes rest, physical therapy, and NSAIDs, but surgicaldecompression may be considered in refractory cases.Conclusions: We present a rare case of right shoulder pain andweakness secondary to isolated teres minor atrophy from axillarynerve injury within the quadrilateral space. Clinicians should con-sider this syndrome in patients with shoulder pain and weakness,and should order MRI and electrodiagnostic studies for furtherevaluation.

Poster 159Adverse Childhood Experiences, MusculoskeletalDisorders and Disability.C. Miryam Schussler-Fiorenza, MD, PhD (Thomas Jeffer-son University, Philadelphia, PA, United States); Marga-ret Stineman, MD; Dawei Xie.

Disclosures: C. Schussler-Fiorenza, No Disclosures.Objective: To examine the effect of childhood adversity on mus-culoskeletal disorder prevalence rates and self-reported musculosk-eletal-related activity limitations and participation restrictions.Design: We analyzed Behavioral Risk Factor Surveillance System(2009-2010) data, a population-based telephone survey. Statisticalanalyses accounted for the complex survey design to obtain appro-

S244 PRESENTATIONS