diagnosis of stinger injury. Because his symptoms had notimproved with time and conservative therapies, and promptreturn to play was desired, a cervical transforaminal epiduralsteroid injection was offered.Setting: University outpatient clinic.Results: Within 1 week after the injection, the patient hadfull resolution of his pain symptoms and neurologic dysfunc-tion, and he was cleared for return to play.Discussion: A “stinger” or “burner” is a transient, reversibleperipheral nerve injury of the upper extremity caused byinjury to the cervical spine and shoulder, usually duringcontact sports. It generally affects the upper trunk or C5/C6nerve roots. To our knowledge, this is the first reported caseof a stinger injury to be treated with a cervical transforaminalepidural steroid injection. It is believed steroids decreaseinflammation, improve regional blood flow, and becomeneuroprotective by inhibiting phospholipase A2 and lipidperoxidation. A transforaminal approach should be consid-ered as it typically produces proximal and distal nerve rootspread to deliver injectate along the suspected pathology.Conclusions: Although cervical injections are not withoutrisk, they may be of great benefit to patients with “chronicstinger syndrome” that have failed conservative treatment.Further investigation is needed to substantiate the benefits ofthis treatment approach.
Poster 278Complex Regional Pain Syndrome Type II inthe Setting of Lumbosacral Plexopathy:A Case Report.Andrew Gallo, DO (Walter Reed Army MedicalCenter, Washington, DC); Vincent T. Codispoti, MD.
Disclosures: A. Gallo, None.Patients or Programs: A 25-year-old male polytraumapatient.Program Description: A 25-year-old male soldier wasinjured in a blast injury sustaining multiple spinal compres-sion fractures and left pelvis and sacral fractures. In theatre,he underwent external pelvic fixation. The surgeons notedtraction on the lumbosacral plexus due to the fractures. Hewas transferred to a U.S. Army medical center for furthersurgery and inpatient rehabilitation. Approximately 3 weeksinto his course, he complained of swelling and burning painin the left ankle and foot. His evaluation was significant forweakness and diminished sensation in the left lower extrem-ity corresponding to multiple myotomes and peripheralnerves. There was hyperesthesia, allodynia, and edema of theleft ankle and foot without point tenderness. Skin tempera-ture and texture was normal. Plain films of the left leg werenegative. EMG/NCS revealed evidence of a left lumbosacralplexopathy, involving all portions of the plexus as well asprobable injury at the nerve roots or cauda equina. We couldnot obtain MRI due to the orthopedic hardware but CT of theleft ankle and foot showed no bony or significant soft tissue
abnormality. A bone scan showed findings consistent withcomplex regional pain syndrome.Setting: Inpatient rehabilitation unit of a military hospital.Results: The patient was treated with aggressive physicaltherapy, modalities, and medications to include pregabalin,nortriptyline, prednisone, and morphine with 75% relief. Hispain continued to improve and he was eventually able towalk independently when his pelvic external fixation devicewas removed.Discussion: To our knowledge, this is only the second caseof complex regional pain syndrome (CRPS) type II describedin the setting of lumbosacral plexopathy.Conclusions: Although CRPS type II has classically beendescribed in the setting of mononeuropathy, it is importantto keep in the differential diagnosis of neuropathic pain in thesetting of known nerve injury to achieve the best functionaloutcome.
Poster 279Gluteal Lipoma Producing Radicular Pain.Debora Mottahedeh, DO (The Mount Sinai Hospi-tal, New York, NY); Houman Danesh; Parag Sheth,MD.
Disclosures: D. Mottahedeh, None.Patients or Programs: A 50-year-old African Americanwoman with radicular pain.Program Description: Process of evaluation and elucida-tion of symptomatic radicular pain.Setting: University hospital.Results: Pain reduction of 80% after surgery, using thevisual analog scale.Discussion: Lipomas are the most common soft-tissue tu-mor, occurring in 1% of the population and are most oftenasymptomatic. They are slow-growing, benign fatty massesenclosed by a thin, fibrous capsule. Nerve compression by alipoma is uncommon but does occur. Lipomas are capable ofcreating neural compression by either enveloping the nerveor being in close approximation in a confined space. Thiscompression can occur at a point where the nerve runssuperficially or the lesion can be derived by deeper-seatedfatty tissue, which is less frequent. The most frequent clinicalpresentation of these tumors is pain. For superficial lipomasthat can be palpated, positive Tinel sign over the lesion is themost useful sign to help identify the tumor as the source ofnerve compression. The situation is different for deeper tu-mors. These lesions often reach a significant size beforeclinical presentation due to the potential space of the retro-peritoneum. Often, such masses mimic other musculoskele-tal syndromes. Resection of the lipoma usually results inresolution of symptoms. Electromyographic studies obtainedpreoperatively can provide guidance for the intended surgi-cal approach. In patients with compromised neural function,the tumor may be resected along with associated neuralelements.
S125PM&R Vol. 2, Iss. 9S, 2010
