Conclusions: Quadriceps tendon rupture should be ruled out,when clinical suspicion is high, to prevent misdiagnosis, delay ofproper treatment, and impaired recovery.

Poster 183Upper Trunk Brachial Plexopathy After RegionalAnesthetic Block for a Rotator Cuff Repair: AUnique Clinical Presentation: A Case Report.Jacqueline D. Neal, MD (Rehabilitation Institute of Chi-cago/Northwestern Memorial Hospital, Chicago, IL,United States); Monica Rho, MD.

Disclosures: J. D. Neal, No Disclosures.Case Description: A 72-year-old man with chronic left shoul-der pain and limited range of motion presented 5 months after a leftrotator cuff repair complaining of weakness in the left shoulder andhand, and diminished sensation in the lateral upper extremity anddorsum of the left hand. Patient underwent 5 months of physicaltherapy with no improvement in his strength. Initial examinationdemonstrated atrophy of the infraspinatus, teres minor, and su-praspinatus. Active range of motion was limited to 5 degrees ofshoulder abduction and 10 degrees of forward flexion, and 3/5strength was noted with supraspinatus, infraspinatus and teresminor muscles. Of note, surgical anesthesia included a regionalintrascalene block followed by general anesthesia. Intra-operatively,the patient underwent repair of the supraspinatus and infraspinatustendons, and a biceps tenodesis.Setting: Outpatient musculoskeletal clinic.Results or Clinical Course: Musculoskeletal ultrasound andelectromyography (EMG) were performed 6 months post-oper-atively. Ultrasound demonstrated persistent tears of the leftsupraspinatus and infraspinatus tendons. EMG revealed findingsconsistent with an incomplete left upper trunk brachial plexopa-thy with evidence of reinnervation. Over 6 to 9 months post-op,patient’s sensory changes resolved and his strength slowly im-proved.Discussion: There is one prior case report describing an uppertrunk plexopathy following an interscalene block. Although it can-not be definitively determined, it is possible that the intrascaleneblock precipitated the upper trunk plexopathy in our patient. It isalso notable that this patient’s rotator cuff remains torn post-oper-atively. Ultimately, his slow post-operative progress may be attrib-uted to both his upper trunk plexopathy and his persistent rotatorcuff tear.Conclusions: Consideration for possible brachial plexopathy fol-lowing rotator cuff repair using regional anesthetic block should betaken in patients progressing slowly in therapy post-operatively.

Poster 184Treating Low Back Pain in Cardiac TransplantRecipients: A Case Report.Jamil Bashir, MD (University of Miami Miller School ofMedicine, Miami, FL, United States); Jackson Cohen,MD; Alberto Panero, DO; Nitin Putcha, DO; Ricardo J.Vasquez-Duarte, MD.

Disclosures: J. Bashir, No Disclosures.Case Description: A 27-year-old man with newly diagnosedHIV. Patient presented with axial back pain for 1 month durationpost cardiac transplantation 6 months previous. Immunosuppresivetreatments after that procedure included steroids and tacrolimus.

Upon acute onset he was seen by his transplant physician. Second-ary to his decreased cardiac function with potential poor renal flow,he was instructed to avoid NSAIDs. His prednisone dosing wasincreased and he was placed on a taper, resulting in mild improve-ment of pain. One month later he was seen in the PMR clinic withcomplaints of continued axial low back pain with limitation inlumbar motion, and pain radiating to his thighs bilaterally. Painscale was 8/10. He reported pain with Valsalva, with little relief bypositioning. Pain was elicited with flexion and extension of thelumbar spine. Deep tendon reflexes, strength and sensation werenormal with a negative straight leg test. Special tests were difficult toperform secondary to severe pain with any lumbar motion. Thepatient was prescribed a narcotic and physical therapy, includingmodalities, lumbar range of motion and core strengthening. Atfollow-up assessment 6 weeks later the patient reported significantimprovements in his pain, 2/10, and lumbar range of motion.Setting: Tertiary care hospital.Results or Clinical Course: Radiographs revealed wedging atL1-L2 with diffuse spondylosis throughout his lumbar spine. MRIwas ordered to rule out acute compression fractures possibly sec-ondary to prolonged steroid use. MRI showed wedging more likelysecondary to degenerative changes with disc dessication and facetarthropathy from L1-S1.Discussion: Algorithims designed to treat patients without exten-sive comorbidities are difficult to follow in the transplant popula-tion. Appropriate management of common complaints such as axialback pain become complicated in the post transplant setting.Conclusions: As tranplantations are becoming more common,this case reveals the need for establishing new recommendations toguide successful management of these patients.

Poster 185Balance Assessments as Objective Measures forReturn to Play in Adolescents. A Case Series.Jason L. Zaremski, MD (Geisinger Health System, Wilkes-Barre, PA, United States); Julio A. Martinez-Silvestrini, MD.

Disclosures: J. L. Zaremski, No Disclosures.Objective: To retrospectively assess if initial balance assessmentmay be used as an objective measure for return to play.Case Description: 3 adolescent athletes, ages 12-17, sufferedconcussions with varying symptoms in different sports (hockey andbasketball). Common symptoms included headaches, nausea, an-orexia, and removal from school due to difficulty concentrating. Thestudent-athletes were assessed using a standardized concussionprotocol that included Balance Error Scoring System (BESS) andBiodex testing until symptoms resolved.Setting: Outpatient sports medicine clinic.Participants: 12-17 year old student-athletes.Results: All 3 patients performed a fall risk assessment using theBiodex, as well as performing BESS. Initial Fall Risk ranged from 8.0to 1.9 in all 3 cases during symptomatic time frames (with normal orno fall risk 1.0). BESS scores initially ranged from 7-30 errors. Oncethe patients stated their symptoms were gone, repeat testing re-vealed Fall Risk assessment to be 1.3-0.6 and BESS scoring revealeda range of 4-6 errors. Return to play ranged from 1 to 3 months frominitial assessments.Discussion: BESS is an inexpensive screening and reassessmenttool when other more expensive devices are not readily available.

S253PM&R Vol. 4, Iss. 10S, 2012