surgery may include nerve traction, nerve compression secondary totaut ligaments and nerve transection.

Poster 114Multifocal Acquired Demyelinating Sensory andMotor (MADSAM) Neuropathy Secondary toInfliximab Infusion: A Case Report.Anupam Sinha, DO (Rothman Institute, Philadelphia,PA, United States); Madhuri Dholakia, MD.

Disclosures: A. Sinha, No Disclosures.Case Description: A 69-year-old man with a history of ulcer-ative colitis, status post C4-C7 fusion (secondary to myelopathyover 10 years ago), presented with a 1-year history of right upperextremity pain and paresthesia. Recent MRI of the cervical spineshowed evidence of a well-healed fusion from C4-C7 with findingsof degenerative changes at C3-4 and C7-T1. The patient did have anMRI of the brachial plexus, which was unremarkable. The patientdenied any lower extremity symptoms; however, he did have someparesthesias in the sole of his feet. The patient noted that most of hissymptoms began after infliximab infusion therapy for ulcerativecolitis. His last infliximab infusion was 8 weeks prior to this ap-pointment. He denied any bowel or bladder dysfunction. On phys-ical examination, the patient was neurologically intact, except forexcept for 4/5 strength in the right hand intrinsics. There were noupper motor neuron signs.Setting: Outpatient spine practice.Results or Clinical Course: Electrodiagnostic studies of theupper and lower extremities showed prolonged latencies, dimin-ished amplitudes and conduction velocities, in multiple nerves in anon-focal distribution. Diminished recruitment and polyphasic po-tentials were found in the majority of muscles in the upper andlower extremities. The patient was diagnosed with multifocal ac-quired demyelinating sensory and motor (MADSAM) neuropathy.He was referred to neurology where he was advised to beginintravenous immunoglobulin (IVIg) therapy.Discussion: Multifocal acquired demyelinating sensory and mo-tor (MADSAM) neuropathy is defined clinically by a multifocalpattern of motor and sensory loss, with nerve conduction studiesshowing conduction block and features of demyelination. Alsoknown as Lewis-Sumner syndrome, this neuropathy is a rarelyreported complication in patients undergoing treatment with theantitumor necrosis factor � (TNF-�) monoclonal antibody inflix-imab. Symptoms may resolve after cessation of the antibody treat-ment; however IV Ig infusion therapy is the treatment of choice ifsymptoms persist.Conclusions: We present a rarely reported case of MADSAM, orLewis-Sumner syndrome, following infliximab treatment. Clini-cians should be aware that electrodiagnostic studies are essential inthe diagnosis of this complex neuropathy.

Poster 115Improving Electrodiagnostic Medicine Skills &Competency in Physical Medicine andRehabilitation Residents Utilizing a Peer to PeerTeaching Module.Brite J. Chalunkal, DO, DPT (NYPH Cornell/ColumbiaUniversity, Yonkers, NY, United States); ChristopherVisco, MD.

Disclosures: B. J. Chalunkal, No Disclosures.

Objective: This project sought to determine the effectiveness of apeer to peer EMG hands-on training course as an educationalmodule including evaluation methodology to instruct residents inelectrodiagnostic evaluation and to quantify acquired competenciesin those electrodiagnostic skills through objective evaluation meth-odology.Design: One-way repeated measure ANOVA.Setting: Level 1 trauma center.Participants: 14 PM&R residents: 7 PGY2s and 7 PGY3s.Interventions: Fourteen residents participated in a course inwhich the senior third-year residents were assigned to teach thejunior residents through technical training concepts. Prior to thehands-on course all residents were required to take a 36-questionwritten examination, which tested basic aspects of EMG and clinicalanatomy. All of the residents also completed a 20-questionhands-on pre-course practical. After delivery of the educationalmodule, knowledge acquisition and skill attainment were measuredin clinical skill in diagnostic procedures via a procedure checklistand written exam.Main Outcome Measures: Objective measures compared res-ident pre and post course written and practical scores in electrodi-agnostics (EDX) before and after institution of the comprehensiveEDX competency module.Results: 14 of the 14 residents (100%) successfully demonstratedproficiency in every segment of the evaluation element of theeducational module by the end of the electrodiagnostic course.There was a statistically significant difference in pre and post scoresin both the written and practical overall with a P score less than .05. In the PGY2 group N(7) there was an improvement of practicalscore from 27.5 � 10 to 77.5 � 15 (P�.0005) and an improvementin written from 41.6 � 4 to 63.43 � 11.3 (P�.0016). In the PGY3group N(7) there was also an improvement of practical scores from70.8 � 11 to 98.3 �3 (P�.01) and an improvement in written from45.8 � 7to 74.75 � 9.6 (P�.00012).Conclusions: The standardized educational peer to peer moduleand evaluation methodology provide a potential frame work for thedefinition of baseline competency in the clinical skill area of EDX.

Poster 116Riche-Cannieu Anastomosis Masquerading asSevere Median Neuropathy: A Case Report.Christopher J. Hess, MD (University of Virginia, Charlot-tesville, VA, United States); Jeffrey G. Jenkins, MD.

Disclosures: C. J. Hess, No Disclosures.Case Description: A 45-year-old woman presented with insid-ious onset of right upper extremity pain over 8 months. She hadbeen diagnosed with acute severe right-hand median neuropathyfound on EMG/NCS performed 2 months after symptom onset byan outside provider. Specifically, the electrodiagnostic reportshowed severe reduction in median compound motor action poten-tial (CMAP) amplitude and 3� fibrillation potentials in the abduc-tor pollicis brevis. The patient was referred for continued symptomsthat were refractory to carpal tunnel injection. It was noted onexamination that her thenar musculature was well preserved; thiscalled into question the diagnosis of severe median neuropathy,prompting referral to our lab for repeat testing.Setting: Academic outpatient electromyography lab.Results or Clinical Course: Repeat EMG/NCS performed 8months after symptom onset showed the following: Findings- 1.

S229PM&R Vol. 4, Iss. 10S, 2012