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Official Journal of the American College of Sports Medicine and reported numbness of the palmer surface of her hand. Her smart phone was still in her grip. PhysICaL EXaMINaTION: Examination of her right hand revealed localized tenderness and bruising of the fingertip of her fourth digit. She had decreased active flexion at the distal interphalangeal joint. She had normal sensation, reflexes and strength of her upper extremities bilaterally. PhysICaL EXaMINaTION: 1.Jersey finger, partial tear of flexor digitorum profundus tendon 2.Distal phalanx fracture 3.Mallet Finger TEsT aNd rEsuLTs: Anterior-posterior and lateral X-ray views of the right hand: --Normal, no fracture or dislocation noted Dynamic ultrasound examination while flexing and extending the right fourth digit to evaluate the tendon ends: --Partial avulsion of the flexor digitorum profundus FINaL WOrKING dIaGNOsIs: Jersey finger, partial tear of flexor digitorum profundus tendon TrEaTMENT aNd OuTCOMEs: 1.Immobilization with finger splint for 6 weeks. 2.Passive range of motion exercises started twice a day from day one. 3.Ice to reduce pain and inflammation, 20 to 30 minutes every 3 to 4 hours. 4.Strengthening exercises using items such as putty and hand therapy balls started 6 weeks post injury when pain free. 5.Return to unrestricted activities when she has full, painless range of motion and normal strength. 1053 May 30, 9:00 AM - 9:20 AM Knee Injury _ distance running Dwan R. Perry, Robert Hosey. University of Kentucky, Lexington, KY. (Sponsor: Mary Lloyd Ireland, FACSM) (No relationships reported) hIsTOry: A 37 year old male, former college cross country athlete noticed insidious onset of medial-sided right knee pain with his runs over the past month. He has participated in several 5Ks per year, including marathons. He recently increased his mileage to 12 miles per day in preparation for a half marathon. He describes his pain as sharp, intermittent, without radiation or swelling of the calf. He runs in his usual shoes and has not changed running style or surfaces. Cryotherapy and over-the-counter analgesics has provided mild relief. PhysICaL EXaMINaTION: Right Knee: No visible effusion. Palpation revealed tenderness to palpation over the medial tibial plateau just above the pes anserine tendon insertion. There was no medial joint line tenderness. There was full range of motion at the knee with a negative bounce home test. No instability on varus or valgus stress testing at 0° and 30°. Ligamentously stable with negative Lachman’s test. McMurray’s test was also negative. There was no fullness in the popliteal space. The extremity was neurovascularly intact. PhysICaL EXaMINaTION: 1. Medial Meniscus Tear 2. Medial Tibial Stress Fracture 3. Articular Cartilage Defect of the Medial or Patellofemoral Compartment 4. Pes Anserine Bursitis 5. Tibial Bone Bruise TEsT aNd rEsuLTs: Radiographs of the Bilateral Knee, standing 30° flexed PA views, patellar views, and lateral views obtained: 1. No evidence of fracture. 2. No joint space narrowing. 3. No osseous loose bodies. MRI of the Right Knee without Contrast: 1. Reactive bone marrow edema in the medial tibial plateau. 2. Irregular edema within the fibular head indicative of early arthrosis affecting the proximal tibiofibular articulation. 3. Normal appearing medial meniscus and articular cartilage. FINaL/WOrKING dIaGNOsIs: Medial Proximal Tibial Plateau Stress Fracture TrEaTMENT aNd OuTCOMEs: 1. Cessation of the painful activities. 2. As symptoms resolved, it was recommended to have a gradual return to running once asymptomatic. 3. The patient began running again after pain subsided. This was followed by a recurrence of pain which prompted another period of rest from running. 4. After resolution of pain, the patient was able to return to running pain free at one year after initial presentation and without need for further imaging. Vol. 45 No. 5 Supplement S191 1054 May 30, 9:20 AM - 9:40 AM Knee Pain - runner Maria E. Reese, Monica Rho. Rehabilitation Institute of Chicago, Chicago, IL. (Sponsor: Joel Press, FACSM) (No relationships reported) hIsTOry: A 39-year-old male recreational runner presented with 3 week history of left anterior knee pain that started on mile 15 of an 18 mile run. He denied trauma, swelling, bruising, or prior knee pain. Pain was a dull ache progressing to sharp severe pain, 6/10, precluding running. For the next 3 days, pain progressively worsened and became present with walking. Pain was worse with weight bearing, especially descending stairs, and prolonged sitting. Pain was better with rest and stretching (quadriceps, hip flexors, and hamstrings). He denied clicking, popping, catching yet confirmed a feeling that his knee would “give out”. Pain improved with rest and he was able to walk pain free. He ran 3 miles during which he had mild left knee pain, yet the severe pain returned the following day. For the next 2 weeks, he decreased his running to 1 mile per week. The elliptical machine and stationary bicycle were non painful yet stairs continued to cause pain. He had not taken medications nor used ice. PhysICaL EXaMINaTION: Examination revealed mildly increased fullness of left tibial tuberosity when compared to right with full range of motion of the bilateral knees with mild discomfort at end range of left knee flexion. No bony tenderness to palpation bilaterally. Tenderness of the left distal patellar tendon, especially the medial aspect just superior to the tibial tuberosity yet no tenderness to palpation of the proximal and mid portions of the left patellar tendon. Hip exam and neurological testing were normal. He was unable to complete left single leg squat due to significant anterior knee pain. PhysICaL EXaMINaTION: 1. Left patellar tendonopathy 2. Stress reaction of left tibial tuberosity 3. Calcific tendonopathy of the left patellar tendon 4. Patellofemoral syndrome TEsT aNd rEsuLTs: Left knee ultrasound: - Tender 8.1mm x 3.4mm x 1.7mm hyperechoic structure located at distal medial aspect of left patellar tendon with acoustic shadowing - Minimal effusion underlying patellar tendon in area described above - No increased blood flow appreciated on Doppler imaging FINaL WOrKING dIaGNOsIs: Calcific tendonopathy of the distal medial left patellar tendon TrEaTMENT aNd OuTCOMEs: 1. Ibuprofen 600mg p.o. TID with food 2. Ice as needed, especially following activity 3. Eccentric strength training of quadriceps 4. Return to running gradually 1055 May 30, 9:40 AM - 10:00 AM Conservative Treatment of Plantar Fascia Pain in a recreational running athlete Noelle Selkow, Jeffrey G. Williams. Illinois State University, Normal, IL. (Sponsor: Kevin Laudner, FACSM) (No relationships reported) hIsTOry: A 24-year-old, female, recreational running athlete (height: 167.6 cm, weight: 61.4 kg) reported with right plantar foot pain while training for a half marathon. Her pain was insidious and persistent for 7-weeks prior to presenting for evaluation and treatment. The patient’s symptoms began as minor pain at rest, discomfort and tightness in the plantar aspect of the foot, particularly upon waking in the morning. Patient stated that her pain progressed to feeling as if her plantar fascia was going to “tear in two pieces” while running. PhysICaL EXaMINaTION: The patient presented with right plantar foot pain. A pea–sized nodular deformity along the middle 1/3 of her medial longitudinal arch was identified and tender to palpate. Examination of range of motion (ROM) revealed limited active dorsiflexion in her affected ankle when compared bilaterally. Manual muscle testing revealed no deficiencies in surrounding foot, ankle, and lower leg musculature when compared bilaterally. Neurologic examination was negative. Initial sonographic images of the nodule revealed a 0.44 cm2 fibroma. PhysICaL EXaMINaTION: 1. Plantar fasciitis 2. Chronic fascial rupture 3. Inclusion cyst 4. Foreign body granuloma 5. Nerve sheath tumor TEsT aNd rEsuLTs: Sonographic examination: -- Initial transverse sonographic images indicated a 0.44 cm 2 fibroma within the plantar fascia. Standard Goniometry: -- Lacking 3° of active dorsiflexion in the affected ankle. Abstracts were prepared by the authors and printed as submitted. Thursday, May 30, 2013
Thursday, May 30, 2013 S192 Vol. 45 No. 5 Supplement FINAL WORKING DIAGNOSIS: Plantar fibromatosis (fibroproliferative condition on the plantar fascia tissue) TrEaTMENT aNd OuTCOMEs: 1. Immediate reduction of running workouts to within a pain free range. 2. Two treatment sessions per week for four weeks within an athletic training facility incorporating an instrument-assisted-soft-tissue mobilization technique. 3. Low intensity strengthening exercises and passive stretching were performed during treatment sessions. 4. A home exercise program was prescribed on days when the patient was not treated by the clinician. 5. Returned to full participation in running at week four of treatments with full, pain free ROM, pain free running gait and decreased size of the plantar fibroma by 17% (0.37cm 2 ). 6. Patient successfully completed the half-marathon race, pain free and at goal pace 1-month following the conclusion of treatment. C-24 Free Communication/Poster - Advances in Exercise Immunology May 30, 2013, 7:30 AM - 12:30 PM Room: Hall C 1056 Board #1 May 30, 8:00 AM - 9:30 AM Endurance-training Effects On Intracellular Calcium and Iron In Cd4 + Lymphocytes In young and Old Men Suzanne Broadbent. Southern Cross University, Lismore NSW, Australia. (No relationships reported) Intracellular calcium (Ca 2+ i )and iron (Fe 3+ i) are critically involved in intracellular signalling within CD4 + cells yet little is known of long-term exercise effects on these variables in relation to CD4 + activation and proliferation. PurPOsE: To investigate the effects of 12 months of aerobic/endurance exercise on Ca2+i and Fe3+i concentrations within CD4+ lymphocytes in old and young men compared to sedentary controls. METhOds: We compared young (30±5 yr) trained (TRY, n=14) and sedentary (UTY, n=12) men to older (69±5 yr) trained (TRO, n=14) and sedentary (UTO, n=10) men for 12 months. The TRY group completed daily endurance training (60-120 min day, 60- 80% VO 2peak ) while the TRO group cycled for three 60 min sessions per week (60-75% VO 2peak ). Venous blood was analysed every month for resting lymphocyte counts. CD4 + cells were separated and stimulated with thapsigargin to quantify Ca 2+ i, using Fluo-3 AM and flow cytometry. Further CD4 + lymphocytes were incubated with Calcein AM to assess Fe 3+ i. rEsuLTs: The TRY group had a significantly higher CD4+ concentration than UTY for 4 months (37±7%, p
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