chronic denervation of the left abductor hallicus muscle, additionaltesting of the left lower extremity was normal.Main Outcome Measures: The patient underwent a left tarsaltunnel release and posterior compartment fasciotomy. Operativefindings noted a flattened tibial nerve as the distal aspect just beforeits terminal branches.Results: The patient returned to swimming with resolution of hersymptoms. She placed second in the U.S. open-water 25-km cham-pionships and third at the international open-water 25-km cham-pionships.Discussion: The case highlights classic clinical symptoms of tarsaltunnel brought out by positional related chronic compression of thenerve and provided the framework for appropriate surgical inter-vention. The intervention allowed for the patient to return to herprevious functional level.Conclusions: Tarsal tunnel syndrome can affect individuals in allage groups with symptoms of foot numbness and are not alwaysrelated to prolonged standing as an exacerbating factor.

Poster 113Bilateral Brachial Plexus Injury After Spine Surgery.Naimish Baxi, MD (The Mount Sinai, New York, NY,United States); Mahmud Ibrahim.

Disclosures: N. Baxi, none.Patients or Programs: A 42-year-old man who was morbidlyobese and with a medical history significant for coronary arterydisease, hypertension, hyperlipidemia, chronic back pain, statuspost T9- T11, L2-L5 laminectomies.Program Description: The patient underwent a multilevel lam-inectomy surgery to alleviate thoracic and lumbar stenosis afterfailed conservative measures to improve back and left lower extrem-ity pain and weakness. There were no significant intraoperativecomplications; however, operating time exceeded 12 hours, withthe patient prone and his arms in “superman” position on an Allentable. After surgery, the patient complained of new onset bilateralupper extremity weakness. Manual muscle testing demonstratedgrades of 2/5 for right elbow flexion and extension, 2/5 for rightwrist extension, 4/5 for right finger flexion and abduction, and 3/5for left elbow flexion, elbow extension, and wrist extension. Elec-tromyography performed 18 days after the surgery was consistentwith bilateral axonal brachial plexopathy that involved the uppertrunk and possible neurapraxia of the right biceps brachii muscle.Repeated testing 6 weeks after surgery confirmed previous findings,with axonal brachial plexus injury to both upper and middle trunk.The biceps brachii muscle remained denervated bilaterally.Setting: An inpatient acute rehabilitation center.Results: Despite gradual improvement in both muscle strengthand function of bilateral upper extremities, the patient continued todemonstrate marked weakness in bilateral elbow flexion and toexperience dysesthesias along the dorsal aspect of both forearms.Discussion: Brachial plexus injuries are the most significantamong perioperative peripheral nerve lesions. As spine surgeries arebecoming more frequent and complicated, the incidence of brachialplexus injuries is also increasing, with bilateral effects being rare andmost debilitating.Conclusions: Bilateral brachial plexus injury may occur duringprolonged surgeries, despite careful placement and padding ofupper extremities. Attention to patient positioning, modifying risk

factors, and the use of intraoperative electrophysiological monitor-ing may prevent or minimize injuries.

Poster 114Electrodiagnostic Manifestations of a BrachialPlexitis: A Case Report.Sameer Kapasi, MD (New England Baptist Hospital,Boston, MA, United States); Mark A. Finno, MD.

Disclosures: S. Kapasi, none.Patients or Programs: A 51-year-old woman with arm weak-ness.Program Description: The patient was a 51-year-old womanwho presented to our office with left greater than right upperextremity weakness preceded by 2 days of bilateral arm aching andflu-like symptoms. The aching was sudden onset and had no incit-ing event. Over the next 2 weeks, the patient lost the ability to dressherself. Cervical magnetic resonance imaging was unremarkable,which revealed a mild spondylosis without major neuroforaminal orcentral canal stenosis. The patient was then sent for electrodiagnos-tic testing. Nerve conduction studies revealed a motor conductionblock on the left, between the Erb point and the axilla, and electro-myograms revealed no significance. The studies were consistentwith a lower trunk brachial plexus neuropathy as may be seen in aneurogenic thoracic outlet syndrome or Parsonage-Turner syn-drome. The patient was referred for physical therapy.Setting: Outpatient clinic.Results: The patient’s weakness slowly resolved over the following2 months.Discussion: Acute manifestations of Parsonage-Turner syndromecan mimic root lesions or thoracic outlet syndrome. The pattern andprogression of symptoms as well as the physical examination find-ings are especially important in the diagnosis of Parsonage-Turnersyndrome. Electrodiagnostic studies can be helpful, whereas cervi-cal magnetic resonance imaging findings are often unremarkable.Conclusions: The Parsonage-Turner syndrome can be diagnosedby using electrodiagnostic studies, but the clinical picture is typi-cally paramount in suspecting the diagnosis. Cervical spine mag-netic resonance imaging is frequently performed to rule out apotential spine etiology to the symptoms.

Poster 115Idiopathic Brachial Neuritis Versus CervicalRadiculopathy After Carotid Endarterectomy: ACase Report.Susan Jeda Orillosa, MD (Loma Linda University, LomaLinda, CA, United States); Foluke A. Akinyemi, MD,Menandro Cunanan, MD.

Disclosures: S. Orillosa, none.Patients or Programs: A 61-year-old man with right shoulderpain and weakness after right carotid endarterectomy.Program Description: One week after surgery, the patient de-veloped acute onset of burning pain in the posterior right shoulderfollowed by weakness, severe atrophy of the right supraspinatus andtrapezius muscles, and scapular winging. He had no neck pain orsensory deficits. An electromyogram revealed abnormal findings ofactive denervation and reinnervation in the right supraspinatusmuscle and rhomboid major. There also were few fibrillations seenin the low cervical paraspinal muscles. These findings were consis-

S208 PRESENTATIONS