she developed elbow and medial forearm pain, numbness,and tingling extending to her medial 2 digits. There are nospecific aggravating activities and the symptoms wax andwane. She notes that she participated in physical therapy forseveral months with improvement in her range of motion.However, her sensory sypmtoms progressed.Setting: Outpatient electrodiagnostic visit.Results: The patient’s clinical history and examination weresuggestive of a right ulnar nerve lesion. Nerve conductionstudies demonstrated a significant focal slowing of motorconduction in the right ulnar nerve at the elbow (51.9 m/s to38.7 m/s). The inching study localized the lesion to a trans-posed location anterior to the tip of the medial epicondyle ofthe right humerus, just 1 cm proximal to the tip of the medialepicondyle (42.9 m/s to 14.3 m/s). High-resolution ultra-sound imaging demonstrated compression of the ulnar nervebetween the superficial overlying skin and a hyperechogenicobject just anterior to the tip of the medial epicondyle.Ultrasound showed that the nerve had been anteriorly trans-posed. Subsequent surgical re-exploration confirmed local-ized scarring of the ulnar nerve adjacent to the medial epi-condyle. A release of the nerve from surrounding fibroustissue, removal of the adjacent impinging hardware, andtransposition of the ulnar nerve were then performed. Exam-ination at follow-up clinic visits showed no further progres-sion in her symptoms.Discussion: This is the first case study, to our knowledge,to demonstrate the localization of ulnar neuropathy at theelbow with combined inching and ultrasonographic evalua-tion. The data obtained from the studies were confirmed bygross intraoperative pathology and led to definitive surgicalintervention.Conclusions: The evaluation of entrapment neuropathiesat the elbow with inching and high-resolution ultrasonogra-phy may provide a greater ability to localize entrapmentlesions and delineate pathology for treatment interventions.Keywords: Rehabilitation, Ultrasonography, Elbow, En-trapment neuropathies

Poster 75

Brachial Plexopathy and Severe RadialNeuropathy After a Traumatic HumeralFracture: A Case Report.Adrian Popescu, MD (Hospital of University of Penn-sylvania, Philadelphia, PA); Francis Lopez, MD.

Disclosures: A. Popescu, None.Patients or Programs: A 54-year-old man, who pre-sented with severe left upper limb pain and weakness after afall, was referred to the electrodiagnostic laboratory to com-ment on the diagnosis, severity and prognosis of his upperlimb deficits.Program Description: The patient initially presentedwith sensory and motor deficits throughout his left upperextremity after a fall that resulted in a left mid shaft spiral-

type humeral fracture. He was seen in the electrodiagnosticlaboratory 6 weeks after the injury. His physical examinationwas significant for decreased strength in the deltoid (2/5),biceps brachialis (2/5), triceps brachialis (0/5), wrist exten-sion (0/5), finger flexion (3/5), and finger abduction (2/5). Healso had sensory deficits in the radial distribution. The elec-trodiagnostic study demonstrated left median and ulnarSNAPs with normal peak latencies and amplitudes. The leftradial SNAP was absent while the right radial SNAP wasnormal. Bilateral medial antebrachial cutaneous nerve (MAC)SNAPs were normal. The left lateral antebrachial cutaneousnerve (LAC) SNAP was absent while the right LAC SNAP wasnormal. Needle EMG of select muscles of the left upper limbdemonstrated abnormal spontaneous activity in radial inner-vated muscles above and below spiral groove. Furthermore,there was abnormal spontaneous activity in the deltoid, bi-ceps, extensor digitorum communis and infraspinatus mus-cles. There was no spontaneous activity in the rest of themuscles tested, including the cervical paraspinal muscles.Setting: Tertiary care academic VA hospital.Results: The electrodiagnostic studies were consistent witha severe radial neuropathy above the spiral groove and anupper trunk brachial plexopathy.Discussion: To our knowledge, this is a rare case of asuperimposed upper trunk brachial plexopathy with a severeradial neuropathy after a humeral fracture. These fracturesare rarely associated with an upper trunk brachial plexopathyunless the dynamic mechanism of injury places traction onthe brachial plexus.Conclusions: Electrodiagnostic studies are extremely use-ful not only to determine the location and the prognosis ofradial neuropathies but also to diagnose the presence of rareassociated nerve injuries, such as brachial plexopathies.Keywords: Rehabilitation, Electrodiagnosis, Brachial plex-opathy, Radial neuropathy.

Poster 76

C5 Nerve Root Palsy — an Under-RecognizedCause of Postoperative Weakness: A CaseReport.Margarita Manahan, (Montefiore Medical Cen-ter, Bronx, NY); Sewon Lee.

Disclosures: M. Manahan, None.Patients or Programs: A 61-year-old man.Program Description: A 61-year-old man with diabeteswas admitted after C3-C4 anterior cervical diskectomy andfusion with C3-T1 fusion and instrumentation secondary tocord compression. Patient had a history of cervical myelop-athy with prior C5-6, C6-7 anterior cervical diskectomy andfusion. On the third hospital day, he was noted to haveincreased weakness of the left proximal shoulder muscles. Hedenied any pain. Manual muscle testing of the left upperextremity demonstrated the following: deltoid 1�, biceps 3,internal and external rotators 3, wrist extension 2�, triceps

S136 POSTER PRESENTATIONS