the infraspinatus. In 3 of the cases, symptoms improved significantly with a physical therapyprogram aimed at strengthening the infraspinatus and thereby restoring the scapulohumeral rhythm.In the fourth case, the patient declined further therapy and/or imaging studies. Discussion: Clas-sically, suprascapular neuropathy presents with posterior shoulder pain and weakness and atrophyof the infraspinatus and/or supraspinatus muscles. This is the first report, to our knowledge, of asuprascapular neuropathy presenting with myofascial pain as the primary complaint. Conclusion:These cases emphasize the need for clinicians who treat cervicobrachial myofascial pain to assessscapular movements for potential suprascapular neuropathy. Key Words: Myofascial pain; Reha-bilitation; Shoulder pain.

Poster 90A Community-Based Pilot Trial of a Communication Tool to Facilitate Work AccommodationAfter Work Injuries. Jaime Guzman, MD, MSc (University of Manitoba Faculty of Medicine,Winnipeg, MB, Canada); Juliette E. Cooper, PhD; Jawad Khokhar, MD; Annalee Yassi, MD,MSc.Disclosure: Guzman, Research grant from the Workers’ Compensation Board of Manitoba; Otherauthors: None.

Objective: To test a simple communication tool to facilitate work accommodation. Design:6-month cluster randomized trial. Setting: 2 small Canadian cities and 2 large emergency depart-ments. Participants: All medical practices and all firms with �30 employees in 1 city, as well asall physicians in 1 emergency department. Workers seen in the other city and emergency departmentserved as controls. Intervention: A paper-and-pencil voluntary tool to facilitate work accommo-dation endorsed by local medical, labor, and employer associations and by the workers’ compen-sation board (WCB). Main Outcome Measure: The proportion of injured workers using the tooland interviews with workers and supervisors. Results: 28 of 32 firms, all 3 group practices, and theemergency department consented to test the tool. The tool was used in 90 of 599 (15%) work injuriesreported to the WCB by the physicians and in 21 of 424 (5%) injuries reported by study firms. 24workers were interviewed and compared with 29 controls; they reported increased discussion ofmodified duties with physicians (50% vs 24.1%, P�.05) and supervisors (62.5% vs 37.9%, P�.05);increased satisfaction with care (75 vs 48.3%, P�.05); and 45% felt the tool was useful. There wereno significant differences in sympton severity and time off work. 23 supervisors were interviewed.Most (65%) had discussed modified duties with the worker but only 1 with a physician; 52% felt thetool was useful. Conclusions: Despite widespread endorsement, the tool was used only in a minorityof injuries. When used, it increased discussion about work accommodation and about half theworkers and supervisors felt it was useful. Effective community implementation of such a toolwould require powerful incentives or regulation. Key Words: Accidents, industrial; Rehabilitation;Workers’ compensation.

Poster 91Tumor Infiltration of the Piriformis Muscle Resulting in Piriformis Syndrome: A Case Report.Peter G. Gonzalez, MD (University of Colorado Health & Science Center, Denver, CO),e-mail: peter.gonzalez@uchsc.edu.Disclosure: None.

Setting: Tertiary care hospital. Patient: A 53-year-old female with high-grade, non-Hodgkin’slymphoma. Case Description: The patient was admitted to the rehabilitation unit after a compli-cated hospital course. She complained of persistent right buttock pain associated with pain andnumbness radiating down her right posterolateral leg to her lateral foot. She did not complain of lowback pain, left lower-extremity symptoms, or bowel or bladder dysfunction. Her pain was accen-tuated with adduction, internal rotation, and flexion of her right lower limb. She demonstratedtenderness, increased pain, and worsening of symptoms with palpation over the right piriformismuscle. Neurologic exam revealed intact strength with normal tone, however, light touch wasabnormal in the right L5-S1 dermatomes. Magnetic resonance imaging revealed an extensive pelvictumor involving the cervix and adnexal regions extending to the margins of the right piriformismuscle. Assessment/Results: Tumor infiltration throughout the pelvis involving the right piriformismuscle likely resulted in right buttock and lower-extremity pain and parathesias. Discussion: Aliterature search revealed no other cases of tumor infiltration causing piriformis syndrome. The mostcommon etiology of piriformis syndrome is local trauma resulting in muscle spasm, inflammation,and hypertrophy. As a result, the sciatic nerve is compressed either between the piriformis musclebelly and the bony pelvis or between 2 inflamed fascicles. In this case report, it is probable thatcompression of the sciatic nerve resulted from direct compression by the tumor or as a result ofsecondary inflammation within the muscle belly. Furthermore, the tumor infiltration may havecaused irritation of the piriformis resulting in muscle spasms and thus compression of the sciaticnerve as it pierced the muscle. Conclusion: Tumor infiltration of the piriformis muscle is a rarecause of piriformis syndrome. Key Words: Neoplasm metatstasis; Rehabilitation; Sciatica.

Poster 92Pain Reduction and Functional Improvement After Kyphoplasty:A Retrospective Study of 50Patients. Zeeshan Ahmad, MD (Portner Orthopedic Rehabilitation, Honolulu, HI); FaheemAbbasi, MD; Morris Mitsunaga, MD; Bernard Portner, MD, e-mail: zeetaj@hotmail.com.Disclosure: None.

Objective: To study pain reduction and functional improvement after kyphoplasty. Design:Retrospective analysis. Setting: Hospital and clinic. Participants: 50 adult patients with osteopo-rotic vertebral compression fractures. Interventions: Kyphoplasty using polymethylmethacrylate(PMMA) was performed to treat vertebral compression fractures. In this procedure, PMMA wasinjected into the involved vertebral body using flouroscopy. A balloon was used, which wheninflated reduces the vertebral compression fractures and creates a void that can then be filled withPMMA under low pressure. Vertebroplasty involves injection of PMMA under high pressure. MainOutcome Measures: Pain and functional outcomes, using a visual analog scale (VAS), andfunctional rating, using the Prolo Scale score. Results: Excellent results were found in 80% ofpatients. Almost all patients were hospitalized for 1 day. 80% showed improvement in the VASscore and functional improvement in Prolo score. 4 patients later developed vertebral compression

fractures that required repeat kyphoplasty at different levels. Asymptomatic extravasation occurredin 2 patients in the spinal canal, but were without any neurologic or pulmonary complications. 14%of patients continued with other complaints related to other conditions of the spine, including spinalstenosis and degenerative disease. Single-level vertebral compression fracture treated with kypho-plasty had higher functional improvement than multiple levels. There were 3 delayed deaths in theseries not related to kyphoplasty but to other medical issues. Radiographic follow-up showedimprovement in vertebral height and sagittal deformity after kyphoplasty. Conclusions: Good painrelief and functional improvement were found in vertebral compression fractures with kyphoplastyand the complications were minimal. The theoretical advantages of kyphoplasty over vertebroplastyinclude better correction of deformity and lower incidence of extravasation and embolism withinjection of PMMA under low pressure. A prospective study comparing kyphoplasty and vertebro-plasty is warranted. Key Words: Compression fractures; Kyphoplasty; Polymethylmethacrylate;Rehabilitation; Vertebroplasty.

Poster 93Reliability of the Isokinetic Measurements of Resistance to Passive Knee Motion and theInfluence of Hip Angle on Peak Torque Values in Healthy Subjects. Meral Bayramoglu(Baskent University, Ankara, Turkey); Metin Karatas; Nafiz Akman; Meltem Akynbingol;Aydan Aytar, PT, e-mail: meral@bayramoglu.org.Disclosure: None.

Objectives: To determine (1) the test-retest reliability of the isokinetically measured resistanceto passive knee flexion and extension movements at different angular velocities and (2) the impactof different hip angles on the measurements. Design: Cross-sectional study. Setting: Outpatientrehabilitation facility. Participants: 30 healthy volunteers (20 women, 10 men) between the ages of21 and 39 years. Interventions: Resistance to passive knee flexion and extension movements at 60°,120°, 180°, and 300°/s were performed twice in the sitting position (hip at 90° of flexion) with a20-minute interval between the 2 tests. The same procedure was performed in the supine position(hip at full extension). Main Outcome Measures: Peak torque measured the resistance to passiveknee motion. Results: The intraclass correlation coefficients (ICCs) ranged between .25 and .65 and.23 and .52, respectively, when the results of the 2 sitting and 2 supine position tests were compared.The ICCs ranged between .22 and 0.6 and .15 and .59 when the results of the sitting and supineposition tests were compared in the first and second measurements, respectively. Conclusions: Themeasurements of resistance to passive knee motion by isokinetic dynamometry were not reliable.Hip position during testing, for example, in the sitting and supine position seemed to have an effecton peak torque values, but because the values for 2 consecutive sitting or supine positions alreadydiffered, the difference cannot be directly attributed to changes in the hip position. Key Words:Knee; Range of motion, articular; Rehabilitation; Reliability and validity.

Pain

Poster 94Percutaneous Neuromodulation Therapy for Treatment of Cervical Spine Pain Patients WithRadiating Shoulder and Arm Pain. Farshad M. Ahadian, MD (University of California, SanDiego, Center for Pain and Palliative Medicine, La Jolla, CA), e-mail: fahadian@ucsd.edu.Disclosure: None.

Objective: To assess the efficacy of percutaneous neuromodulation therapy (PNT) for neck andupper-extremity pain. Design: Randomized controlled study. Setting: 7 outpatient pain treatmentcenters. Participants: 94 patients randomized to 2 treatment groups: PNT or no electric current PNT(NC-PNT). Subjects were further classified based on the presence or absence of persistent structuralpathology: recurrent pain due to prominent structural and mechanical problems leading to nocicep-tive pain (eg, protrusion) or time-limited nonrecurrent injuries leading to centrally facilitated pain(eg, myofascial pain). Interventions: Patients received up to 8 weekly treatments, with 1-week and1-month follow-ups after completion of the last treatment. Main Outcome Measures: 10-cm painvisual analog scale (VAS). Results: A multivariate analysis of variance revealed that a decrease inpain VAS scores was dependent on treatment received and type of pain (P�.01). Within the PNTgroup, subjects with centrally facilitated pain experienced greater decreases (P�.02) in VAS ratingscompared with subjects with structural pathology (baseline, 6.3�1.9cm vs 6.3�1.4cm; 1wk post,3.3�1.9cm vs 5.0�2.3cm; 1mo post, 4.0�2.0cm vs 5.6�2.0cm). Differences in VAS scores, withinthe NC-PNT group, were not related to diagnostic classification but to change from baseline(P�.001) (baseline, 6.1�1.4cm; 1wk post, 4.6�2.6cm; 1mo post, 5.1�2.5cm). Conclusions:Central facilitation is an underlying mechanism for intractable pain in the cervical spine causingneck and upper-extremity pain. Results support the proposal that PNT reverses neuroplastic changesleading to centralization of pain. In the case of structural problems, persistent nociceptive inputpotentially limits analgesia obtained by modulation of the neural circuitry. Key Words: Electricstimulation therapy; Neck pain; Neuronal plasticity; Rehabilitation.

Poster 95A 5% Lidocaine Patch Significantly Improves Pain Intensity and Pain Relief in the Treatmentof Low Back Pain. Charles Argoff, MD (Endo Pharmaceuticals, Chadds Ford, PA); JosephGimbel, MD; Martin Hale, MD; Bruce Nicholson, MD; Michael Moskowitz, MD; Arnold R.Gammaitoni, PharmD, e-mail: gammaitoni.arnold@endo.com.Disclosure: Gammaitoni, Endo Pharmaceuticals employee; Other authors: None.

Objective: To assess the effectiveness of a 5% lidocaine patch (Lidoderm), a targeted peripheralanalgesic, in acute and chronic low back pain (CLBP) after 2 weeks of daily treatment. Design:Open-label, nonrandomized, 2-week, multicenter trial. Setting: Clinic. Participants: Men andwomen aged �18 years with nonradicular acute and subacute (�3mo: group 1; n�21), short-termchronic (3–12mo: group 2; n�33), and long-term (�12mo: group 3; n�77) CLBP, an average dailypain intensity score �4 (scale range, 0–10) within 24 hours prior to screening, and normalneurologic examination and clinical laboratory tests. Intervention: Patients applied up to 4lidocaine patches every 24 hours to the area of maximal peripheral pain for 2 weeks and were

A21ACADEMY ANNUAL ASSEMBLY ABSTRACTS

Arch Phys Med Rehabil Vol 84, September 2003