Clinical Findings and Electrodiagnostic Testing in Ulnar Neuropathy at the Elbow and Differences According to Site and Type of Nerve Damage Objective To evaluate the clinical and electrodiagnostic testing (EDX) in ulnar neuropathy at the elbow (UNE) and differences according to site (humeroulnar arcade, HUA, vs. retroepicondylar groove, REG) and injury physiopathology (axonal vs. demyelinating), through prospective multicenter case-control study. Design Cases and controls were matched by age and sex. UNE diagnosis was made on symptoms. Statistical analysis was performed using Mann-Whitney, Chi-square and ANOVA tests. Results 144 cases and 144 controls were enrolled. Sensory loss in the fifth finger (U5) had the highest sensitivity (70.8%) compared to clinical findings. Motor conduction velocity across-elbow (MCV-AE) reached the highest sensitivity (84.7%) in localizing UNE recording from at least one of two hand muscles (first interosseous-FDI and abductor digit minimi-ADM). Abnormal sensory action potential amplitude from U5 occurred more frequently in axonal than in demyelinating forms. Differences between REG and HUA regarded conduction block (CB) and job type. Conclusions Clinical findings have less usefulness than EDX in UNE diagnosis. MCV-AE recorded from both ADM and FDI increases diagnostic accuracy. Axonal forms have greater clinical and EDX severity than demyelinating forms, that are more frequent in REG. Manual workers prevailed in HUA. These findings may be helpful in prognostic and therapeutic approaches. Disclosures: The authors state that there are no conflicts of interest and that they have not received any financial support. This research has never been presented previously as a full manuscript, nor as an abstract for scientific congresses. Correspondence: Dr. Claudia Vinciguerra, MD, Department of Medicine, Surgical and Neurological Sciences, University of Siena. Viale Bracci 2, 53100 Siena, Italy, Phone: +39-0577-235808, Fax: +39-0577-233411. E-mail: claudiavinci@hotmail.it What is known: Electrodiagnostic testing (EDX) compared to clinical findings, remains the most sensitive tool for the diagnosis of Ulnar Neuropathy at the Elbow (UNE). What is new: Delayed Motor Conduction Velocity (MCV)-across-elbow achieves higher sensitivity in localizing UNE than MCV drop and increases the diagnostic accuracy when recorded from both abductor digiti minimi (ADM) and first dorsal interosseous (FDI). Identifying both the site and physiopathology of injury, can be useful for prognosis and treatment of UNE. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Prevalence and Anatomical Distribution of Bone Stress Injuries in the Elite Para Athlete Bone stress injury (BSI) is a common overuse injury in athletes. Risk factors for BSI in athletes include the Female Athlete Triad (Triad); this has not been evaluated in para athletes. The purpose of this study is to identify risk factors, prevalence and anatomical distribution of BSI in para athletes. A cross-sectional online survey on health characteristics and prior fractures including BSI was completed by para athletes training for the 2016 or 2018 Paralympic Games. 260 para athletes completed the survey (659 invited, response rate 40%). Half reported prior fracture, and BSI was reported in 9.2% of all athletes. Twenty-four athletes (11 men and 13 women) sustained ≥1 BSI, including 13 athletes with two BSIs. No risk factors of the Triad, disability type or duration of disability were associated with BSI. Injuries were most common in the metatarsals (n=8) and hand/wrist (n=7). In an elite para athlete population, locations for BSI included both the upper and lower extremities. Clinically, para athletes presenting with pain localized to bone require further workup to evaluate for BSI particularly for pain in both upper and lower extremities. Further research is required to identify risk factors for BSI in para athletes. Disclosure/Funding: Authors have no conflicts of interest to disclose related to this work. No funding was received to support this investigation. Adam S. Tenforde, 1575 Cambridge Street, Cambridge, MA 02138. atenforde@partners.org. Fax: 617-952-6836 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Painful Myoclonus Triggered By Lateral Antebrachial Cutaneous Nerve Entrapment at Brachioradialis Muscle: A Case Report Compression of the lateral antebrachial cutaneous nerve (LACN) is a rare clinical entrapment syndrome often overlooked as an initial etiology of pain 1. We present a case of an episodic upper extremity painful movement disorder (myoclonus) in a 16 year old female with a remote history of a surgically stabilized supracondylar humeral fracture who was later found to have entrapment of the LACN. The incidence of a painful myoclonus triggered by a peripheral nerve entrapment is unknown 1. Combining a history and physical examination, electromyography, nerve conduction studies and ultrasound enabled us to make an accurate diagnosis that was confirmed by resolution of symptoms after surgical release. This study conforms to all CARE guidelines and reports the required information accordingly (see Supplemental Check list, Supplemental Digital Content 1, http://links.lww.com/PHM/A855). Correspondence: Heidi Prather, DO, Department of Orthopaedic Surgery, 14532 South Outer Forty Road, Chesterfield, MO 63017, Phone: 3145143544. Email: pratherh@wustl.edu Authors Disclosures: None No funding was received for this research Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Use of Ultrasonography in Expediting Septic Joint Identification and Treatment: A Case Report No abstract available

Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Is platelet rich plasma injection more effective than corticosteroid for treatment of gluteal tendinopathy? No abstract available

An Uncommon Cause of Lateral Hip Pain After Multi-Trauma: A Clinical Vignette No abstract available

Repetitive transcranial magnetic stimulation on motor recovery for patients with stroke: A PRISMA compliant systematic review and meta-analysis Objective A systematic review and meta-analysis were conducted to determine the efficacy of repetitive transcranial magnetic stimulation (rTMS) in recovering motor function in patients with stroke. Design A comprehensive literature search was performed to identify studies published before September 20th, 2018. Electronic databases were searched. Standard mean differences (SMD) and 95% confidence intervals (CI) were used to evaluate the effects of rTMS. The stability and sensitivity of the results and sources of heterogeneity were also analyzed. The Cochrane Risk of Bias Tool was used to determine the quality of the studies. Result Twenty randomized controlled trials (n=841 patients) were included. The results showed that rTMS is beneficial to patients with post-stroke hemiplegia, as demonstrated by four scales: the Fugl-Meyer Assessment (SMD=0.635, 95% CI: 0.421–0.848); grip strength (SMD=1.147; 95% CI: 0.761–1.534); Barthel Index (SMD=0.580; 95% CI: 0.377–0.783); and National Institutes of Health Stroke Scale (SMD=-0.555; 95% CI: -0.813–-0.298). Few adverse events were observed. Conclusion The analysis showed that low-frequency rTMS has a positive effect on grip strength and lower limb function as assessed by FMA. Correspondent Author: Dingqun Bai, The First Affiliated Hospital of Chongqing Medical University, the department of Rehabilitation; Chongqing, China. Tel/Fax:18623380876. E-mail: baidingqun2014@163.com Declarations of interest: None. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Clinical Trial Registration Information: PROSPERO under the identification CRD42017058219 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Exercise in the Aquatic Environment for Patients with Chronic Spinal Cord Injury and Invasive Appliances: Successful Integration and Therapeutic Interventions Objective Our primary objective of this initial “proof-of-principle” trial was to evaluate the interventions used in skilled aquatic therapy and to identify any clinical benefits for individuals with spinal cord injuries (SCI) who use invasive appliances including pressure ulcer dressings, supra-pubic catheters, indwelling catheters, colostomy bags, and tracheostomy tubes. Design Retrospective chart review of patients with chronic SCI using invasive appliances who had also undergone skilled aquatic therapy. Results 49 patients with traumatic SCI spinal cord injuries demonstrated scores showing statistically significant improvement using their total mobility and self-care of SCIM III (p-values ≤0.021, 0.039, 0.021) scores. 45 patients with traumatic SCI demonstrated significant improvement of AIS motor scores (p-value ≤0.002) and 9 patients with traumatic SCI walked longer distance in 6MWT (p-value ≤0.011). SCIM III efficiency of 0.26 per hour (95% CI=0.037-0.475). There was one reported unplanned bowel evacuation that occurred but did not prevent future therapy. All patients successfully completed aquatic therapy. Conclusion SCI patients with various invasive appliances can safely participate in specialized aquatic therapy without complications and appear to achieve clinically significant benefits. We recommend that SCI rehabilitation centers seek out and connect with opportunities for aquatic therapy within their institutions and communities. Correspondence: All correspondence and requests for reprints should be addressed to Albert C. Recio, MD, International Center for Spinal Cord Injury, Kennedy Krieger Institute Outpatient Center, 801 N. Broadway, Baltimore, MD 21205 Conflict of Interest and Disclosures: Albert C. Recio, Eva Kubrova and Steven A. Stiens, have no disclosures to declare. This article does not contain any studies with human or animal subjects performed by any of the authors and written patient consent forms have been collected. This material is original and has not been presented previously. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was conducted with the approval of the Johns Hopkins Medicine institutional review board reference number IRB00103188: AQUA-Aquatics, Quantify, Understand, Analyze. What is Known Water, the major ingredient within the body and the predominant substance covering the Earth, long known to provide healing benefits from its inherent properties (buoyancy, resistance, compression, and energy transmission) has been an underutilized environment of exercise for patients with SCI. What is New This retrospective review of aquatic therapy for chronic SCI patients who utilized invasive devices showed it could be safe and effective. With therapeutic pools at many rehabilitation centers, community pools and multiple water recreation activities now accessible to people with disabilities, patients utilizing invasive devices ought not to be excluded and should be encouraged to participate. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Ultrasound Imaging for Painful Lipomatosis: Cutaneous Nerves Really Matter! No abstract available

A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors Following Curative-Intent Treatment Objective The cost-effectiveness of exercise interventions in lung cancer survivors is unknown. We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors. Design We used Markov modeling to simulate the impact of the Lifestyle Interventions and Independence for Elders (LIFE) exercise intervention compared to usual care for stage I-IIIA lung cancer survivors following curative-intent treatment. We calculated and considered incremental cost-effectiveness ratios (ICERs) <$100,000/quality-adjusted life-year (QALY) as cost-effective and assessed model uncertainty using sensitivity analyses. Results The base-case model showed that the LIFE exercise program would increase overall cost by $4,740 and effectiveness by 0.06 QALYs compared to usual care and have an ICER of $79,504/QALY. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of $100,000/QALY, LIFE had a 71% probability of being cost-effective compared to 27% for usual care. When we included opportunity costs, LIFE had an ICER of $179,774/QALY, exceeding the cost-effectiveness threshold. Conclusions A simulation of the LIFE exercise intervention in lung cancer survivors demonstrates cost-effectiveness from an organization but not societal perspective. A similar exercise program for lung cancer survivors may be cost-effective. Correspondence:Scott M. Lippman, MD; 9500 Gilman Drive, MC 0658; La Jolla, CA 92093; Telephone: 858-822-1222; Email: slippman@ucsd.edu. Author Disclosures: a) Conflict of Interest: All authors declare no conflict of interest exists b) Funding: This work was supported by the National Institutes of Health (L30CA208950 and 1T32HL134632-01); and the American Cancer Society (PF-17-020-01-CPPB). c) Financial Benefits to Authors: none d) Previous manuscript: A pre-print version of this manuscript is available at https://www.biorxiv.org/content/10.1101/533281v1 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.