strengthening and gait training. On postoperative day 3, she wasadmitted to acute inpatient rehabilitation. She demonstrated de-creased balance with gait secondary to quadriceps weakness. After10 days of therapy, she achieved modified independence withtransfers and ambulation by using a rolling walker.Setting: A tertiary care hospital.Results: At 6 weeks after surgery, electromyography and nerveconduction studies revealed axonal injury to the femoral nervesbilaterally. At 12 weeks after surgery, the patient noted significantimprovement in her lower extremity strength. Hip flexion was 4�/5bilaterally, right knee extension was 4�/5, and left knee extensionwas 4/5. She progressed to ambulation by using a cane in thecommunity.Discussion: Lithotomy positioning can lead to bilateral femoralneuropathy due to prolonged hip flexion, extreme hip abduction,and external rotation. This position may not only compress thefemoral nerve but also stretch it beneath the inguinal ligament,which results in demyelinating or axonal nerve injuries. This com-plication may be prevented by modifying posture and decreasingoperating time.Conclusions: Bilateral femoral neuropathy is a rare complicationof prolonged surgery in the lithotomy position. Clinicians shouldtimely recognize this condition and promptly initiate a comprehen-sive rehabilitation program to address the significant functionalimpairments and associated psychological stress.

Poster 185Miller Fisher Variant of Guillain-Barré SyndromeWith an Unusual Presentation: A Case Report.Lisa R. Kroopf, MD (Loma Linda University MedicalCenter, Loma Linda, CA, United States); Murray Brand-stater, MD, Menandro Cunanan, MD.

Disclosures: L. R. Kroopf, none.Patients or Programs: A 64-year-old man with hypertensionand diabetes mellitus.Program Description: The patient presented with blurred vi-sion, bilateral hand numbness, unsteady gait, dysarthria, and dys-phagia for several days. He was unable to stand up unassisted. Theinitial diagnosis was a small brainstem stroke although brain mag-netic resonance imaging was normal. The patient was transferred tothe acute rehabilitation unit for stroke rehabilitation 8 days afterinitial presentation. The physical examination was notable for slightdysarthria, nystagmus, diplopia, ptosis of the right eye, and ataxia.There was no motor weakness, and deep tendon reflexes weresymmetric and normal. The patient progressed poorly. He hadsevere truncal ataxia. On the fourth day of admission, he fell fromhis wheelchair and sustained a head injury. He was transferred tothe acute medical ward for further workup.Setting: Veterans Affairs inpatient rehabilitation center.Results: Three weeks later, the patient was readmitted to the acuterehabilitation unit. He had undergone a full neurologic workup andwas now diagnosed with Miller Fisher variant of Guillain-Barrésyndrome. Ganglioside GQ1b auto antibody test was positive, andcerebrospinal fluid showed high protein levels without white cells,features indicative of Guillain-Barré syndrome. A nerve conductiontest was nondiagnostic, with mild abnormalities. Intravenous im-munoglobulins were not administered.Discussion: Miller Fisher syndrome is a rare clinical variant ofGuillain-Barré syndrome, an acute inflammatory polyneuropathy,

and a diagnosis of this variant may be difficult. It typically presentswith ataxia, ophthalmoplegia, and areflexia, and there may beoropharyngeal weakness. Anti-GQ1b antiganglioside antibodies arepresent in 90% of cases.Conclusions: Patients usually show significant improvement inneurologic function within several weeks after diagnosis and fullneurologic recovery in approximately 10 weeks. It is important toconfirm the diagnosis because of the expected good recovery andbecause this gives therapists the opportunity to create a customizedrehabilitation program to address the patient’s specific deficits.

Poster 186Avulsion of the Adductor Muscle at the SymphysisPubis Diagnosed With Ultrasound: A Case Report.David J. Chen, MD (University of Pennsylvania, Philadel-phia, PA, United States); Franklin E. Caldera, DO, MBA,Woojin Kim, MD.

Disclosures: D. J. Chen, none.Patients or Programs: A 58-year-old woman with obstructivesleep apnea and hyperlipidemia, presented to the clinic with left hipand left groin pain for 1 month, which began after taking a misstep.Program Description: We describe the use of ultrasound indiagnosing an avulsion tear at the insertion of the adductor musclesat the symphysis pubis, predominantly involving the adductorlongus and brevis muscles.Setting: Tertiary care academic teaching hospital.Results: The patient ultimately was treated conservatively withnonsteroidal anti-inflammatory drugs for pain control, and physicaltherapy for muscle strengthening and balance improvement, andsubsequently did well on follow-up.Discussion: The long adductor, short adductor, and gracilis mus-cles insert into the symphysis pubis and inferior pubic ramus.Avulsion injuries have previously been described at the symphysispubis, with patients experiencing pain localizing to the groin. It ismost common in adolescent athletes, and commonly mistaken formuscle or tendon injuries. The differential diagnosis of such chronicavulsion injury also includes infection or sarcomas. The standardtreatment includes conservative measures, with rest and limitedweight-bearing status for several weeks. The accepted method ofdiagnosis includes reviewing the history; physical examination; andradiologic imaging, such as the use of bone scans (which willdemonstrate increased linear uptake) and the use of magnetic reso-nance (can have findings of bone marrow edema with enhancingperiostitis).Conclusions: The use of ultrasound can be helpful in the diag-nosis of avulsion tear at the insertion of the adductor muscles, aswell as adductor insertion avulsion syndrome at the symphysispubis. Sonography is becoming an increasingly used imaging mo-dality in evaluating the musculoskeletal system because of its por-tability, absence of ionizing radiation, and relatively low cost com-pared with other cross-sectional imaging modalities.

Poster 187Groin Pain Can Be Quite Painful With the WrongDiagnosis: A Case Report.Sebastian Klisiewicz, DO (MCW, Wauwatosa, WI, UnitedStates); Thomas Kotsonis, MD.

Disclosures: S. Klisiewicz, none.

S234 PRESENTATIONS