In a cadaveric model, ultrasound-guided PTS injections are significantly more accurate than palpation-guided injections. When performing PTS injections, clinicians should consider ultrasound guidance to improve injection accuracy and minimize potential complications such as intratendinous injection.

Posterior alien hand syndrome is a new addition to a poorly understood group of movement disorders. Historically, anatomical lesions causing uncontrolled limb movement and a feeling of foreignness were found to be located in the corpus callosum or frontal lobe. Recent case reports, however, demonstrate the typical symptoms of alien hand syndrome with lesions located in the parietal/occipital lobes. Disturbance of normal function in these regions tends to produce less complex motor activity, such as hand levitation, along with a sensory component characterized by feeling of estrangement. We discuss a patient who presented with unusual symptoms following an outpatient procedure and was found to have posterior alien hand syndrome.

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Ultrasound guidance does not appear to be indicated for routine deep or superficial posterior leg compartment pressure testing. However, this does not preclude the need for ultrasound guidance in selected clinical scenarios.

Cauda equina syndrome is a well described state of neurologic compromise due to lumbosacral root compression. In most cases, it is due to a herniated disc, tumor, infection, or hematoma. We report a case of rapid lumbar synovial cyst expansion leading to acute cauda equina syndrome and compare it to similar cases in the literature. The patient is a 49-year-old woman with a history of chronic low back pain who developed cauda equina syndrome. Serial lumbar magnetic resonance imaging studies demonstrated a significant increase in the size of a lumbar synovial cyst over a 2 week interval. After an unsuccessful attempt to relieve her acute symptoms with computed tomography-guided cyst aspiration, an L4-5 posterior spinal decompression with excision of the synovial cyst was performed. Postoperatively the patient’s perineal numbness, bladder incontinence, and associated pain complaints resolved. The only residual symptom at one month follow-up was continued numbness in the right lower limb in an L5 distribution. This report adds to 6 other well described similar cases found in the literature by illustrating several important points. First, a lumbar synovial cyst is a rare but possible cause of acute cauda equina syndrome. Second, magnetic resonance imaging is the test of choice to diagnose and characterize lumbar synovial cysts; serial imaging can detect fluctuations in cyst size. Third, percutaneous treatment of lumbar synovial cysts is variable in efficacy and proved to be unsuccessful in our patient. Finally, surgical management has shown high success rates for symptomatic cysts. Specifically, in the setting of acute cauda equina syndrome secondary to a lumbar synovial cyst, urgent surgical decompression has led to resolution of neurologic symptoms in most reported cases. A lumbar synovial cyst is an uncommon cause of acute cauda equina syndrome. Prompt diagnosis and treatment may lead to reduced morbidity associated with this condition. Key words: Acute pain, cauda equina syndrome, lumbar, polyradiculopathy, synovial cyst, zygapophyseal joint

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Results: Participants rated the system technically acceptable, clinically appropriate, operationally effective, safe, and comfortable. The games ranged in levels of engagement (5-10), difficulty, (3-10), and competitiveness (0-10). Recordings from the sensors confirmed the scores given by the participants. A higher range of motion activity was present during games that were described as challenging and engaging. Discussion: Postburn joint contractures are common, difficult to treat, and negatively impact quality of life and function. Gaming and virtual reality have been explored in burn wound care management, but there is a paucity of data regarding its use in rehabilitation therapy interventions. There is a clinical need for novel treatment approaches to this important problem. Conclusions: Our novel gaming system is feasible for use in the burn population for upper extremity range of motion therapy. Future analysis will evaluate the efficacy of this intervention in treating upper extremity burn contractures. Disclosures: H. M. Curtiss, none. Objective: To evaluate the accuracy of ultrasound-guided and palpation-guided knee injections by an experienced and a less-experienced clinician by using a superolateral approach. Design: A single-blinded, prospective study. Setting: Academic institution procedural skills laboratory. Participants: Twenty cadaveric knee specimens without trauma, surgery, or major deformity. Interventions: Each specimen received an ultrasound (US) guided and palpation-guided knee injection by an experienced and a less-experienced clinician with colored liquid latex by using a superolateral approach. The injection order was randomized. The specimens were subsequently dissected by a blinded investigator and assessed for accuracy. Main Outcome Measures: Accuracy was divided into 3 categories: (1) accurate (all of the injectate within the joint), (2) partially accurate (some of the injectate within the joint and some within the periarticular tissues), and (3) inaccurate (none of the injectate within the joint). The accuracy rates were calculated for each clinician and guidance method. Results: US-guided knee injections by using a superolateral approach were 100% accurate for both clinicians. Palpation-guided knee injections by using a superolateral approach were significantly influenced by experience with the less-experienced investigator demonstrating an accuracy rate of 55% (95% confidence interval, 34%-74%), whereas the more experienced investigator's accuracy rate was 100% (95% confidence interval, 81%-100%). Conclusions: US-guided knee injections by using a superolateral approach are very accurate in a cadaveric model, whereas the accuracy of palpation-guided knee injections by using the same approach is variable and appears to be significantly influenced by clinician experience. These findings suggest that US guidance should be considered when performing knee injections with a superolateral approach that requires a high degree of accuracy.