Results: Electroneurography 5 days post-admission: upperand lower limb delayed motor distal latencies, slow conduc-tion velocities, low compound muscle action potential(CMAP) amplitudes and universal absence of sensory actionpotentials (SNAP). Electromyography (EMG)-added follow-ups at 2 and 4 months: left peroneal and tibial CMAP ampli-tude major new drop in first, total loss in second, with noresponse in foot/toes dorsiflexors to peroneal nerve, verysmall response in plantarflexors to tibial nerve knee level, anddirect to muscles up-to 500-�s duration supramaximal stim-ulations. Findings static in remaining nerves. Initial EMG:marked proximal and distal denervation potentials in bothlegs, somewhat worse proximally and on the left, reduced butstill fair number motor unit (MU) recruitment; normal inarms. Second EMG: persistent florid denervation activity,very few or no MU recruitment in left leg, in contrast todenervation potentials decline and MU recruitment gain inthe right.Discussion: WNV neuropathy is known as an asymmetricmotor neuronopathy of variable distribution and recoverycourse quite like polio. Also reported, a demyelinating vari-ant. This case may be the first with electrodiagnostic evidenceof one limb MU loss progression over 4 months, whileexpected gradual recovery is proceeding in contralateral one.Given its one-extremity limitation and deterioration speed,diabetes should be playing no role, while explaining theabsent SNAPs.Conclusions: WNV neuropathy can show localized sub-acute progression.Keywords: Rehabilitation, West Nile virus, Paraparesis,Neuropathy.

Poster 95

Suprascapular Neuropathy at theSuprascapular Notch in a 27-year-Old Soldier:A Case Report.Ankur Mehta, DO (Loyola University Medical Cen-ter, Maywood, IL); Sung Ahn, DO.

Disclosures: A. Mehta, None.Patients or Programs: A 27-year-old, 6'4" healthy malesoldier with suprascapular neuropathy at the suprascapularnotch.Program Description: The patient presents with chroniclocalized shoulder pain with acute exacerbation. Was re-ferred from emergency department after 3 visits within 10days for shoulder pain. He was deployed to Middle East for 2tours totaling 20 months. He wore 25 pounds of armor for upto 12 hours per day or a 40-pound one-size-fits-all rucksack.During deployment he had severe intermittent shoulderpain, resolved with rest, he denies parasthesias. Pain is lan-cinating, sharp, interferes with sleep and job. Examinationreveals atrophy of the left supraspinatus and infraspinatusmuscles. Motor examination is normal except for left shoul-der external rotation and abduction weakness. Reflex andsensory examinations are normal; range of motion is limiteddue to weakness and pain. MRI revealed no cystic or mass

lesion at suprascapular notch. Nerve conduction studies(NCS) revealed a low compound muscle action potential ofthe left suprascapular nerve. Electromyography (EMG)showed fibrillation potentials in the supra- and infraspinatusmuscles with large motor units. Study shows left suprascap-ular neuropathy at the suprascapular notch with no evidenceof brachial plexopathy.Setting: Veterans Affairs Hospital.Results: Atraumatic suprascapular neuropathy at the su-prascapular notch.Discussion: Physiatrists are seeing a growing number ofpost-combat soldiers who must wear heavy armor and ruck-sack. Risk factors for suprascapular neuropathy in the soldierpopulation are the force and duration of load on shouldersand compatibility of equipment ergonomics with physique.This the first case to our knowledge of unilateral suprascap-ular nerve impingement after carrying a rucksack and wear-ing armor in the military population. Even though EMGshows suprascapular neuropathy, brachial plexopathyshould remain in the differential.Conclusions: Suprascapular neuropathy should be part ofthe differential diagnosis in shoulder pain especially in mili-tary populations and those wearing shoulder packs. NCS/EMG and MRI can be used to assist in the diagnosis ofsuprascapular neuropathy. Proper rucksack and armor ergo-nomics could prevent suprascapular neuropathy.Keywords: Rehabilitation, Electromyography, Brachialplexopathy, Suprascapular neuropathy.

Poster 96

Ultrasonography to Assess an Isolated SuralNeuropathy Due to a Ganglion Cyst: A CaseReport.Jeffrey A. Strakowski, MD (The McConnell Spine,Sport & Joint Center, Columbus, OH); Ernest W.Johnson, MD; Brian R. Kincaid; Ali A. Shah, MD.

Disclosures: J. A. Strakowski, None.Patients or Programs: A 45-year-old man with left lateralfoot numbness.Program Description: The patient presented to theclinic with a 3-month history of isolated numbness and mildpain involving the left distal lateral ankle and lateral foot. Hehad no history of trauma, unusual compression or knownpredisposing medical conditions. His clinical examinationrevealed decreased sensation in a left distal sural distributionand mild tenderness above the lateral malleolus with no otherabnormalities noted. Electrodiagnostic studies showed anabsent left sural sensory nerve action potential with a normalcomparison study on the right and the remainder of thetesting unremarkable. Imaging with high-frequency ultra-sound was performed for further assessment.Setting: Outpatient clinic.Results: The ultrasound study revealed a large anechoicsignal consistent with a ganglion cyst adjacent to the rightsural nerve, with compression of the nerve at that site and

S145PM&R Vol. 1, Iss. 9S, 2009