The patient continued on toe-touch weight bearing until she was asymptomatic with passive range of motion. Assessment/Results: The patient received relief of her pain with the sympathetic blocks, yet discoloration and cool temperature were still present. Subsequent MRI performed 4 and 6 months after the onset of the fracture continued to show bone healing. Orthopedic surgery deferred surgical evaluation because the stress fracture was healing on the second MRI and in the setting of her complications. She remains mildly symptomatic on passive rangle of motion of the hip. Warfarin treatment is being re-evaluated at 6 months. Conclusions: DVT and CRPS are unusual complications of a femoral neck stress fracture and its treatment. This patient improved with treatments including physical modalities, exer- cise, and sympathetic blocks. Key Words: Deep vein thrombosis; Rehabilitation; Stress fractures. Poster 119 Conservative Management of a Patient With an Unusually Large Post-Partum Pubic Symphysis Diastasis: A Case Report. Marek Kurowski, MD (Albert Einstein College of Medicine, New York, NY). Disclosure: M. Kurowski, none. Setting: Tertiary care hospital. Patient: A 39-year-old woman 2 days after a 7-hour vaginal delivery of her 8lb, 14oz third child, using an epidural anesthesia. Case Description: The patient complained of post-partum pubic and low back pain associated with movement of her legs, and inability to transfer and ambulate. The delivery was compli- cated by infant shoulder dystocia with subsequent Erb’s palsy. On physical examination, the patient had tenderness over her perineum, pubic, and sacroiliac joints bilaterally with no vaginal lacerations observed. Wide pubic separation was readily palpable. Reflexes were symmetrical and no sensory deficits were noted. X-rays demonstrated a significant 50mm pubic symphysis diastasis and accompanying 7mm left sacroiliac joint separation. Assessment/Results: Initially, the pa- tient remained in the semi-recumbent position with her legs at 70° of abduction for comfort. Gradually, she was able to adduct her legs, ambulate with a walker, and participate in a gentle physical therapy program while wearing a pelvic stabilizing belt/binder by the eighth day following delivery. Within 2 weeks, the patient was discharged home with a walker and follow up for physical therapy. Discussion: The reported incidence of peripartum pubic separation varies from 1 in 300 to 1 in 30,000 deliveries. Minor separation of the symphysis pubis during pregnancy is physiological. Separations of more than 10mm are usually pathologic and associated with painful ambulation. Interpubic gap confirms diagnosis but does not predict outcome. Few pubic symphysis diastasis of this size have been reported in medical litera- ture and there are no clear guidelines for conservative versus surgical management. Radiological images are presented. Conclusions: Even a severe, vaginal delivery-induced pubic symphysis diastasis with ac- companying sacroiliac joint separation can be successfully managed without strict, prolonged bed rest or surgical intervention. Key Words: Puerperal disorders; Rehabilitation. Poster 120 Crowned Dens Syndrome: A Case Report. Peter Bailey, MD (Mayo Clinic, Rochester, MN); Lester Mertz, MD; Stephen F. Noll, MD. Disclosure: P. Bailey, none; L. Mertz, none; S.F. Noll, none. Setting: Tertiary care hospital. Patients: 82-year-old man with acute onset neck pain. Assessment/Results: An 82-year-old man with history of myelodysplastic syndrome and diabetes presented with acute onset of neck pain 4 days prior to initial evaluation. He was seen in the emergency department and then by his primary care provider. Working diagnosis included neck strain or disk herniation and he was treated with a trigger point injection, muscle relaxant, and oral nar- cotics. He eventually required hospital admission for intractable pain. His workup revealed an elevated ESR and a magnetic resonance imaging which showed retropharyngeal soft tissue edema concerning for hemorrhage or infection. Computed tomography (CT)-guided as- piration was negative. He was referred to physical medicine and rehabilitation for further evaluation. Physical exam showed limited, painful cervical range of motion (ROM) and pain with palpation and ROM of the left shoulder, right wrist, and right knee. An inflammatory arthropathy was suspected and rheumatology department was con- sulted. ESR was elevated and aspiration of the right knee showed positively birefringent crystals under polarized light. Review of the cervical CT scan revealed calcification of the transverse ligament of the atlas consistent with Crowned Dens syndrome which is typically caused by calcium pyrophosphate dihydrate deposition disease (CPPD or pseudogout). The patient improved readily with oral steroid therapy. Conclusions: Crowned Dens syndrome is an uncommon, or probably under-reported, cause of acute neck pain. It may be more prevalent in those with concomitant CPPD affecting other joints. As in this case, the diagnosis may be elusive, mimicking other causes such as radic- ulopathy, neck strain, or infection. The onset of pain may be acute and severe, commonly affecting older and female patients. Evaluation should include a comprehensive physical exam with attention to cer- vical rotational ROM. Identification of inflammatory markers, cervical CT showing crescentic calcification posterior to the dens, plain films of other involved joints, and synovial fluid analysis showing positively birefringent crystals, helps confirm the diagnosis. Treatment with nonsteroidal anti-inflammatory drugs or corticosteroids is usually suc- cessful. Thorough evaluation is necessary as complications may be disabling. Key Words: Calcium pyrophosphate dihydrate deposition; Neck pain; Rehabilitation. Poster 121 Decreased Primary Afferents Effect Proprioception in an Area Proximal to the Site of Injury. Dennis E. Enix, DC, MBA (Logan University, Chesterfield, MO); Kristan Giggey, DC, MPHc; David V. Lenihan, DC, PhD. Disclosure: D.E. Enix, none; K. Giggey, none; D.V. Lenihan, none. Objective: This study investigates whether proprioceptive deficits in the cervical spine are associated with the loss of primary afferents from injuries peripheral to the cervical spine. Design: A cross sec- tional descriptive study. Setting: University research laboratory. Par- ticipants: 41 healthy participants assigned to groups with either a history of multiple grade 2/3 inversion ankle sprains (n=21) or a control group (n=20). Interventions: Not applicable. Main Outcome Measures: Proprioception was determined by measuring the absolute angular error during passive and active joint angle repositioning in cervical spine flexion and rotation at 15°, 30°, and 45°. Results: The loss of primary afferents commonly seen in ankle injuries have a cumulative negative effect on proprioception in the cervical spine. In participants with an injury to only 1 ankle, the absolute angular error of cervical rotation was greater on the side of injury 69.7% of the time, the mean  SD for participants with 1 ankle injury is equal to 6.4615.120 compared to the noninjured side equal to 4.8523.807 (t=4.61, P=0.001). Secondly, participants with injuries to both ankles showed greater increases in the absolute angular error of cervical flexion, mean  SD for injuries to both ankles is equal to 5.8324.529 compared to participants with only 1 ankle injured is equal to 4.751 .418, (t=2.052) (P=0.041). All tests in cervical flexion and rotation at 15°, 30°, and 45° showed similar trends toward angular error with the exception of right rotation at 45°, which showed only mild differences between groups. Conclusions: Injuries to an extremity alter proprio- E59 ACADEMY ANNUAL ASSEMBLY ABSTRACTS Arch Phys Med Rehabil Vol 89, November 2008