The purpose of this study was to evaluate radiographically the effects of cervical bracing upon swallowing thin liquids and solid food in normal adults under three cervical bracing conditions. This was a prospective, repeated measures design study. Seventeen healthy adult volunteers between the ages of 30 and 50 were recruited from hospital staff. All subjects reported no previous history of swallowing difficulty or diseases that might affect swallowing. Subjects were radiographically observed swallowing thin liquids and solid food without cervical bracing and with three common cervical orthoses (Philadelphia collar, SOMI, and halo-vest brace). Order of bracing and type of bolus were randomized. Changes in swallowing function (point of initiation of swallow response, presence of pharyngeal residue, airway penetration, hyoid bone movement, diameter of oropharyngeal airway, and durational measurements) were analyzed by two independent raters. Eighty-two percent (14/17) of the subjects demonstrated radiographic changes under one or more of the bracing conditions. Forty-seven percent (8/17) of subjects demonstrated changes with point of initiation of the swallow response, 59% (10/17) demonstrated increased pharyngeal residue, and 23.5% (4/17) demonstrated changes with bolus flow with laryngeal penetration present. Aspiration did not occur under any of the bracing conditions. Changes noted in durational measurements for oral containment and total pharyngeal transit under the bracing conditions were not considered statistically significant. This study shows that cervical bracing does change swallowing physiology in normal healthy adults.

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A 47-year-old African American woman with no significant past medical history presented to the Emergency Department (ED) with right buttock pain one month after slipping on her porch, landing directly on her buttocks. She had been seen in the same ED one week prior. At that time imaging revealed a resolving hematoma over the right gluteal region but no bony abnormalities of the pelvis or femur. The pain was localized, sharp, and constant but worsened with ambulation, severely limiting her mobility over the prior ten days. She denied any left sided, constitutional, bowel or bladder symptoms. Her musculoskeletal and neurological examination was normal except for tenderness over the right gluteal region and weakness in right hip abduction and extension (MRC 4/5). Setting: Tertiary care hospital. Results or Clinical Course: EMG was ordered and revealed an isolated inferior gluteal nerve neuropathy with evidence of re innervation. The patient was discharged from the ED with a prescription for physical therapy and follow up with Physical Medicine and Rehabilitation. Discussion: The inferior gluteal nerve originates from the lumbosacral plexus and passes through the greater sciatic foramen inferior to the piriformis muscle. Inferior gluteal neuropathy is a rarely reported but recognized complication of the posterior approach to hip arthroplasty. It is also subject to injury by compression and ischemia in sedentary individuals and following penetrating trauma. This case demonstrates a unique cause of an isolated inferior gluteal neuropathy from hematoma which can be missed as occurred with this patient on her first visit to the ED. Furthermore, diagnostic imaging of peripheral nerves in the hip is challenging due to the complex regional anatomy. For this reason, electro-diagnostics can be a valuable tool to localize the injury and provide prognosis as seen in this case. Conclusion: The inferior gluteal nerve's position makes it vulnerable to injury during hip arthroplasty, prolonged compression, ischemia and penetrating trauma. This case illustrates that inferior gluteal neuropathy can also result from a hematoma and this should be could considered in the differential when examining patients.

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