Working Diagnosis:
Post-polio Syndrome

Treatment:
Patient was diagnosed with postpolio syndrome from her electromyography findings. Her goal was to improve pain and to return to ambulation. Her multidisciplinary care team initiated a treatment plan involving regular physical therapy and obtaining a new ankle-foot-orthotic for her foot drop.

Outcome:
Since her diagnosis one year ago, the patient has been regularly following with physical therapy and has seen improvements in her pain, strength, and ambulation. She obtained an appropriate ankle-foot-orthotic for her foot drop. Follow up was focused on clinical function and no further imaging, repeat electromyography studies, or specialist referrals have been pursued. The patient has resumed ambulation and has increased her day-to-day activity. We anticipate further improvement.

Author's Comments:
Post-polio syndrome (PPS) is a neurological disorder that affects patients who have had polio, and is characterized by new or worsening muscle weakness, abnormal muscle fatigability, pain, and functional decline (1-4). Typically, there is a prolonged period of neurological stability after initial poliomyelitis, and then PPS presents years-decades afterwards. Diagnosis is based on clinical criteria and the exclusion of other disorders (1). Evidence supporting the efficacy of specific treatments is limited (2). Most patients continue activity and do physical therapy to promote muscle reinnervation (2). This patient likely had prior poliomyelitis given her weakness from a young age with preserved sensory function and prior residence in a polio-endemic area. This case serves as an illustration of post-polio syndrome and highlights the importance of considering neurologic causes of musculoskeletal complaints.

Editor's Comments:
This case illustrates the importance of obtaining a social history from patients and considering the medical challenges faced by refugees. As the author stated, this case is a good example of a neurologic condition presenting with a musculoskeletal complaint. Post-polio syndrome typically occurs years after the poliomyelitis infection and presents with pain, muscle weakness and/or fatiguability (3). Treatment is multimodal and includes physical therapy, adaptive equipment and mobility aids (3).

References:
1. Gonzalez H, Olsson T, Borg K. Management of postpolio syndrome. Lancet Neurol. 2010;9(6):634-642. doi:10.1016/S1474-4422(10)70095-8
2. Koopman FS, Beelen A, Gilhus NE, de Visser M, Nollet F. Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2015;2015(5):CD007818. Published 2015 May 18. doi:10.1002/14651858.CD007818.pub3
3. Lo JK, Robinson LR. Postpolio syndrome and the late effects of poliomyelitis. Part 1. pathogenesis, biomechanical considerations, diagnosis, and investigations. Muscle Nerve. 2018;58(6):751-759. doi:10.1002/mus.26168
4. Lo JK, Robinson LR. Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis. Muscle Nerve. 2018;58(6):760-769. doi:10.1002/mus.26167

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