Author: David Ross, MD
Co Author #1: Rahul Kapur, MD
Co Author #2: John Vasudevan, MD
Editor: Michelle Szczepanik, MD
The patient is a 29 year old female professional SCUBA diver who presented with left leg weakness for two months duration.
Her weakness started after a vaginal delivery of her first child with the assistance of a midwife. During the delivery, she was lying on her left side with her hips and knees flexed continuously for four hours. Immediately after delivery, she noticed difficulty with ambulation. She initially sought therapy with a chiropractor, however she had no relief with treatment. The patient described the weakness as a "funny numbness" down the anterior thigh. She had difficulty and fatigue with stair climbing and squatting. She also described decreased sensation in her anteromedial thigh. She denied any hip, leg, knee, or back pain. She was particularly worried about her unsteadiness because of her occupation as a professional diver, which required walking up stairs with a 60-pound oxygen tank and climbing in and out of an aquarium with her equipment.
The patient's initial exam was notable for full range of motion of her lumbar spine, hip and knee joints. She had no bony tenderness or paraspinal tenderness in her lumbar spine. She had decreased sensation to light touch down her anterior thigh to the dorsal foot on her left side. Her strength was 3+/5 with knee extension on left side. The rest of her motor exam was within normal limits. There was no effusion in her knee. There was no defect noted of her distal quadriceps muscle or tendon. She had a negative straight leg raise bilaterally. Her deep tendon reflexes were 2+ bilaterally. Pulses were 2+ bilaterally in her femoral, popliteal, posterior tibial and dorsalis pedis arteries.
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