Leg Weakness In A Professional Diver - Page #4
 

Working Diagnosis:
The patient was diagnosed with a left Femoral Nerve Entrapment secondary to prolonged left sided hip flexion.

Treatment:
The patient was enrolled in aggressive physical therapy with twice weekly sessions focused on increasing her leg strength by climbing and lifting. She was enrolled for ten months.

Outcome:
The patient regained her strength with physical therapy focused on weight lifting and ladder climbing. She was re-evaluated with an EMG eight months after her initial presentation, which showed evidence of substantial re-innervation of the left femoral nerve innervated muscles. The fibrillations on initial EMG due to the femoral neuropathy had resolved. These results were consistent with her improved strength.

Editor's Comments:
In a patient with sensory or motor symptoms that are not explained by pathology noted on MRI of the spine, an EMG is a necessary tool to diagnose peripheral neuropathy. In some cases, the EMG may be normal if performed less than 6 weeks from onset. Therefore the clinician should consider repeating the EMG if initially negative and obtained less than 6 weeks from injury.

This case also highlights the need for position changes and/or rest from flexion of the legs during labor to prevent a neuropathy.

References:
1. Stewart JD. Other mononeuropathies of the lower limb. In: Neuromuscular Function and Disease, 1st edition, Brown WF, Bolton CF, Aminoff MJ (Eds), WB Saunders Company, Philadelphia 2002. Vol 1, p.1004.
2. Wong CA, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 2003; 101:279.
3. Kuntzer T, et al. Clinical and prognostic features in unilateral femoral neuropathies. Muscle Nerve 1997; 20:205.
4. Meadows JR, Finnoff JT. Lower extremity nerve entrapments in athletes. Curr Sports Med Rep. 2014;13(5):299-306.

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