I realize this makes 2 cases today. I’ll lay off for a few days after this one.
Patient describes progressive heaviness sensation and weakness when walking. It’s interfering with his quality of life. We’ve done L spine and left Hip MR examinations and the only thing I see is psoas atrophy. The hip was done a week ago and to be honest, I didn’t see the psoas finding until I went back to look because of today’s Lumbar exam. No mass lesion along the rami of L1 and L2 identified and no MR evidence of inflammation. I just spoke with the orthopedist and the patient has not had any abdominal or hip region surgery and no other history. I found a nice pertinent article by Adam Zoga with the reference below. Also I thought maybe there is a lumbar plexus equivalent of Brachial plexitis, Parsonage Turner type of syndrome to explain it and found the abstract reproduced below. According to the article, it is characterized primarily by pain along with neurological deficits. Pain isn’t a feature of this patient’s presentation.
I told the orthopedist that I would submit to OCAD. Have you seen this before? What else could do it? Maybe like the teres minor in the shoulder, just happens?
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Zoga, A, Hobbs, G, Chi, A, Long, S, Meyers, W, Morrison, W, Psoas Muscle Atrophy in Patients with Ipsilateral Groin Pain: Is there an Association with Prior Hip Surgery and Why?. Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 – December 6, 2013 ,Chicago IL. archive.rsna.org/2013/13021138.html Accessed November 17, 2020
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[Idiopathic lumbosacral plexopathy]
[Article in French]
P Seror<pubmed.ncbi.nlm.nih.gov/?term=Seror+P&cauthor_id=16097208> 1<pubmed.ncbi.nlm.nih.gov/16097208/#affiliation-1>, T Maisonobe<pubmed.ncbi.nlm.nih.gov/?term=Maisonobe+T&cauthor_id=16097208>, K Viala<pubmed.ncbi.nlm.nih.gov/?term=Viala+K&cauthor_id=16097208>, P Bouche<pubmed.ncbi.nlm.nih.gov/?term=Bouche+P&cauthor_id=16097208>
Affiliations expand
* PMID: 16097208
* DOI: 10.1016/s0755-4982(05)84063-1<doi.org/10.1016/s0755-4982(05)84063-1>
Abstract
Introduction: Lumbosacral plexopathy is the equivalent in the lower limbs of neuralgic amyotrophy (also known as Parsonage-Turner syndrome) in the upper limbs. It is well-known in patients with diabetes mellitus, when it is known as Bruns-Garland syndrome.
Case: We report the case of a 47-year-old woman who developed a unilateral neuropathy of the leg, neither radicular nor truncal in origin. The slow continuous improvement was not affected by any of the treatments administered.
Discussion: Lumbosacral plexopathy is characterized by intense pain in one or both legs, associated with motor and sensory deficits. Recovery is usually slow (6 to 36 months) and often incomplete. The electrodiagnostic examination shows important acute motor and sensory axonal loss, characterized by denervation and low-amplitude sensory action potential. Treatment generally combines analgesics with narcotic agents, neuropathic pain medication, short-term corticosteroids, and rehabilitation. In the most severe cases, long-term corticosteroids and other immunosuppressive agents may be required. This diagnosis cannot be reached until all other radicular, plexal and truncal origins have been ruled out.
Phillip Tirman
