Stiff Person Syndrome With Evidence of Nonspecific Focal Myositis Secondary to Sustained Muscle Contraction: A Case Report

Stiff person syndrome (SPS) is a rare neuroimmunological disorder characterized by progressive muscular rigidity and spasms that affect axial and limb muscles. There have been a few reports that patients with SPS had evidences of polymyositis. There have been no clear explanations about the characteristics of polymyositis in SPS. We report the case of a 36-year-old woman with SPS in association with nonspecific focal myositis secondary to sustained muscle contraction. She presented with stiffness and pain in her extremities, and diazepam and baclofen were ineffective. With immunotherapy, her serum creatinine kinase levels reduced; however, her clinical symptoms progressively worsened.

Transient Hypokalemic Quadriplegia After a Lumbar Transforaminal Epidural Dexamethasone Injection: A Case Report

A 30-year-old man with no significant medical history presented with hypokalemic quadriplegia 4 hours after he received a lumbar transforaminal epidural steroid injection (ESI) containing dexamethasone and lidocaine. A comprehensive workup ruled out acquired and hereditary causes of hypokalemic paralysis. Symptoms gradually resolved within hours after potassium restoration with no residual neurologic deficits. Paralysis after transforaminal ESI is uncommon but has been associated with particulate steroids that can coalesce into aggregates and occlude vessels. To our knowledge, there have been no case reports of paralysis after ESI with dexamethasone, a nonparticulate steroid. This transient paralysis is possibly caused by the effects of glucocorticoids on Na-K channels and insulin resistance resulting in hyperglycemia and subsequent hypokalemia. We reviewed the differential diagnosis of transient paralysis after epidural steroid injection in this report.

Lumbar Intraspinal Spindle Cell Rhabdomyosarcoma as a Rare Cause of Spinal Stenosis: A Case Report

Rhabdomyosarcoma (RMS) represents the most common sarcoma in childhood yet is extremely rare in adults, with only a handful of cases reported. Here we present a case of intraspinal spindle cell RMS in an adult who presented as a typical case of spinal stenosis. To our knowledge, this is the first reported case of lumbar intraspinal spindle cell RMS in an adult patient. Furthermore, RMS phenotypically presents more aggressively in adults compared with children.

Neutropenia as a Complication of Tumefactive Demyelinating Disease: A Case Report

Tumefactive demyelination is an aggressive, localized, generally solitary area of demyelination that often mimics a neoplasm. We present a case of a 13-year-old female patient who presented with sudden-onset progressive hemiplegia and hemianopsia. Magnetic resonance imaging of the brain showed tumefactive demyelination with partial rim of enhancement. During inpatient rehabilitation, she developed myalgias, rash, and abdominal and mouth pain with evidence for severe neutropenia. The neutropenia was determined to be a secondary complication of the tumefactive disease process. This scenario may be concerning in an inpatient rehabilitation setting, as patients share common areas, increasing the risk of acquired infection while neutropenic.

Safety Considerations in Prescription of NSAIDs for Musculoskeletal Pain: A Narrative Review

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for the treatment of painful musculoskeletal conditions. When prescribing oral NSAIDs, clinicians must consider coexisting cardiovascular, cerebrovascular, gastrointestinal, and renal disease because oral NSAIDs are associated with a broad spectrum of adverse effects on these systems. The different safety profiles of NSAIDs can be attributed to differences in the extent to which the drug inhibits cyclo-oxygenase-1 vs -2 and their potential for drug-drug interactions. This narrative review intends to guide the clinician in prescribing oral NSAIDs while taking into consideration these comorbid conditions and drug interactions.

Dynamic Sonographic Visualization of an Occult Posterior Lateral Meniscocapsular Separation: A Case Report

Meniscocapsular separation describes detachment of the meniscus from the knee joint capsule. Diagnosis is challenging with conventional examination and imaging methods. We report a case of an 18-year-old female softball catcher with unrevealing magnetic resonance imaging despite continued left knee locking and discomfort with deep squatting. Meniscocapsular separation was revealed only on dynamic sonographic examination, where knee flexion revealed a 3.1-mm gap that developed between the capsule and peripheral meniscus. Arthroscopy confirmed the sonographic findings, and repair resulted in complete resolution of symptoms. This case highlights the utility of dynamic diagnostic sonography in a rare case of posterior lateral meniscocapsular separation.

Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey

Background

Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted.

Effectiveness of Bilateral Transforaminal Epidural Steroid Injections in Degenerative Lumbar Spinal Stenosis Patients With Neurogenic Claudication: A Case Series

Background

As our population ages, neurogenic claudication (NC) from central canal stenosis of the lumbar spine is becoming an increasingly common condition. Studies have been undertaken to assess the efficacy of caudal, interlaminar, or unilateral transforaminal epidural injections, but bilateral transforaminal epidural injections (BTESIs) have not been evaluated to date.

Leg Pain From Periostitis as the First Clinical Manifestation of Large-Vessel Vasculitis: A Case Report

We report a case of a 47-year-old woman with isolated periostitis of the lower leg as a first manifestation of large-vessel vasculitis. The diagnosis was first suspected when a second magnetic resonance imaging of the lower leg approximately 4 months after onset of shin pain showed edema near intramuscular vessels. Isolated periostitis is a very rare skeletal manifestation of systemic vasculitis and easily could be misdiagnosed. This case demonstrates that maintaining a broad differential diagnosis for a common presenting complaint such as localized leg pain is imperative.

Genicular Radiofrequency Ablation for the Treatment of Post-traumatic Knee Pain: A Case Presentation

This is the first reported case presentation utilizing cooled genicular radiofrequency ablation (C-RFA) for the treatment of post-traumatic knee pain. The patient is a 29-year-old man who sustained open right femoral and tibial fractures following 2 motor vehicle collisions. He was deemed too young to undergo total knee arthroplasty by orthopedic surgery. It was recommended he trial diagnostic genicular nerve blocks followed by C-RFA. The procedure provided a >50% reduction in average pain with an increase in activity tolerance lasting 9 months. In this case, C-RFA of the genicular nerves was a safe, effective, and durable treatment modality for post-traumatic knee pain.

Chronic Thigh Pain in a Young Adult Diagnosed as Synovial Sarcoma: A Case Report

Synovial sarcoma is a slow-growing, intermediate- to high-grade neoplasm with extensive metastatic potential. Accurate diagnosis of synovial sarcoma may pose a challenge to providers because of its indolent growth and variable presentation. The findings of a soft-tissue, periarticular mass with calcifications in a young patient are highly suggestive of synovial sarcoma. Although different imaging modalities can aid in the diagnosis of synovial sarcoma, diagnostic certainty is typically only confirmed by biopsy and histologic analysis. We present a case describing the diagnostic workup of synovial sarcoma with an emphasis on imaging findings in a patient with increasing symptomatology spanning more than a decade.

Ultrasound-Guided Carpal Tunnel Release Using Dynamic Expansion of the Transverse Safe Zone in a Patient With Postpolio Syndrome: A Case Report

The prevalence of carpal tunnel syndrome (CTS) in patients with postpolio syndrome occurs at a rate of 22%. Irrespective of those with CTS, 74% of postpolio patients weight bear through their arms for ambulation or transfers. As open carpal tunnel release is performed along the weight-bearing region of the wrist, their functional independence may be altered while recovering. This case demonstrates that ultrasound-guided carpal tunnel release was successfully performed in a patient with postpolio syndrome allowing him to immediately weight bear through his hands after the procedure so he could recover at home.

Challenging Diagnosis and Inpatient Rehabilitation of Acute Bilateral Neuralgic Amyotrophy Possibly Attributed to Lyme Disease: A Case Report

Neuralgic amyotrophy (NA) is a neurologic syndrome of unknown etiology primarily affecting the brachial plexus. We are reporting an unusual case of acute bilateral NA that was possibly secondary to Lyme disease. The patient demonstrated significant functional gains and was discharged home after 2 weeks of inpatient rehabilitation, supporting the role of inpatient rehabilitation in acute NA. In this report, we discuss the diagnosis, electrodiagnostic progression, pain management, goals for inpatient rehabilitation, and overall prognosis of NA.

Nonoperative Management of a Severe Proximal Rectus Femoris Musculotendinous Injury in a Recreational Athlete: A Case Report

This report describes a severe injury to the proximal rectus femoris (RF) muscle in a 37-year-old recreational athlete. This injury is a relatively rare occurrence in both the general and elite athletic populations. Acute and long-term imaging and functional outcomes are described. This athlete was able to return to full activity without surgical intervention. Follow-up imaging demonstrated gross healing of both complete (or near complete) muscle and tendon tears.

Association of Hip Radiograph Findings With Pain and Function in Patients Presenting With Low Back Pain

Background

Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA.

Amantadine-Induced Corneal Edema in a Pediatric Neuro-Oncology Patient: A Case Report

Amantadine is commonly prescribed as a neurostimulant in patients with brain injuries. This is a case of a 14-year-old male with a history of brain tumor that developed corneal edema after initiation of amantadine, a rare but documented side effect of this medication. After discontinuation of amantadine, the corneal edema resolved within two months, but endothelial cells density remained low.

Transforaminal Epidural Blood Patches for the Treatment of Postsurgical Dural Leaks: Two Case Reports

Unintended dural punctures with leakage of cerebrospinal fluid (CSF) are recognized as a frequent complication of spinal surgery. Although conservative or invasive options may be used to treat postoperative CSF leaks, the existing literature does not define either an algorithmic treatment approach or a universally accepted standard of care. We believe that a transforaminal epidural blood patch (EBP) can serve as a minimally invasive, cost-effective option to treat postsurgical CSF leaks that do not resolve with conservative management. We have performed an EBP via the transforaminal route to treat postsurgical CSF leaks in both the cervical and lumbar spine. The first case describes a patient who underwent an anterior cervical diskectomy and fusion with a complication of profuse CSF leakage. The application of a cervical transforaminal EBP at the levels of surgical repair was effective in stopping the dural leak. The second case involves a patient who experienced classic positional spinal headaches after a lumbar hemilaminectomy and diskectomy. After utilization of lumbar transforaminal EBPs, his symptoms revolved. This article presents the potential use of an EBP via the transforaminal route to treat postsurgical dural leaks in both the cervical and lumbar region.

Case Report: Aquatic Therapy and End-Stage Dementia

A 54-year-old woman, retired due to progressive cognitive decline, was diagnosed with early-onset Alzheimer dementia. Conventional medication therapy for dementia had proven futile. Initial evaluation revealed a nonverbal female seated in a wheelchair, dependent on 2-person assist for all transfers and activities of daily living. She had been either nonresponsive or actively resistive for both activities of daily living and transfers in the 6 months before assessment. After a total of 17 1-hour therapy sessions over 19 weeks in a warm water therapy pool, she achieved the ability to tread water for 15 minutes, transfers improved to moderate-to-maximum assist from seated, and ambulation improved to 1000 feet with minimum-to-moderate assist of 2 persons. Communication increased to appropriate “yes,” “no,” and “okay” appropriate responses, and an occasional “thank you” and “very nice.” The authors propose that her clinical progress may be related to her aquatic therapy intervention.