Location
Philadelphia
Start Date
1-5-2024 1:00 PM
End Date
1-5-2024 4:00 PM
Description
Introduction: The purpose of this research is to describe a patient who presented with double crush syndrome that originally presented with signs and symptoms of a peroneal neuropathy at the fibular head. However, Electromyography (EMG) later confirmed an L5 lumbar radiculopathy. In this case report, we aim to present a rare occurrence which has been recognized, however, very few detailed reports exist.
Case Description: This is a case report of a 77-year-old male farmer who presented to the private practice with complaints of right foot-drop and bilateral low back pain. These symptoms began after falling off a ladder about 2 years ago. The foot-drop was getting worse and the patient had reduced sensation in the dorsum of the right foot in the peroneal innervated distribution. Tibial sensation was intact. On examination, his scores for manual muscle testing (MMT) were as follows: extensor hallucis longus 4, tibialis anterior 4, flexor hallucis longus 5, and gastrocnemius 5. His deep tendon reflexes were normal. X-ray imaging revealed moderate disc degeneration from T9 to S1 and moderate facet arthrosis from L3 to S1. MRI revealed a right disc herniation at L4-5 causing severe foraminal stenosis. EMG was completed and showed a right peroneal neuropathy at the fibular head but could not completely rule out a L5 lumbar radiculopathy. Double crush syndrome was most likely suspected.
Intervention and Results: The patient received bilateral L4-S1 medial branch blocks and right L4 and L5 transforaminal epidural steroid injections. Overall, he reported a 70% reduction in pain. The patient also completed physical therapy which helped his range of motion and strength. The ongoing right foot drop with numbness persisted, however, he is not tripping and has no history of falls.
Discussion: This report discusses a case of double crush syndrome, a diagnosed peroneal neuropathy that was accompanied by an L5 lumbar radiculopathy after EMG was performed. Making the distinction between a radiculopathy and a peripheral neuropathy is important to correctly diagnose because they rarely occur together. This case report emphasizes the importance of completing a thorough history, physical exam, radiographic diagnostic tools, and an EMG to accurately diagnose.
Embargo Period
6-17-2024
Included in
Double Crush Syndrome presenting as Foot Drop due to a Peroneal Neuropathy and an L5 Radiculopathy: A Case Report
Philadelphia
Introduction: The purpose of this research is to describe a patient who presented with double crush syndrome that originally presented with signs and symptoms of a peroneal neuropathy at the fibular head. However, Electromyography (EMG) later confirmed an L5 lumbar radiculopathy. In this case report, we aim to present a rare occurrence which has been recognized, however, very few detailed reports exist.
Case Description: This is a case report of a 77-year-old male farmer who presented to the private practice with complaints of right foot-drop and bilateral low back pain. These symptoms began after falling off a ladder about 2 years ago. The foot-drop was getting worse and the patient had reduced sensation in the dorsum of the right foot in the peroneal innervated distribution. Tibial sensation was intact. On examination, his scores for manual muscle testing (MMT) were as follows: extensor hallucis longus 4, tibialis anterior 4, flexor hallucis longus 5, and gastrocnemius 5. His deep tendon reflexes were normal. X-ray imaging revealed moderate disc degeneration from T9 to S1 and moderate facet arthrosis from L3 to S1. MRI revealed a right disc herniation at L4-5 causing severe foraminal stenosis. EMG was completed and showed a right peroneal neuropathy at the fibular head but could not completely rule out a L5 lumbar radiculopathy. Double crush syndrome was most likely suspected.
Intervention and Results: The patient received bilateral L4-S1 medial branch blocks and right L4 and L5 transforaminal epidural steroid injections. Overall, he reported a 70% reduction in pain. The patient also completed physical therapy which helped his range of motion and strength. The ongoing right foot drop with numbness persisted, however, he is not tripping and has no history of falls.
Discussion: This report discusses a case of double crush syndrome, a diagnosed peroneal neuropathy that was accompanied by an L5 lumbar radiculopathy after EMG was performed. Making the distinction between a radiculopathy and a peripheral neuropathy is important to correctly diagnose because they rarely occur together. This case report emphasizes the importance of completing a thorough history, physical exam, radiographic diagnostic tools, and an EMG to accurately diagnose.