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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. <br> <br>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. <br>2. Wong CA, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 2003; 101:279. <br>3. Kuntzer T, et al. Clinical and prognostic features in unilateral femoral neuropathies. Muscle Nerve 1997; 20:205. <br>4. Meadows JR, Finnoff JT. Lower extremity nerve entrapments in athletes. Curr Sports Med Rep. 2014;13(5):299-306.

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