| 제목 |
A Lumbosacral Plexopathy, Compressed by Huge Uterine Myoma |
| 소속 |
St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Department of Rehabilitation Medicine1, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Department of Obstetrics and Gynecology2 |
| 저자 |
Seong Hoon Lim1*†, Sung Jong Lee1, Bo Young Hong1, Joon Sung Kim1, Won Jin Sung1, Joo Hee Yoon1 |
A 54-year old female visited a rehabilitation outpatient clinic with a 2-week history of right-sided foot drop and pain on the dorsum of the right foot. The patient had undergone total right knee arthroplasty 2 weeks prior to presentation. Electrodiagnostic studies were conducted to test for peroneal or sciatic nerve injury secondary to the surgical intervention. The left sural nerve was obtained normally. No discernable response followed superficial peroneal nerve stimulation from the lateral calf. Reduced amplitude of the compound muscle action potential (CMAP) was observed at the tibialis anterior muscle on common peroneal nerve stimulation (Table 1). Needle electromyography of the right lower limb revealed abnormal spontaneous activities, such as positive sharp waves and fibrillation potentials, of the long and short heads of biceps femoris, tibialis anterior, fibularis longus, and tibialis posterior muscles at rest. The interferential patterns were reduced at all denervated muscles on maximal volition. Together, these findings were suggestive of right proximal sciatic nerve injury or lumbosacral plexopathy.
Magnetic resonance imaging (MRI) (3.0T MRI, Siemens, Germany) of the lumbar spine and pelvis revealed that multiple, variable-sized, intramural and subserosal myomas had nearly replaced the uterus. The largest myoma was in the anterior mid- to lower body of the uterus and measured 11.8 x 11.6 x 11.5 cm. Another large myoma was located near the right L5 root outlet and the right lumbosacral plexus (Figure 1). The patient was referred to the Department of Obstetrics and Gynecology for a total hysterectomy (Figure 2). Post-operatively, the patient had recovered right lower-limb strength. Follow-up electrodiagnostic studies showed marked improvement of the interferential pattern during maximal voluntary muscle contraction.
Lumbosacral plexopathy typically occurs following trauma. Uterine myomas are a rare cause, and have only occasionally been previously described1. In this case, a prolonged supine position during anesthesia for knee surgery likely caused a compression of lumbosacral plexus by a uterine myoma. In the physiatrist’s view, the discrepancies between the clinical history and the electrodiagnostic evidence were crucial for informing diagnosis and treatment planning. |
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T2 sagittal and axial magnetic resonance imaging (MRI) showed multiple, variable-sized, intramural and subserosal myomas had nearly replaced the uterus. A uterine myoma was located near to the right L5 root outlet and right lumbosacral plexus.
Surgical exploration revealed huge myoma
Table 1
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