Joanneth M. Padro-Serrano, MD
Resident
VA Caribbean Healthcare System
San Juan, Puerto Rico, United States
Jose A. Espinal San Miguel, MD
Resident, PGY-2
VA Caribbean Healthcare System
San Juan, Puerto Rico, United States
Anelys Torres RIvera, MD
Attending/MD
VA Caribbean Healthcare system
San Juan, Puerto Rico, United States
A 74-year-old male with a diagnosis of Paget's Disease of Bone (PDB) complains of a one-year history of decreased mobility and pain in the left elbow. Physical examination revealed a left elbow contracture. The patient was referred for an electrodiagnostic study (EDX) to evaluate for a left cervical radiculopathy. EDX showed decreased conduction velocity across the left ulnar motor nerve at the elbow, consistent with ulnar nerve entrapment. Also found with moderate left median focal neuropathy at the wrist, as commonly seen in carpal tunnel syndrome. EDX did not show electrodiagnostic evidence of an active left cervical radiculopathy.
Discussions:
The etiology of entrapment neuropathies is varied and primarily associated with anatomical variations, trauma, or repetitive stress. Rarely are metabolic bone disorders considered in the differential diagnosis. PDB is characterized by abnormal and disorganized bone remodeling, which may often be asymptomatic, and commonly, diagnosis is made incidentally. However, most symptoms are associated with bone turnover, including pain, bone deformity, osteoarthritis, and, in some cases, significant nerve compression. Studies show that peripheral nerve compression is a less common complication, with a prevalence of 2% in patients with PDB. This case serves as an example that in patients without apparent cause of nerve entrapment with underlying metabolic bone disease, a complication from PBD may be considered.
Conclusions:
Clinical suspicion should arise in patients presenting with unexplained peripheral neuropathies and an underlying history of metabolic bone disorders. Understanding the complications of PDB and recognizing patient symptoms is crucial, as early diagnosis and management are essential to tailor patients' treatment, optimize patient outcomes, and improve quality of life. Further imaging and endocrinologist follow-up are necessary for assessing disease progression in such cases.
