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402 - A case of right lower extremity weakness after pelvic mass removal

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

JF

Jeronimo J. Ferriol Alonso, MD

Resident Physician
University of Puerto Rico
PONCE, Puerto Rico, United States

Co-Author(s)

JQ

Jose E. Quintana Soler, MD

Resident Physician
University of Puerto Rico School of Medicine
San Juan, Puerto Rico, United States
MC

Myriam Crespo-Hernandez, MD, MD

Attending Physician
University of Puerto Rico School of Medicine
San Juan, Puerto Rico, United States

Case Diagnosis: Right femoral neuropathy in a 74-year-old female.

Case Description: A 74-year-old female with a pelvic mass underwent a pelvic mass resection on 6/13/2024. There was a cystic lesion anterior to the right psoas muscle. The biopsy report is pending. After the surgical intervention, the patient reported right lower extremity numbness and weakness. Post-op pelvic MRI w/w-o contrast was inconclusive due to extensive edema throughout the lower pelvis. The physical exam was remarkable for MMT of 0/5 in right knee extension and decreased right saphenous nerve distribution. The patient was admitted to inpatient rehabilitation on 6/18/2024. The physical exam is unchanged from the prior evaluation. Upon discharge on 6/28/2024, the patient could ambulate 300 ft with a rolling walker independently and underwent outpatient PT/OT. On 8/7/2024, EDX study was performed, with remarkable results: no recruitment and denervation on EMG in right quadriceps muscle groups and no response in right saphenous nerve conduction. Confirming our diagnosis of right femoral nerve neuropathy.

Discussions: The patient's initial findings of weakness and numbness in her right lower extremity were suggestive of nerve injury. However, post-imaging findings were inconclusive, and an EDX study confirmed the diagnosis of right femoral nerve neuropathy. Despite these clinical and electrodiagnostic findings, the patient progressed in gait and balance throughout her rehabilitation program. After rehabilitation, the patient was able to ambulate with a rolling walker.

Conclusions: We should consider this mechanism of femoral nerve injury in gynecologic patients. These are rare cases, and few are published in the scientific literature. Electrodiagnostic studies are a modality that can still help us confirm this diagnosis cost-effectively. This case also proves the importance of rehabilitation in restoring function and independence.