Mustafa Hashmi, BS
Medical Student
UMass Chan Medical School
Southborough, Massachusetts, United States
Faren H. Williams, MD, MS
Physiatrist, Professor
UMass Chan Medical School
Worcester, Massachusetts, United States
A 33-year-old female, who had returned from Colombia two days prior, was found lying on her left side for an extended period, unable to move her left arm and leg. She presented to the ED and was diagnosed with rhabdomyolysis (CPK >60,000). A urine toxicology screen was positive for cocaine and cannabis. Two months later, a physiatrist evaluation and electrodiagnostic testing revealed unobtainable left median and ulnar sensory responses, significantly decreased left median and ulnar motor amplitudes, decreased recruitment in distal left upper extremity muscles, unobtainable left sural sensory responses, unobtainable left fibular motor responses recording from the extensor digitorum brevis and tibialis anterior, low amplitude left tibial motor. There were no motor units in left fibular-innervated muscles on needle EMG. An anterior shell carbon composite brace was recommended.
Discussions:
Significant muscle and peripheral nerve damage can occur directly or indirectly from substance use. In this case, substance use most likely resulted in prolonged immobility and left-sided compression neuropathy. The young patient with no co-morbidities showed substantial improvement over time. Follow-up electrodiagnostic testing a year later showed complete recovery of the left arm, low amplitude left fibular motor responses recording from the tibialis anterior, improved left tibial motor amplitude, and polyphasic motor units in the tibialis anterior and fibularis longus. A shorter brace was recommended since she had reinnervation in proximal fibular-innervated muscles.
Conclusions:
Physiatrists can manage various neuropathic and musculoskeletal conditions, including this unique case of rhabdomyolysis and compression neuropathy from static positioning caused by passing out from substance use. Continuous follow-up, diagnostic workups, emotional support, and physiatry collaboration with orthotists and physical therapists are crucial for effective treatment and recovery.
