rhabdo pain?

[NEPain]

Has anyone seen long term pain (stocking distribution) after a bout of exercise induced rhabdo? All labs have long since returned to normal. No spine dz. Otherwise healthy in his 20's.
The usual social factors exist that could result in malingering, but first I want to see if this could be real. I can't find anything in any textbook or online.

Anyone seen this?

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[SSdoc33]

Has anyone seen long term pain (stocking distribution) after a bout of exercise induced rhabdo? All labs have long since returned to normal. No spine dz. Otherwise healthy in his 20's.
The usual social factors exist that could result in malingering, but first I want to see if this could be real. I can't find anything in any textbook or online.

Anyone seen this?

never seen it, but it doesnt sound impossible. lot of pedal swelling during the incident? EMG would have good positive predictive value, but if its negative, it doesnt rule out a small-fiber neuropathy.

 

[101N]

never seen it, but it doesnt sound impossible. lot of pedal swelling during the incident? EMG would have good positive predictive value, but if its negative, it doesnt rule out a small-fiber neuropathy.

Never seen it either. However, I have seen an anterior compartment syndrome in high school soccer player. It got missed in the ER and he ended up with permanent foot drop. EMG - at the time that I saw him - showed fatty replacement of the TA. Sad case.

 

[Jitter Bug]

I've never seen exercise induced rhabdo. Got drunk and spent the night lying on the tile floor rhabdo, yes. Took all my xanax and spent the night at the bottom of my stairs rhabdo, yes.

 

[NEPain]

Reminds me of a case in a class in med school. A woman slipped and got wedged between her sink and toilet bowl. Couldn't move. Got rhabdo and died, but my friends and I found it so funny that we had to leave the classroom.
Obviously the case was sad, but sometimes you can't stop the giggles...

 

[emd123]

Has anyone seen long term pain (stocking distribution) after a bout of exercise induced rhabdo? All labs have long since returned to normal. No spine dz. Otherwise healthy in his 20's.
The usual social factors exist that could result in malingering, but first I want to see if this could be real. I can't find anything in any textbook or online.

Anyone seen this?

I've seen exercise induced rhabdo, very severe, particularly in steroid users. Marathon runners can get this, and it's generally mild, sub-clinical and self limited, in these cases. I've never seen chronic pain from it. Sounds a little weird. I can't say it's impossible, just sounds a little odd. UDS, UDS, UDS. Rx report, Rx report, Rx report.

Exercise induced compartment syndrome isn't rare either. Happens in teenage athletes not infrequently because their muscles are growing so fast they out grow the fascia of their muscle compartments.

 

[Apollyon]

When I was prelim IM, we had a guy from Riker's Island who had a CPK of 160k. He said he had been doing deep knee bends for 8 hours. Turns out he actually had been severely beaten with a rubber hose.

 

[NOSfan]

Did the patient have any degree of renal failure as a possible etiology for his neuropathy?

Journal of Clinical Neuromuscular Disease:
June 2005 - Volume 6 - Issue 4 - pp 153-156
Short Report

Bilateral Femoral Neuropathy Complicating Rhabdomyolysis and Acute Renal Failure

Nicolle, Michael MD, FRCPC, DPhil*; Doherty, Timothy MD, PhD, FRCPC*; Algahtani, Hussein MD, FRCPC†
Simultaneous bilateral femoral neuropathies are uncommon and are usually seen as a consequence of pelvic surgery or related to pregnancy. This report describes the case of a young man with rhabdomyolysis after a drug-induced coma, which led to intramuscular dystrophic calcification and compression of the femoral nerves. Acute dystrophic calcification has been documented in the setting of rhabdomyolysis with renal failure. This is the first reported case of a compressive neuropathy occurring as a result of such dystrophic calcification.

 

[PMR 4 MSK]

Need EMG to really know anything

 

[NEPain]

NOSfan, thanks for the interesting reference. Pretty crazy case. The closest I've seen is a bone spur in the cubital canal causing ulnar neurpathy<g>. But the pt in the OP had normal renal function. As always, the possibility of malingering exists, but I find, especially with peripheral neuropathies, that there are endless causes that I'm not aware of.

Thanks to everyone for the helpful comments.

My best prison story is secondhand. I was seeing a pain pt who was incarcerated. The guard and I were chatting and he told me about a prisoner who got methadone and was always last in line for her dose. Turned out she would immediately barf it up and sell the barf.

 

[joshmir]

in fellowship I saw a patient who had a pump put in her in alaska for muscle pain s/p statin reaction; years later she felt she didn't need it anymore and asked to be weaned off; towards the end of the weaning she changed her mind

i also saw a case of bilateral plantar foor pain in a young healthy marine which seemed to develop as a chronic overuse injury (had severe flat feet, marines denied him orthotics for his boots, by the end of boot camp his feet were allodynic to light touch) whch persisted for about a yearat which point i saw him; straight shooter guy; wanted definitive dx so was gonna try to get a nerve biopsy but bone scan came back positive for CRPS changes so we left it at that