Case Reports: Painful Limbs/Moving Extremities: Report of Two Cases

• Published in: Clinical orthopaedics and related research 2010-12, Vol.468 (12), p.3419-3425
• Main Authors: Miyakawa, Tsuyoshi, Yoshimoto, Mitsunori, Takebayashi, Tsuneo, Yamashita, Toshihiko
• Format: Article
• Language: English
• Subjects: Adult; Case Report; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Conservative Orthopedics; Decompression, Surgical; Diskectomy - adverse effects; Female; Fingers - innervation; Humans; Lower Extremity - innervation; Lumbar Vertebrae - surgery; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Movement Disorders - diagnosis; Movement Disorders - etiology; Movement Disorders - physiopathology; Movement Disorders - therapy; Myelography; Nerve Block; Orthopedics; Pain - diagnosis; Pain - etiology; Pain - physiopathology; Pain - surgery; Pain Measurement; Spinal Cord Compression - diagnosis; Spinal Cord Compression - etiology; Spinal Cord Compression - physiopathology; Spinal Cord Compression - therapy; Spinal Stenosis - complications; Spinal Stenosis - diagnosis; Spinal Stenosis - physiopathology; Spinal Stenosis - therapy; Spine; Sports Medicine; Surgery; Surgical Orthopedics; Syndrome; Toes - innervation; Tomography, X-Ray Computed; Treatment Outcome; Upper Extremity - innervation
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-010-1437-y

Background Painful limbs/moving extremities is a relatively rare condition characterized by aching pain in one limb and involuntary movement in the affected fingers or toes. Its pathomechanism is unknown. We report two patients with painful limbs/moving extremities. In one patient with a painful arm and moving fingers, the symptoms were resolved after surgery. Case Descriptions Patient 1 was a 36-year-old man with a painful arm and moving fingers. Treatment with administration of analgesics was not effective. Postmyelographic CT showed stenosis of the right C5/C6 foramen attributable to cervical spondylosis and a defect of the contrast material at the foramen. He was treated with cervical foraminotomy. Patient 2 was a 26-year-old woman with a painful leg and moving toes. The pain and involuntary movement appeared 2 weeks after discectomy at L5/S1. Lumbar MRI and myelography showed no indications of nerve root compression. She was treated with a lumbar nerve root block. The pain and involuntary movement completely disappeared in both patients after treatment. Literature Review Numerous studies report treatments for painful limbs/moving extremities, but few report successful treatment. Recently, botulinum toxin A injection and epidural spinal cord stimulation have been used and are thought to benefit this condition. Successful surgical treatment previously was reported for only one patient. Purposes and Clinical Relevance If imaging indicates compression of nerve tissue, we believe surgical decompression should be considered for patients with painful limbs/moving extremities who do not respond to nonoperative treatment.