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hi bardy, has someone tried an abdominal sonography? she might have had some bleeding, and a haematoma might be pressing somewhere, hence the "funny" distribution of symptoms. good luck, pieter --- Bardy McNair <[log in to unmask]> schrieb: > Can anyone help with this? I'm a women's health > physio, so more of a dabbler > in musculoskeletal/neuro work and this one is way > beyond me. > A woman in her late 30s, qualified nurse (learning > disabilities/ challenging > behaviour), severe asthmatic has surgery for an > ovarian cyst. She has had a > bad experience with spinal anaesthetics in the past > so was given a GA with > an abdominal wall block for the operation. This > consisted of infiltration at > 6 points, two for ilioinguinal nerves, two for > rectus sheath and two > subcutaneous. The surgery itself was completely > uneventful. The surgeon had > expected it might be difficult because she has had > some pelvic and vaginal > surgery in the past, but the cyst 'popped out' > without difficulty. > > Immediately postoperatively she had severe weakness > and sensory loss in > obturator and femoral nerve distributionsof her left > lower limb. Not > assessed in detail - everyone expected it to wear > off. > But it didn't. > Now at 17 weeks post op she has severe burning pain > over mons pubis and > anteriorly down thigh to knee. This began about 3 > weeks post op. This is > partially helped by carbemazepine and oromorph. > She has no discernible activity in gracilis or hip > adductors. > Gross wasting and loss of activity in extensor > digitorum brevis. > Sensory loss in ilioinguinal, obturator and deep > peroneal distribution. > > She walks with great difficulty with a stick, poor > hip stability and unable > to control abduction, also partial foot drop, > sufficient to cause her to > trip frequently. She has difficulty dressing, > manoevring round objects, > performing even minor household tasks. She has > children (youngest age 4) and > can't look after them properly. She cannot work, and > her sick pay will run > out in a few weeks. She is fairly desperate and > looking to me for answers. > > The surgeon and anaesthetist are completely puzzled > as to why this has > happened. The nerve block was very superficial, > could not possibly have come > near the obturator nerve (especially not proximal to > its division). anyway, > nerve block usually wears off. She has consulted a > neurologist, who didn't > examine her, ordered sensory and motor studies of > sural and peroneal nerves > and emg of Tib ant, vastus medialis, triceps surae > and ext. dig. brevis > which found nothing untoward. (?why didn't he ask > for adductors?). He also > told her that the problem is 'in the brain' and that > the intense neurogenic > pain is 'postural'. He also dismissed the physio > assessment ( done by one of > my most expert musculoskeletal colleagues) as > irrelevant. > > This unfortunate woman is desperate to return to > work and a normal life. > There is no explanation and no prognosis. > > Can anyone suggest what has happened? And why the > mysterious distribution? > And can anyone suggest a neurologist (or any other > specialist?) in the UK > (Midlands or North of England) who might be able to > give an intelligent > second opinion? > > Many thanks to anyone who can shed some light. > Bardy > ===== Homepage "Physiosupport" und "Physiotherapie Islikon" http://www.physiosupport.org __________________________________________________________________ Gesendet von Yahoo! Mail - http://mail.yahoo.de Ihre E-Mail noch individueller? - http://domains.yahoo.de