Basketball Player With A Limp

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Basketball Player With A Limp - Page #4

Working Diagnosis: Left tibial non-malignant intraneural perineurioma Treatment: Excisional biopsy and epineurotomy of the left tibial nerve tumor of both lesions Outcome: The patient tolerated the procedure well. Pathology results confirmed both left tibial nerve biopsies to be diagnostic for intraneural perineurioma, negative for malignancy. Four months following the procedure his left gastroc-soleus complex has improved strength to 4/5. Counseled that full recovery may take several months vs. being at his new baseline. He continues to play basketball recreationally Author's Comments: Clinical suspicion must remain high for a neuropathic cause when asymmetric weakness does not have a clinical mechanism of injury for which to correlate Perineurioma, specifically the intraneural form, are rare and often go unrecognized due to their insidious development in young patients Commonly intraneural Perineuriomas lead to slowly progressive motor changes, muscle atrophy and occasionally alterations in sensation Diagnosis can be revealed using EMG and MRI with contrast enhancement Once a targeted nerve biopsy is performed, a detailed microscopic evaluation can rule out malignancy and differentiation from other neuromas such as Schwannomas which are difficult to distinguish clinically Return To The Case Studies List.		Back
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