DVT and Loss of Muscle Power, please help

[pjlambe]

Hey, I'm on work placement at the moment in an Outpatients department and I have a patient who got a DVT roughly a year ago and subsequently has a severe loss of power in one leg. When I mean severe, I mean she's almost monoplegiac.

I've been trying to find information on how DVTs can cause this severe loss of power but I still haven't found anything of relevance. I want to do case presentation on her and so I need some more information. Can anyone help me?

She has a background on injecting cocaine into the groin and that is what supposedly caused the DVT.

Thanks,
pjlambe

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[nikhilkasar]

HELLO THERE!
Its straight in this senario , i think these are the important reasons for power loss:-

1. DVT is a life threatening disease with sharp pain in calf, patient has strong tendency to become non ambulatory, leading to DISUSE ATROPHY.

2. DVT compensates proper venous circulation in gastro-soleus leading to accumulation of waste metabolites , which keep on accumulating and leading to improper nutrition of gastro-soleus hence atrophy and weakness.

ONE WORD OF CAUTION:- IF THAT PATIENT HAS STILL BY ANY MEANS MINOREST SIGN OF DVT ON DOPPLER STUDY, PHYSIOTHERAPY IS SHARPLY CONTRAINDICATED.
DO NOT ATTEMPT TO TREAT HIM.

[Fyzzio]

Hi,
these days, DVTs are rather well treated and any loss of power due to misuse should be temporarily only. Certainly, a year after a DVT, there should not be any weakness as severe, as you have described it.
So, I start wondering whether there could be anything else going on. For example, she could have injured the nerve or suffered from a Cocaine induced stroke.

But to make any further comments, it would be helpful if you give us the findings of your neurological testing on this patient. E.g.
- history (was the weakness spontaneous and has not changed since onset, has it progressively got worse, has it improved at all),
- reflexes,
- muscle power in more detail (i.e. does the pattern indicate a central or peripheral origin = does the weakness follow any nerve distribution; how's the foot, how about abdominals, etc.),
- any medical testing (e.g. biopsies, conduction studies, etc.),
- muscle tone,
- sensation,
- medication.

Hope this helps a little,
regards,
Fyzzio

[nikhilkasar]

ya i agree with FYZZIO that the neuronal component should too be ruled out in order to arrive at a proper conclusion. I initially neglected at Cocaine injections in groin.
I also believe that there might be a strong possibility of Femoral nerve injury of a degree greater than just neuropraxia for which EMG studies would be definitive which should be then co related clinically.
Being said so there might be too underlying circulatory pathology contributing to paresis.
So right now the best thing to do is get an Doppler study done too, as patient had been taking cocaine shots at groin, DVT may be too underlying.....
and it would be a nightmare to treat patient on just neurological component as if at all there is DVT present right now then he first belongs to medical doctors for treatment then when confirmed of no DVT he may be treated with pt.
As you said patient had been taking cocaine shots at groin, his injury to tunica externa, media , interna of vein may not be healed completely moreover as its at groin due to movements recurrences may take place.

[pjlambe]

Thank you all for your help. I am seeing her agin hopefully on Monday to complete a more thorough neurological examination and find when exactly the weakness occured.

When testing the patient for the Babinski response there was no plantar reaction at all and her sensation was deminished in her right leg comapered to her left. Also her proprioception was decreased in her her right foot and ankle yet a contributing factor may have been her very poor concentration levels.

I have asked her GP to reffer her to get an EMG.

There have been no signs of a DVT when I've been treating her but I'll keep an eye out for it.

Her general musle power in her leg seems 2/5 but I'm going to do a more thorough assessment when I see her next to find out which muscles are being effectected the most. So far it appears her knee extensors are the most affected which makes me think she may have damaged her femoral nerve.

With a cocaine induced stroke is it likely that her only symptoms would be monoparesis?

[Fyzzio]

Hi,
a stroke usually causes hemiparesis.
Maybe you could also ask the GP to organise a CT scan.
Regards,
Fyzzio

[pjlambe]

I understand that but was just wonedring since it's monoparesis and not hemiparsis. I realised that a less severe bleed or infarct to a specific part of the brain can just cause monoparesis.

I looked at her CT and the report was clear so it seems to be pointing towards Femoral nerve damage and disuse atrophy. Anyone know any good articles on disuse atrophy?

[Hankfreid]

Very good information about health. Thanks for sharing this useful information.