Joint Laxity post schwannoma excision

I have a patient who is having difficulty walking due to atrophy of LL muscles. She had a T2-4 operation for schwannoma excision in July 2009. Prior to this, she was able to walk with nil issues. She currently walkes with severely internally rotated (L) hip and knee and (L) ankle pronation (foot is rotated approximately 50 degrees laterally). On knee extension, patella moves ++++laterally. Anterior tibial translation indicatives +++++laxity.

Unable to get record of operation notes, as patient had operation at non-affiliated hospital.

Has anyone heard of or can provide some light as to why her joints have become so lax post surgery? I'm assuming possible surgical complication?

We have attempted knee braches and AFO's but these have no effect are the joints are far too lax. Any suggestions? Currently mobilising with 4WF.

Hi spaceangelz

the most likely reason is because of damage to the motor tracts in the spinal cord and that your patient has quite extensive damage. Basically it would be a case of incomplete spinal cord injury. that would be the most likely reason for all the impairments whether deformity or joint laxity.

Sounds like she has major movement impairment syndromes resulting from weakness?

Has she also got contractures (or eve spasticity) in the antagonist muscles? Have you conducted a detailed muscle chart of her? Can you explain all the gait abnormalities by this? eg:

Internal rotation by weak hip lateral rotators
patella translation by weak quads etc. And what about sensory disturbance, particularly proprioception?

Can the joint laxity not be explained by marked weakness? that is usually the most likely problem although if your patient has anaesthesic joints this could be an additional problem. For example the Anterior tibial translation may be gross weakness of the hamstrings

If you are going to have success with orthotics I think you have to be really clear about what deformity/instability you are trying to tackle in relation to walking and the underlying impairments behind the deformity/instability. As a general rule you want to do the minimal amount of orthotic intervention to obtain the maximal benefit.


How has your patient gone with strengthening post surgery? Hopefully she has had had a really intensive strengthening programme targeting the paretic muscles and has reached a plateau. If not is there more that could be achieved here?

Have you got a report on the MRI or CT of the spinal cord post surgery? that could give a bit more information