Muscle Spasms after Extensor Tenotomy

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Hi all,

Yesterday I saw a patient, female 50's, no prior health issues, except this:
she had an extensor tenotomy done (orthopedic surgeon) 6 months ago (2nd to 5th toe - right foot); after that, she developed intense involuntary spasms (flexors) - causes discomfort and pain and she cannot walk long distances. There's one maneuver she discovered that helps - passive dorsiflexion of the hallux stops/diminishes the spasms while doing it.
She did all sort of exams, including neurological, but nothing has been found.
I did a silicone digital orthosis to avoid the "flexor curling" - she felt a lot better - lets see how it goes...

Any ideas? Does someone know a similar case?

Thank you and best regards,

 

Anyone?

Thanks...

 

Hola:
I would suggest that her unopposed flexor tendons are beginning to spasm. If the short and long extensors were tenotomized this would increase the chance of spasm.
I've seen this before and it does tend to be self limiting and resolve itself. In the meantime passive stretching and NASAs as needed.
Good luck
Steve

 

... NASA (I suppose you are referring to Norepinephrine Antagonist Serotonin Antagonists). How long would you guess to see improvements?

Thank you.
Best regards,

 

Hi
No
Sorry, typo!
NSAI...non steroidal anti inflammatories.

I'm a better surgeon then typist.

Steve

 

I thought something was wrong, but...
NSAI? Don't see the reason...

Cheers

 

Hi
Don't see the reason..... For NSAID?
Well, most have analgesic as well as anti inflammatory
Properties. The anti inflammatory for the tendon
Sheaths for those tendons in spasm, and
Analgesic because it's always good to make
Your patient feel better!!
Like I said, these are usually self limiting.

 

My apologies - I was out of context. I thought I'd already wrote that the patient has taken different NSAID's for quite a long time... She felt no difference at all.
When she came to me, a Neurologist had just prescribed medication (she forgot the name) - I'll know next Monday and I'll post it here.

Regards,

 

No Problem:
Your patient is likely on a muscle relaxant.
If they do not improve you may consider tenotomizing the FDL at the digits.

Did your patient ever return the the original surgeon? What did he tell her?

Steve

 

Yes she did. He said he'd never seen such a case - medicated her with NSAID's - and then sent her to me (more than 6 months passed from the surgery)...

Cheers

 

Hi,

Sorry for the delay...
The Neurologist prescribed Clonazepam. The patient said that feels a little better.

Cheers,