کلینیک طب فیزیکی دکتررئيسی و دکـتراحدی

The patient was a 43 years old lady who came with low

back and thigh pain since about 8 months Pain started in low back radiating to anterior thigh region. Pain was 10 in visual analog scale. Aggravated with walking and relieved with sitting and lying at first. Later pain was constant, burning type with paresthesia and numbness in anterior thigh and medial leg region. Patents had mild L4-L5 disc and surgery has been done. But pain did not decrease and even aggravated since then. In CT Scan of hip was reported as normal.

In physical examination, patient hardly walked with cane and the gait pattern was antalgic with decreased stance phase.  Range of motion was decreased in hip extension. In MMT hip flexion forced was 4/5 due to pain. Knee extension was 4+/5, hip adduction was 4/5 with pain. Hip abduction 5/5 and ankle dorsiflexion, plantar flexion and big to extension were 5/5.

In MSR right patellar reflex was 1+and in left side was 2+. Sensory examination, light touch was reduced in anterior, medial thigh and medial leg.

 negtive Patient was not able to sleep prone due to pain , reverse SLR was done in lying in left side and patient felt severe ridiculer pain up to knee with hip extension.  Lumbar lordosis increased with lying straight on bed Thomas test was positive for right hip flexion contracture.

in electromyography, patient had denervation potential in obturator territory.

With electrodiagnosis of lumbosacral plexus lesion, we requested pelvic MRI. a diffuse enhancement was seen suggestive of infiltration. Patient was referred to general surgeon. A diffuse hard infiltration was seen with difficulty in biopsy taking.

The pathologic diagnosis was undifferentiated sarcoma.

1.     Patient surgery could be prevented as there was no significant root entrapment, and patient’s symptoms did not match the clinical picture.

2.     Patients paraspinal muscles were also involved. EMG cannot completely exclude plexus lesion form lumbosacral plexus lesions.

3.     In lumbosacral plexus lesion by tumoral infiltration, typical findings may not be seen and high suspicion and clinical correlation is needed for diagnosis

 Gholam Reza Raissi MD-Tannaz Ahadi MD

Tehran University of Medical Sciences