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Drug Induced Tibial Nerve Neuropathy in Former Collegiate Baseball Player

Journal: The AAO Journal Date: 2023/06, 33(2):Pages: 22-23. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/20/493544/LBORC-NUFA-Poster-Abstracts-2023-Students)

Keywords:

case report [514]
drugs [17]
lower leg [2]
male [479]
neuropathy [13]
OMT [2951]
osteopathic manipulative treatment [2973]
tibial nerve [1]

Abstract:

Introduction/Background: Peripheral neuropathy is commonly seen as an adverse reaction in a varying number of prescribed medications. Some drugs, however, are more well known to produce neuropathic symptoms than others. Often, a drug induced neuropathy (DIN) effects individuals more at risk, for example, those with preexisting neuropathy or diabetes. DIN also tends to produce a systemic reaction across the nervous system and less so a focal nerve lesion. Case: A 23-year-old male retired collegiate baseball player presents with paresthesia of his left lower extremity that occurred six days after being treated with low dose olanzapine for refractory panic and generalized anxiety disorder. Paresthesias began across multiple limbs during treatment but persisted in the left lower leg six months after olanzapine was discontinued. Physical exam was unremarkable except for neurological abnormalities in the tibial nerve distribution. Medication and OMT had minimal improvements. EMG/NCS revealed increased latency within the tibial nerve. MSK US revealed enlargement of the tibial nerve within the tarsal tunnel. Results: OMT was directed at correcting structural somatic dysfunctions as well as myofascial binds around the neuropathic lower extremity. Treatment has been aimed at restoring proper balance and removing obstruction to allow for proper nerve regeneration. Discussion: Tibial nerve neuropathy is most often seen in patients with tarsal tunnel syndrome (TTS). TTS commonly presents with paresthesia of the sole of the foot and/or weakness of the plantar flexors. In this case, a thorough Osteopathic examination allowed for potential etiologies as well as their role in the prognosis of the neuropathy to be investigated. This case highlights the interconnectedness between the structural, neurologic, and behavioral models of osteopathic medicine and the importance in addressing them.


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