Jumping stump phenomenon: a case report

Abstract

Case description: The jumping stump phenomenon is a peripherally induced movement disorder that is due to peripheral nerve damage. We report on a very resistant case in which different treatment strategies were applied. Objectives: To inform physicians about this condition, its implications, and treatment options. Study design: Case report of a 52-year-old man with a transtibial amputation, experiencing very painful involuntary muscle contractions in the residual limb.Treatment and outcomes: Various drug treatments, including baclofen, diazepam, clonazepam, clotiazepam, pramipexole, and pregabalin, peroneal nerve block, prosthesis modifications, and physiotherapy were ineffective for our patient. Botulinum toxin A treatment showed temporary decrease of symptoms but was not repeated because of high cost for the patient and his fear of injections. In our case, tibial nerve neuroma had no ectopic trigger zone, so local treatment was not indicated. Surgical interventions, based on contraction location and muscle tension, were partially successful. Eventually, due to serious functional and psychological impact, a transfemoral amputation was performed, with complete resolution of symptoms but recurrence later that year. Relapse was correlated with recurrence of local residual limb pain. Conclusions: Treating this phenomenon remains challenging because pathophysiology is still not fully understood, and the available literature is limited. A multiprofessional and interdisciplinary treatment approach is recommended, and botulinum toxin treatment is promising.

Jumpy stump syndrome treated by targeted muscle reinnervation (TMR): a case report and review of the literature

“…17 Rombauts et al also reported that botulin toxin type A resulted in a temporary decrease in symptom severity for a 52-year-old male transtibial amputee who failed various pharmacological treatments. 32 Unfortunately, due to costs and the patient's fear of injections, the procedure was not repeated. 32 Kern et al detailed the effects of botulin toxin type B injections into muscular trigger points of four patients with dosages of 2500 IU or 5000 IU (two with upper limb amputation and two with lower limb amputation).…”

“…32 Unfortunately, due to costs and the patient's fear of injections, the procedure was not repeated. 32 Kern et al detailed the effects of botulin toxin type B injections into muscular trigger points of four patients with dosages of 2500 IU or 5000 IU (two with upper limb amputation and two with lower limb amputation). 30 Two patients reported that the injections themselves were painful, but all reported significant decreases in overall stump pain.…”

“…24 Neuromuscular blockade through injection of alcohol, phenol, or botulinum toxin has additionally shown to diminish the tone of overactive muscles. 32,33 Alcohol or phenol can be injected directly onto the motor nerve, which leads to the breakdown of axons and proteins, reducing muscle tonicity and limiting stump spasms. 32 Koh and Leng demonstrated that focal intramuscular block with alcohol is effective in controlling spasticity, both in the upper and lower extremities.…”

“…32,33 Alcohol or phenol can be injected directly onto the motor nerve, which leads to the breakdown of axons and proteins, reducing muscle tonicity and limiting stump spasms. 32 Koh and Leng demonstrated that focal intramuscular block with alcohol is effective in controlling spasticity, both in the upper and lower extremities. 35 In our case, injection of isopropyl alcohol into the patient's sartorius almost entirely terminated the residual muscle spasms.…”

“…Tyvaert et al reported that injection of 30 U botulin toxin type A resulted in the cessation of myoclonic activity one week post-injection which lasted 14 wk in a patient with a shoulder disarticulation amputation 17 . Rombauts et al also reported that botulin toxin type A resulted in a temporary decrease in symptom severity for a 52-year-old male transtibial amputee who failed various pharmacological treatments 32 . Unfortunately, due to costs and the patient’s fear of injections, the procedure was not repeated 32 .…”