Case reports: Painful limbs/moving extremities: report of two cases

Abstract

Background: Painful limbs/moving extremities is a relatively rare condition characterized by aching pain in one limb and involuntary movement in the affected fingers or toes. Its pathomechanism is unknown. We report two patients with painful limbs/moving extremities. In one patient with a painful arm and moving fingers, the symptoms were resolved after surgery.

Case descriptions: Patient 1 was a 36-year-old man with a painful arm and moving fingers. Treatment with administration of analgesics was not effective. Postmyelographic CT showed stenosis of the right C5/C6 foramen attributable to cervical spondylosis and a defect of the contrast material at the foramen. He was treated with cervical foraminotomy. Patient 2 was a 26-year-old woman with a painful leg and moving toes. The pain and involuntary movement appeared 2 weeks after discectomy at L5/S1. Lumbar MRI and myelography showed no indications of nerve root compression. She was treated with a lumbar nerve root block. The pain and involuntary movement completely disappeared in both patients after treatment.

Literature review: Numerous studies report treatments for painful limbs/moving extremities, but few report successful treatment. Recently, botulinum toxin A injection and epidural spinal cord stimulation have been used and are thought to benefit this condition. Successful surgical treatment previously was reported for only one patient.

Purposes and clinical relevance: If imaging indicates compression of nerve tissue, we believe surgical decompression should be considered for patients with painful limbs/moving extremities who do not respond to nonoperative treatment.

Fig. 1

A postmyelographic CT scan shows stenosis of the right C5/C6 foramen (arrow) attributable to cervical spondylosis and a defect of the contrast material at the foramen.

Fig. 2

According to the interneuron theory of Nathan [17], pain is perceived through the lateral spinothalamic tract. The impulse excites the spinal interneuron and leads to stimulation of spinal ventral horn cells, resulting in involuntary movement of the extremity.