Disclosures: Lucas F. First, MD: Nothing to disclose

Case Description: Patient presented to the hospital for recurrent falls and was admitted to the medical floor for hyperglycemia and symptomatic hyperkalemia. She was subsequently transferred to the inpatient rehabilitation unit for impairments in gait, mobility, and activities of daily living secondary to severe electrolyte abnormalities. On day 3, the patient underwent 90 minutes of occupational therapy which consisted of coordination of pincer and three-jaw chuck grip patterns using colored clothespins, as well as fine motor coordination using marble beads. No acute issues were present before the session and the patient tolerated the session well. Two hours after the session, the patient began complaining of severe, 10/10, acute left hand pain associated with paresthesia. On exam, the left hand was cooler compared to the right, radial and ulnar pulses were not palpable. There was limited wrist flexion and extension, gross sensation was intact. The vascular surgical team was urgently consulted out of concern for arterial occlusion.

Setting: Inpatient rehabilitation unit at tertiary care hospital.

Patient: 46-year-old female with a history of type one diabetes mellitus (T1DM), hypertension (HTN), coronary artery disease (CAD), peripheral vascular disease (PVD), and end-stage renal disease (ESRD) with left upper extremity (LUE) arteriovenous (AV) fistula.

Assessment/Results: Vascular surgery obtained a radial and ulnar pulse using Doppler ultrasound, ruling out complete occlusion. A diagnostic angiography determined there was no acute complete occlusion, but evidence of minor distal perfusion compromise consistent with steal syndrome.

Discussion: This case describes a potential relationship between repetitive hand movements performed in occupational therapy and dialysis access steal syndrome, which is, to our knowledge, unreported in the literature.

Conclusion: We recommend close observation of patients with AV fistulas following strenuous therapy sessions. Care must be utilized when exercising the AV fistula limb, we caution against reaching the point of exhaustion.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dialysis-access-steal-syndrome-following-strenuous-distal-fine-motor-therapy-a-case-report/