Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 4
Disclosures: Justin X. Tu, MD: Nothing to disclose
Case Description: This patient with no previous CNS insult was diagnosed with Guillain-Barre syndrome (GBS). He had a prolonged hospitalization including an extended ICU stay where he required mechanical ventilation. Upon subsequent transfer to and evaluation in an inpatient rehabilitation setting it was noted that the patient had severely limited range of motion in his bilateral hips, and bilateral (right worse than left) foot drop causing impaired mobility. Plain radiographs demonstrated bilateral heterotopic ossifications (HO) in the sciatic nerve region. He also developed chronic urinary retention requiring Foley catheterization. Because of persistent pain, weakness, and limited range of motion of his hips, the patient underwent bilateral hip arthrotomy and capsulectomy with neurolysis (freeing) of his sciatic nerves roughly 1 year after diagnosis of GBS. Post-operative day 1 after these procedures, he underwent radiation therapy for HO prophylaxis.
Setting: Acute inpatient rehabilitation facility.
Patient: A 64-year-old male with bilateral hip HO, Guillain-Barre Syndrome, and sciatic neuropathies.
Assessment/Results: The patient’s post-operative course was complicated by a right posterior thigh abscess after his right hip arthrotomy, but after appropriate treatment, the patient was able to participate with therapies in an acute inpatient rehabilitation (AIR) setting. During his AIR course, he improved from a moderate-assist to minimal-assist level on admission to a modified-independent to independent level at discharge.
Discussion: HO is the formation of mature lamellar bone in extra-skeletal soft tissue, frequently deposited around a joint. HO associated with neurologic dysfunction is usually limited to injuries to the central nervous system (CNS); the pathophysiologic mechanism for HO in this setting remains controversial.
Conclusion: While typically associated with patients who have CNS-related pathology, HO can occur in the setting of GBS and other peripheral nervous system pathology. If decreased range of motion is found in the setting of GBS, HO should be considered as a possible etiology.
Level of Evidence: Level V
To cite this abstract in AMA style:Tu JX, Alfano A, Smith G, Ide W. Heterotopic Ossification of Hip Joints as a Rare Cause of Gait Dysfunction After Guillain-Barre Syndrome: Rehabilitation Course and Outcome [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/heterotopic-ossification-of-hip-joints-as-a-rare-cause-of-gait-dysfunction-after-guillain-barre-syndrome-rehabilitation-course-and-outcome/. Accessed September 24, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/heterotopic-ossification-of-hip-joints-as-a-rare-cause-of-gait-dysfunction-after-guillain-barre-syndrome-rehabilitation-course-and-outcome/