VCOM Louisiana Research Day Program

Clinical & Case Studies

Zachary Dickey, OMS-II [1] ; Jacob Turnbull DO [3] , CAQSM; Navneet Sharma MD [3] ; Stephanie Aldret, DO, CAQSM [2] Edward Via College of Osteopathic Medicine-Louisiana, Department of Family Medicine and Sports Medicine, Monroe, Louisiana 14 DRUG INDUCED TIBIAL NERVE NEUROPATHY IN FORMER COLLEGIATE BASEBALL PLAYER

Context/Impact: Peripheral neuropathy is commonly seen as an adverse reaction in numerous medications; however, some medications are more well known to produce neuropathic symptoms than others. Typically, when a drug induced neuropathy (DIN) occurs it tends to produce a systemic reaction across the nervous system and less so a focal nerve lesion. Here we present the development of a mononeuropathy of the tibial nerve after a short course of olanzapine which has not previously been described in literature to be a significant cause of DIN. Report of 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. Paresthesia’s began across all extremities 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 compression of the tibial nerve within the tarsal tunnel. MRI was unremarkable for significant

findings.

Comments/Conclusion: 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, reproduction of a positive tinsels test and improves with rest. In this case, however, symptoms did not present characteristically of TTS. EMG/NCS results showed an isolated neuropathy of the tibial nerve. From there point of care MSK US was then able to help determine a site of potential pathology as US showed the nerve to be compressed within the tarsal tunnel. This was a significant finding as recent literature has shown that a significant difference in cross sectional area of the tibial nerve proximal to the tarsal tunnel and within the tarsal tunnel can be diagnostic of TTS. Innovated treatment methods such as a hydro-dissection of the tibial nerve are currently being explored. This case provides one with a unique approach to addressing neuropathic symptoms by highlighting the importance of EMG/NCS, point of care MSK US and the use of osteopathic treatment models to healing.

27 2023 Via Research Recognition Day