Jumping stump phenomenon: a case report.

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.