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Inicio Rehabilitación Movimientos involuntarios del muñón tras una amputación transtibial: síndrom...
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Vol. 57. Issue 2.
(April - June 2023)
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Vol. 57. Issue 2.
(April - June 2023)
Caso clínico
Movimientos involuntarios del muñón tras una amputación transtibial: síndrome del muñón saltarín
Involuntary movements of the stump after transtibial amputation: Jumping stump syndrome
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M. Hernández López
Corresponding author
mariahernandez_lopez@hotmail.com

Autor para correspondencia.
, A.B. Puentes Gutiérrez, M.C. López Zarzuela, M. García Bascones
Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
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Resumen

Mujer de 45 años, con antecedente de cirugía de hallux valgus de evolución tórpida, derivando en amputación transtibial. A los 6 meses poscirugía comenzó con movimientos involuntarios del muñón tipo mioclonías desencadenados con el roce o extensión de la cadera, agravándose el dolor previo de muñón y de miembro fantasma. Durante el siguiente año, coincidiendo con el cambio de prótesis, empeoró la clínica progresivamente limitando la marcha. El abordaje terapéutico del dolor y de las mioclonías fue inicialmente farmacológico, sin respuesta. Ante la sospecha clínica y ecográfica de neuroma en el nervio ciático poplíteo externo, se infiltró el mismo con corticoide y anestésico y los gastrocnemios con toxina botulínica tipo A, sin éxito. Finalmente, las mioclonías desaparecieron y el dolor disminuyó tras el remodelado quirúrgico del muñón y la resección del neuroma. Este cuadro clínico es conocido como síndrome del muñón saltarín, y es una complicación rara que debe tenerse en cuenta tras una amputación.

Palabras clave:
Síndrome del muñón saltarín
Amputación
Movimientos involuntarios
Dolor neuropático
Neuroma
Rehabilitación
Abstract

45-year-old woman with history of hallux valgus surgery and torpid evolution, which led to transtibial amputation. Six months after surgery, she began to experience involuntary movements of the stump such as myoclonus, that were triggered by touch or hip extension, associating worsening of the previous stump and phantom limb pain. During the following year, concurring with change of prosthesis, symptoms progressively worsened, which limited walking. The therapeutic approach to pain and myoclonus was initially pharmacological, without response. Given the clinical and ultrasound suspicion of neuroma in the external popliteal sciatic nerve, it was infiltrated with corticosteroid and anesthetic, and the gastrocnemius with botulinum toxin type A, without success. Finally, the myoclonus disappeared, and the pain decreased after surgical remodeling of the stump and resection of the neuroma. This clinical picture is known as jumping stump syndrome and is a rare complication that must be considered after amputation.

Keywords:
Jumping residual limb
Amputation
Involuntary movements
Neuropathic pain
Neuroma
Rehabilitation

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