Jumping Stump Syndrome in a Transtibial Amputee

Case Diagnosis: Jumping Stump Syndrome in a transtibial amputee.

Case Description or Program Description: A 53-year-old male presented to Prosthetics two years post transtibial amputation secondary to ischemia. He reported debilitating muscle spasms and resultant pain that limited prosthesis use and interrupted sleep. Exam demonstrated myoclonus and dystonia concentrated in the posterior, lateral and distal residual limb. The prosthetist fit the patient with a new, more comfortable prosthesis. However, the patient’s symptoms continued to limit prosthesis use to 5 to 20 minutes daily.

Setting: Academic Clinic

Assessment/Results: The prosthetist referred the patient to Physiatry for trial of botulinum injections in the residual limb. He received 75 units of onabotulinumtoxin A each to the medial and lateral gastrocnemius, tibialis anterior, and fibularis longus. After three months, the patient reported ten weeks of symptom improvement and increased prosthesis tolerance up to 45 minutes daily. He next received repeat injections to the same sites, with an increased dose of 400 units of botox total. At next follow up, the patient reported 13 weeks of improved sleep quality, prosthesis wear time, and mobility. He denied adverse effects to botulinum toxin, and received further injections of consistent dosage.

Discussion (relevance): Jumping Stump Syndrome is characterized by painful, convulsive movement of the residual limb following amputation. This can include spasms, myokymia, myoclonus, and/or psychogenic movement disorders. Treatments include pramipexole, clonazepam, or sciatic nerve block. With neuroma involvement, phenol injection into the neuroma or excision of the neuroma has elicited beneficial results. Few case reports describe botulinum toxin use in treatment of Jumping Stump Syndrome. However, available reports note reduction in frequency and severity of spasms, improved sleep quality, and increased prosthesis use after repeat botulinum toxin injections.

Conclusions: When evaluating patients with residual limb pain or difficulty tolerating their prosthesis, Jumping Stump Syndrome should be considered. In these cases, botulinum toxin injections may be of use.