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Pain and Spine Medicine

Tibia Schwannoma Masquerading as Complex Regional Pain Syndrome: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 4

    Primary Author(s)

  • Eric Poole, MD

    Resident Physician, PGY-3
    Charles Drew University
    Long Beach, California

    • Co-Author(s)

  • TM

    Tamiel Murray, Other

    4th-year medical student
    Wright State University Boonshoft SOM
    Dayton, Ohio

  • CH

    Calvin Ho, MD

    Associate Program Director
    Charles Drew University/VA Long Beach Healthcare
    Huntington Beach, California

  • RM

    Roya Moheimani, MD

    Clinical Assistant Professor
    Charles Drew University
    Santa Ana, California

Disclosure(s):
Eric Poole, MD: No financial relationships to disclose
Case Diagnosis: Tibia Schwannoma

Case Description or Program Description: Tibial schwannomas are rare benign tumors of the peripheral nerves that can present with symptoms similar to Complex Regional Pain Syndrome (CRPS), including localized pain, swelling, temperature changes, and skin discoloration. Misdiagnosis can lead to a delay in appropriate treatment and prolonged patient discomfort.

Setting: Private Clinic

Assessment/Results: This case describes a 68-year-old female with progressive left lower leg pain, initially diagnosed as complex regional pain syndrome (CRPS). Conservative treatments provided no sustained relief. She declined a nerve conduction study/electromyography (NCS/EMG) due to sensitivity. Based on physical exam findings, including a positive Tinel’s sign at the medial ankle, she was diagnosed with tarsal tunnel syndrome.

After shared decision-making, she underwent tarsal tunnel release, but her pain persisted. Multiple lumbar sympathetic nerve blocks provided only temporary moderate relief.

Despite CRPS as the primary diagnosis, podiatry evaluation, including MRI, revealed a well-circumscribed mass posterior or medial to the distal tibial shaft. Neurosurgical excision resulted in immediate, complete pain relief. Pathology suggested a schwannoma compressing the tibial nerve. Additional symptoms—including sharp pain, tingling, ambulation difficulty, and muscle fasciculations—also resolved postoperatively.

Discussion (relevance): A thorough workup and a broad differential diagnosis are essential in refractory cases to uncover conditions like peripheral nerve tumors. This case highlights tibial schwannomas as a CRPS mimic, risking misdiagnosis and delayed treatment. MRI aids diagnosis, and timely surgery can ensure symptom resolution and improved outcomes.

Conclusions: This case underscores the importance of considering peripheral nerve tumors, such as schwannomas, in the differential diagnosis of CRPS. Early advance imaging and timely surgical intervention can prevent misdiagnosis, leading to symptom resolution, functional recovery and improved patient outcomes.