Clinical Professor of Physical Medicine and Rehabilitation U of Massachusetts Worcester, Massachusetts, United States
Case Diagnosis: The patient’s mild diabetes with HgA1C 6.1 doesn’t explain his symptoms and electrodiagnostic findings. These are more consistent with a critical care neuropathy.
Case Description: 60 y/o male with a past medical history of type 2 diabetes and polyneuropathy in his feet, hypertension, peripheral vascular disease, and osteoarthritis, presented for physiatry consultation and electrodiagnosis. He had profound weakness in R > L hands and numbness in his fingertips, unlike that in his toes. He was previously diagnosed with COVID 19 and hospitalized for 2 months, with intubation, trach, and PEG tube placement. He denied tobacco use but used alcohol. He was physically fit and worked in construction prior to his illness. Physical exam revealed duputren’s contractures L > R, decreased distal sensation (hands > feet, R > L), generalized distal hand muscle atrophy, L > R, gait without focal abnormalities. Electrodiagnostic findings were consistent with significant sensory neuropathy, in the lower and upper extremities, with L > R decreased ulnar motor amplitude, and conduction block and decreased recruitment on needle EMG in ulnar innervated muscles.
Discussions: One of the side effects of COVID 19 treatment involving long-term critical care and ventilation is a critical care neuropathy or myopathy. This problem along with deconditioning has significant implications for recovery of prior function including ability to perform basic ADL’s, and higher-level ones such as a job which in this case involved physical work.
Conclusions: This case illustrates the rehabilitation and neuromuscular issues that can result from COVID 19 and is a reminder that physiatrists need to be astute diagnosticians, utilizing tools like electrodiagnosis, when evaluating one’s potential for a complete, functional recovery. This holistic approach to patient care also includes management of the mobility impairments along with treatment of other concomitant problems such as neuropathic pain to improve the patient’s quality of life.