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Neurological Rehabilitation

(Kiosk 3) Jumping Stump Syndrome: A Case Report

Thursday, November 16, 2023
5:00 PM – 7:00 PM CT

    Primary Author(s)

  • Rachel H. Anderson, MD (she/her/hers)

    Resident Physician
    University of Kentucky College of Medicine PM&R Program
    Lexington, Kentucky

    • Co-Author(s)

  • Jamie Key, DO

    Residency Program Director, Brain Injury Medicine Fellowship Director
    University of Kentucky College of Medicine PM&R Program
    Lexington, Kentucky

Case Diagnosis: 76-year-old female with jumping stump syndrome

Case Description or Program Description: The patient is a 76-year-old female with a history of left dysvascular below-the-knee amputation who presented to clinic with abnormal movements of her residual limb. She initially recovered well from her amputation with mild residual phantom limb pain. Three years following the amputation, the patient experienced a backwards fall with loss of consciousness; she was evaluated in the emergency department and noted to have no acute injuries. Following the fall, she began experiencing non-painful myoclonus of her residual limb. She was noted to have two neuromas for which she received phenol injections. The patient also began experiencing painful intermittent sustained contractions of her hip flexors that would resolve spontaneously. She was placed on an oral Baclofen regimen, resulting in some improvement of myoclonus; however, the dystonic character persisted. These dystonic movements resulted in difficulty sleeping, decreased mood, and decreased mobility. MRI Head with and without contrast showed posterior occiput evidence of post-concussion and chronic vascular changes, but no acute process was observed.

Setting: Outpatient Physical Medicine and Rehabilitation Clinic

Assessment/Results: Upon evaluation, the patient had sustained myoclonus with provocation of the residual limb, potentiated by palpation of the neuromas. Botulinum toxin injections to lateral and medial hamstrings, rectus femoris, and iliopsoas were performed with EMG guidance (100 units total). At 6-week and 3-month post-injections, patient had noted decrease in dystonic events. She had marked improvement in mobility, mood, and sleep.

Discussion (relevance): Jumping Stump Syndrome is a rare peripherally-induced movement disorder following limb amputation. Available literature is limited, therefore, there are no clear treatment guidelines for Jumping Stump Syndrome.

Conclusions: Botulinum toxin in conjunction with oral Baclofen should be considered as a treatment option for Jumping Stump Syndrome.