Spatz Moshe, O'Donnell Madison, Gamil Amir, Gerstman Brett
Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ, USA.
New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA.
Interv Pain Med. 2025 Mar 5;4(1):100560. doi: 10.1016/j.inpm.2025.100560. eCollection 2025 Mar.
Intramuscular schwannomas are rare tumors originating from Schwann cells in the peripheral nervous system. These tumors typically occur along small motor nerves deep within the muscle, presenting diagnostic challenges for clinicians due to their rarity and nonspecific symptoms. They can induce pain that is resistant to interventions, and surgical removal is often the only method that provides relief of symptoms. We present a case of a 65-year-old male with low back pain and concurrent right anterior thigh pain and paresthesia. Despite extensive evaluation by numerous specialists and thorough diagnostic testing, including spinal MRIs and electrodiagnostic studies, no clear diagnosis was initially established. His symptoms remained resistant to medical and interventional treatments. Ultimately, MRI imaging of the right thigh revealed a mass measuring approximately 2 cm in the vastus medialis. Following excision of the mass, the patient experienced immediate symptom relief. This case highlights the importance of maintaining a broad differential when evaluating low back pain with associated lower extremity symptoms. We aim to highlight the importance of recognizing this possibility of extra-spinal pain generators.
肌内神经鞘瘤是起源于周围神经系统施万细胞的罕见肿瘤。这些肿瘤通常沿着肌肉深处的小运动神经发生，因其罕见性和非特异性症状给临床医生带来诊断挑战。它们可引发对干预措施有抵抗性的疼痛，手术切除往往是缓解症状的唯一方法。我们报告一例65岁男性，有腰痛，同时伴有右大腿前侧疼痛和感觉异常。尽管众多专科医生进行了广泛评估并进行了全面的诊断检查，包括脊柱磁共振成像（MRI）和电诊断研究，但最初并未明确诊断。他的症状对药物和介入治疗均有抵抗性。最终，右大腿的MRI成像显示股内侧有一个大小约2厘米的肿块。切除肿块后，患者症状立即缓解。该病例突出了在评估伴有下肢症状的腰痛时保持广泛鉴别诊断的重要性。我们旨在强调认识到脊柱外疼痛源这种可能性的重要性。
