1650 - When Rhabdomyolysis Gets on Your Nerves: A Case of Lumbosacral Plexopathy Versus Radiculopathy

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SK

Shubhangi Kumar, DO

PGY-2
MossRehab
Philadelphia, Pennsylvania, United States

Co-Author(s)

CS

Channarayapatna Sridhara, MD

Attending Physician
MossRehab
Elkins Park, Pennsylvania, United States
NM

Neville Mathews, DO

Attending Physician
MossRehab
Elkins Park, Pennsylvania, United States
TW

Thomas Watanabe, MD

Physician - Physical Medicine and Rehabilitation / Brain Injury and Stroke Rehabilitation
Jefferson Moss-Magee Rehabilitation
Elkins Park, Pennsylvania, United States

Submitter(s)

SK

Shubhangi Kumar, DO

MossRehab
Philadelphia, Pennsylvania, United States

Case Diagnosis: Lumbosacral Radiculopathy

Case Description: This is an 80-year-old woman with osteopenia, hypertension, and diabetes who was found in her bathtub after a fall. She was down for 16 hours with her back in an extended position. On admission, creatine kinase and creatinine were elevated; intravenous fluids resulted in renal recovery. She was then transferred to acute rehabilitation for lower extremity weakness. There was hyporeflexia at the patellar and Achilles tendons with new urinary retention. MRI of the lumbar spine demonstrated venous plexus engorgement at L5–S1, which partially accounted for her bladder dysfunction. Electromyography showed severe acute axon loss in bilateral L1-L5 distribution with decreased to absent voluntary motor unit potential recruitment, increased insertional activity, and lack of obtainable sensory nerve action potentials (SNAP), which in this clinical context leads to suspicion of lumbosacral plexopathy or radiculopathy.

Discussions: Rhabdomyolysis involves the breakdown of skeletal muscle, most commonly from traumatic injury, presenting with myalgias, muscle weakness, and acute kidney injury. Paraspinal abnormalities may be related to rhabdomyolysis in paraspinals. Loss of SNAP may be due to local factors. Neurological complications are uncommon, but in this case the patient exhibited hyporeflexia, sensory deficits, and urinary retention, but MRI did not fully explain the neurological symptoms. Electromyography was essential in identifying the cause of lower motor neuron involvement, diagnosis, and guiding rehabilitation planning.

Conclusions: This case highlights a rare presentation of rhabdomyolysis with associated lumbosacral radiculopathy masquerading as plexopathy. Clinicians should maintain a broad differential when evaluating patients with rhabdomyolysis who present with neurological deficits as weakness, sensory changes, and hyporeflexia may signal plexus or root involvement rather than isolated myopathy. Although MRI provides useful structural information, electrodiagnostic testing may be necessary to confirm the diagnosis and fully characterize the extent of neurological injury. Early recognition of complications is critical for management and functional recovery during rehabilitation.