352 - Diagnostic Challenges and Rehabilitation Strategies for Inclusion Body Myositis: A Case Report

Case Diagnosis: A 71-year-old woman presented with a 7-year history of progressive lower extremity weakness, gradually affecting her hands. Initial misdiagnoses led to lumbar spine fusion surgery for sciatica, followed by a lumbar decompression procedure for foot drop. Despite resolution, her muscle weakness persisted, more pronounced in the left lower extremity. Additional symptoms include Sjogren’s syndrome with increased dysphagia. EMG and muscle biopsy revealed a diagnosis of Inclusion Body Myositis (IBM) after presentation to the rehab clinic.

Case Description: The patient's weakness interfered with daily life, requiring an Ankle-Foot Orthosis (AFO) and impeding activities like climbing stairs, writing, and cooking. Despite surgical interventions, muscle function continued to deteriorate, mimicking as radiculopathy. A physical therapy approach with subthreshold muscle engagement resulted in substantial functional improvements. However, after discontinuing therapy, muscle function declined. This case emphasizes the importance of tailored exercise guidelines for IBM management and early consideration of EMG and muscle biopsy for patients not recovering after lumbar surgeries and procedures.

Discussions: This case underscores the role of EMG and muscle biopsy in diagnosing patients presenting with muscle strength findings that do not correlate with a specific nerve root. In such cases, where clinical findings are inconclusive and radiculopathy-like symptoms persist, these diagnostic tools become essential. The timely use of EMG and muscle biopsy can unveil underlying neuromuscular conditions, enabling prompt intervention and symptom management. Future research should investigate the earlier consideration of EMG/muscle biopsy in similar patient presentations, where prior procedures weren’t definitive.

Conclusions: This case highlights the significance of tailored rehabilitation, particularly subthreshold muscle engagement, and underscores the importance of considering EMG and muscle biopsy when clinical findings and surgeries are inconclusive. These diagnostic tools can unveil rare neuromuscular conditions, enabling prompt intervention. The role of physiatrists in IBM management are evident, emphasizing the importance of early diagnosis and comprehensive care.