Introduction:Jumping stump syndrome is considered to be a peripherally induced movement disorder due to damage to peripheral nerves.It is one of the rarest complications post-amputation with very few cases seldom reported world-wide.Pathophysiology is not well understood.Certain cases are considered to be due to propriospinal myoclonus.Psychogenic cases have also been reported.To date,there are no consensus-based best practice recommendations to treat jumping stump syndrome.

Case presentation:54year old male who presented after 2years since transtibial amputation came with complaints of paraesthesia,phantom limb sensation along with involuntary twitching movements of the residual limb.These movements which started within1month of amputation were initially occasional and gradually hampered sleep.In the following years,it increased in frequency and was reproducible on tapping or massaging the limb.On admission these movements were visible in the residual limb.Tinels sign was present in the retained twigs of fibular and tibial nerves.Onprosthetic fitment,patient had experienced movements of the limb within the socket and had thereby developed repeated ulcerations on shin.This also led to decrease in the prosthetic wearing time.

Discussion:In this jumping stump,along with amitriptyline and gabapentin,nerve blocks were given for both tibial and fibular nerve twigs.Botulinum toxin typeA was given to both heads ofgastrocnemius.Post injection patient had reduction of involuntary movements and this helped in wound healing of residual limb.This led to increased prosthetic wearing time and better prosthetic rehabilitation. 

Conclusion:Botulinum toxin typeA addressed consequences rather than cause of this movement disorder.It should be considered as treatment for jumping stump syndrome to improve prosthetic wearing time and comfort

Anjana Chandran Nair has completed her MD in Physical Medicine and Rehabilitation from Government Medical College Thiruvananthapuram, Kerala, India. During her post graduation she had won many prizes including First prize in quiz competition and scientific paper presentation in Indian Association of Physical Medicine and Rehabilitation conference.She has publications as first author in both indian and international journals. She has attended several national and international conferences and workshops and presented scientific papers and posters.