Hepatic Encephalopathy Masquerading As Bilateral Cubital Tunnel Syndrome: A Case Report

BACKGROUND: Neurologic manifestations of liver dysfunction may mimic common musculoskeletal conditions, complicating differential diagnosis in physical therapy practice. This case highlights hepatic encephalopathy presenting as bilateral upper extremity neuropathic symptoms. CASE PRESENTATION: A 39-year-old woman, status post liver transplantation, was referred to physical therapy with a diagnosis of bilateral cubital tunnel syndrome. Examination revealed bilateral, nonspecific sensory changes, preserved reflexes, and previously unrecognized bilateral asterixis, raising concern for systemic pathology. OUTCOME AND FOLLOW-UP: Physical therapy intervention was deferred, and the patient was referred for urgent medical evaluation. Laboratory testing demonstrated significant hepatic dysfunction and hyperammonemia. Electrodiagnostic studies were normal, and liver biopsy confirmed T-cell–mediated transplant rejection. DISCUSSION: This case illustrates the importance of neurologic screening and systems-based clinical reasoning in identifying hepatic encephalopathy masquerading as focal neuropathy.