Low Back & Leg Pain - Part I

Pelvic fracture and nerve damage (LL pain) after pelvic bone graft for cervical disc operation           Top

Question

This is a long story, but I'll try to keep it short. Five months ago, I had neck surgery for 3 degenerated discs in my neck. The surgeon took bone from my pelvis to insert between the discs in my neck. The day after surgery when I stood on my feet, I suffered a fractured pelvis - the bone broke off from where the donor bone had been taken. The next day, the surgeon operated again and tried to put the bone back in place with a plate and screws. A week later, the hardware came apart. After consulting with a pelvic specialist, I underwent a third surgery, where the bone was taken off completely and the ligaments involved were reattached. After much pain and much struggle, I am walking with a cane. However, I am now suffering with severe nerve pain in the knee to thigh area. The stinging severe pain with bouts of searing stabbing sharp pains are starting to get to me. I have undergone PT and I exercise daily at the gym. Of course the only way I can do this is because I am taking the pain medication Vicodin. I also have been diagnosed with stenosis and I have osteoarthritis. I have also suffered with muscle and joint pain for the last ten years. All I needed was damaged nerves in my leg to add to the misery.

Can you tell me if this nerve pain will go away in time or should I see a neurologist. Thanks.

Answer

My best advice to you is to see a neurologist because if the nerve pain is due to nerve damage (you have had many manipulations to that area), it is not likely to go away on its own.

Loss of sexual competency after pelvic surgery Top

Question

I had a total hysterectomy a year ago. I am 45 years old. I was extremely sexual active, etc. Since the surgery, I seem to have lost desire and stimulation sexually. I am taking hormones and testosterone. No luck, No thrills, Nothing. I am wondering could I have experienced nerve damage during my surgery and this could be the reason why I feel dead everywhere. Can nerve conduction restore any damage in this area, the pelvic region...

Answer

To answer the EMG question, Nerve conductions WILL NOT restore damaged nerve, they are purely diagnostic in nature and have no therapeutic effects. The other question is more the domain of ob/gyn specialists but certainly nerves can be damaged during surgery in this area causing symptoms similar to yours

Post laparoscopic hernia operation leg pain Top

Question

I have had leg pain for 3.5 years. It started just after laparoscopic surgery for my hernia. The first 18 months left me crippled. The pain is less now but still persists in the hamstring area. I recently saw a local neurologist and he thought the leg pain and hernia surgery were unrelated and he did not think an EMG was appropriate (I disagreed).

Question: In your travels, have you ever heard a story like mine, & what do you think? Thanks

Answer

Pain after surgery could be due to injury during the surgery or to the position of the patient during the procedure. When the symptoms improve, it means that the nerve is slowly growing back. What patients may be left with is some unusual posturing which they used to put themselves in to relieve the pain but which is no longer needed. These types of postures respond very well to physical therapy.

Femoral Nerve entrapment Top

Question

Would complex repetitive discharges at L3-L4 and a H-reflex latency of 32.4 msec on the right side be possible evidence or indication of femoral nerve entrapment, especially 5 months post op for femoral hernioplasty ?

Answer

The involvement of L3-4 paraspinals and a prolonged tibial H-reflex provide no information about the integrity of the Femoral nerve. If you meant L3-4 Femoral muscle was involved (Quadriceps) and H reflex in the Quadriceps was that prolonged, then indeed Femoral neuropathy is present.

Post discotomy Lumbar Radiculopathy Top

Question

I had a microdiscetomy on my lower lumbar L5-S1 and had a large portion of disc removed. I had 2 EMGs that were stated normal, and basically considered to be a malingerer since I couldn’t activate my leg like they wanted me to, so anyways just recently I under went the 3rd this one was stated as a abnormal study, having electrical evidence of an old (healed ) or chronic right l5 radiculopathy, also stated needle exam reveals mild chronic reinnervation in a right l5 distribution, here’s the question What does this mean in human terms

Answer

In human terms, this is like having scar tissue on your nerve which can be detected by the needle inside the muscle. These findings are likely scar tissues from your previous surgeries, not evidence of a new nerve injury

EMG in Hamstring pain Top

Question

The muscles (I think it's the muscles) in the back of my left leg from my gluteuss maximus to my ankle has been hurting since November. I've seen my doctor and she prescribed Motrin and heat. That didn't seem to work. I thought it was a strained/pulled muscle but I know by now it would've gotten better and it hasn't. My doctor thought that's what it was too. I went to an orthopedic and he examined me too. My appointment for an EMG test is tomorrow and I've wanted to know what they do? Does it hurt? What could it be? Please tell all.

Answer

It sounds like your doctor is suspecting a pinched nerve and an EMG will be very useful in showing it or ruling it out. It is an uncomfortable test, where the doctor uses electrical shocks to study the nerves and needle probes to study the muscles, but does not last too long and is usually quite useful for conditions like yours.

 EMG in lumbar disc prolapse Top

Question

A friend of mine recently had and EMG with normal results. His MRI reveals herniated discs at L4-5 and L5-S1. He frequently has pain radiating into his legs. Is an EMG a reliable test? Are there ever false negatives? Any feedback would be greatly appreciated.

Answer

Yes, EMGs can be "normal" in clinically and MRI confirmed root lesions. So if your friend has the clinical and MRI signs, a negative EMG does not rule it out.

Numbness in the legs Top

Question

My mother is suffering from a numbness in her feet and legs that makes it almost impossible to walk It initially started as numbness in her feet several years ago. It has now advanced all the way to her thighs. The original diagnosis was Parkinson’s - it's not. The Neurologist then suggested B-12 shots-it hasn't helped. She is now scheduled for an EMG next week. Any thoughts? Any past experiences?

Answer

Peripheral neuropathy (among other causes) commonly present with numbness in feet. Although we do not have all history and examination but as a first step in case of your mother is to rule out peripheral neuropathy by doing EMG and nerve conduction studies. I wonder do your mother have any symptoms in the hands? B12 deficiency is one cause of peripheral neuropathy.

Answer

The symptoms you describe are commonly seen with peripheral neuropathies, and when they go up to the thigh, it's a pretty advanced form. Neuropathies are most commonly seen with diabetes and alcohol (now or in the past) but there are a slew of other conditions, which can cause them such as (to cite only a few) toxic, occupational exposure, metabolic and nutritional problems, thyroid disease, a disease known as Guillain-Barre syndrome and of course B12 deficiency, which is accompanied by anemia. The EMG should help in finding out whether or not there is a neuropathy and what type, but does not tell you what's causing it. Based on the EMG results, a neurologist should be able to order some blood tests to determine (and see if it is possible to treat) the cause of the neuropathy.

Numbness along shin (anterior aspect of right leg) Top

Question

2 months history of numbness along the shin complaint in a 55 yr. lady with no clinical evidence of peripheral neuropathy. No low backache, started insidiously.

Answer

Numbness along the anterior aspect of the lower leg/dorsum of foot could be due to a superficial peroneal nerve lesion (check out the anatomy at: http://www.teleEMG.com/Anatomy/Nerves/peranat.htm) or a root lesion or a mononeuropathy among others.. An EMG would be very helpful in this case

Heel pain Top

Question

I worked in the yard for a couple of hours on Monday morning. that afternoon it felt like there was a golf ball under my right heel when i walked. The next morning when I got out of bed my right heel hurt so bad I couldn’t put the slightest weight on it. All day Wednesday and Thursday I couldn’t walk because of the worst pain I have ever felt. (right heel) this is Friday morning and I am slightly recovering. Could this be a sciatic nerve thing? I have had this twice before in the last 40 years but it was both times in the knee. I am 69. any help would be welcome.

Answer

What you describe does not sound like a sciatic nerve injury to me. My guess is that you have a local tendinitis, perhaps Achille's (heel) tendinitis which should improve on its own with some rest and icing of the heel.

EMG / NCV in lumbar disc Top

Question

I am scheduled for EMG/NC's next week. The latest MRI shows herniated disc at L5S1 and bulging disc at L4, with no significant changes from original one 2-1.2 years ago. 'Have had pain in back and legs for what seems like forever, now weakness is developing in left leg. What do these tests entail and do they hurt? Thanks for your help.

Answer

EMG stands for electromyography, which loosely translates into electrical testing of the muscles and nerves. The test is a little uncomfortable. The doctor uses electrical impulses applied to your skin to test nerve conductions and then uses a needle probe (without electricity) to study muscles in your leg and back. The whole test takes 30-45 minutes. The test is quite useful, although not a 100% fool proof, in detecting pinched nerves and diseased muscles.

Nerve damage healing process Top

Question

Upon your advice, I went to see a neurologist and had an EMG. The doctor told me that I had nerve damage due to the three surgeries I had in October. He said that the nerves would eventually regenerate and gave me a prescription for amitriptaline. He wants me to work up to 50mg daily. Right now I am up to 40 mg. I notice a very slight improvement in the pain, burning, numbness, etc. Can you tell me how long the nerves could take to repair themselves? Am I looking at possibly a year or even more? It is the nerve that runs from the groin down both sides of the thigh and across the knee. Thanks for your comments.

Answer

Nerves grow very slowly, about 1mm/day, you can almost compare it to how fast a hair grows and you will have a ballpark figure. So it takes usually anywhere from 6 to 18 months. Amitryptilline and other drugs like it help relieve nerve pain such as yours so this should help and you should start noticing some improvements.

Intense thigh pain Top

Question

About 3 weeks ago I woke up with a sore and stiff knee. 2 days later it went to what seemed to be my hip. I went to the doctor and was put on Vioxx and Ultram, X-rays were normal. I then went to a rheumatologist who said she thought the pain to be coming from my adductor muscle. I have intense pain especially at night, a limp, and muscle weakness upon lifting my leg, or walking. This came on suddenly and without any injury. Please any comments or thought on the cause would be greatly appreciated. This has been going on now for three weeks. I am beginning to get so down from this not to mention extremely fatigued from the lack of sleep. Please help!!!

Answer 1

I am not quite sure from your description if you're having joint or neurological symptoms. Certainly a pinched nerve in your back could cause the thigh pain and weakness. Also there is a nerve called the femoral nerve which could be compressed in the groin in patients with diabetes (the condition is called diabetic amyotrophy) and cause these symptoms as well. If your pain and weakness are not improving, you should see a Neurologist.

Comment

I have now gone to see a physical therapist, who, it seems has done more for me than any Dr. so far. She seems to think, after a half an hour of counsel with me and working on me, that my pelvis is of balance or out of line. This in turn is affecting the capsule around the hip joint, which is then affecting the muscles in the thigh and groin. She also said that the muscles in both of my legs were very tight. I must say, when I got of her table I thought I was cured for about a half an hour. I was able to go up stairs and walk without any pain. It was all back again that night. What are your thoughts on diagnoses like this. Is this very common? Have you ever heard of a case like this? Or any symptoms like this? Thanks!

Answer

Again my concern in your case is the weakness you mention. A nerve lesion could cause the pain and the weakness whereas a pelvis lesion would cause mostly the pain. So unless you are sure that there is no nerve lesion or pinched nerve, you can treat it with Physical Therapy. But if the nerve is involved you'd have to do something about it otherwise no amount of physical therapy is going to cure your symptoms.

EMG for CTS & Spinal Stenosis vs. Hip Replacement Top

Question

My mother broke her hip and her wrist in 1993. She has since been diagnosed with CTS and Spinal Stenosis. She is in quite a bit of pain and has just been referred for an EMG for the arm and the leg. Is there any reason that both could not be done on the same day? Also, will the EMG help to resolve the question of whether the stenosis or the hip is causing her pain?

Answer 1

Usually the EMG of the arm and leg are done in a single session. Also the EMG will be able to determine whether or not the spinal stenosis is causing nerve damage which in turn causes pain.

Leg Crossing leading to foot drop Top

Question

My teenage daughter recently had to observe her dance classes for 4 weeks instead of participating because of a healing stress fracture and while doing so continually crossed her bony long legs resulting in a peroneal injury affecting her toes and top arch. We had noticed a foot drop but thought it was related to adjusting to walking in an air cast for the opposite leg stress fracture. After noticing drop (into third week) of repetitive leg crossing, we backtraced the cause of the peroneal pressing and she is on the road of recovery. She went from a grade 0 of extreme weakness with no strength to a grade 3 - 3 1/2 of being able to lift her foot and flex toe in about three days of corrective behavior. Can we continue to see immediate and fast recovery as we have seen or will the recovery slow as the complete heal is in sight? Do you have any insight as to what we should do to help her recovery along? Her stress fracture on her opposite leg is healed after the six-week rest and she hoped to get back to dancing this week. Should she dance while holding onto the dance bare or would you recommend a complete recovery of the peroneal nerve before returning to dance. By the way, she is able of get on toe point and has not loss any leg muscle strength. We consider ourselves very lucky to notice this and stop the leg-crossing activity, although not quite soon enough.

Answer

Thank you for a great description. Most likely, as you have figured out, this was due to her leg crossing behavior, specially if she doesn't have much fat padding which makes the nerve especially vulnerable to leg crossing. The rule of thumb is that if recovery begins early and fast, it will continue to do so because it is likely the lesion just involved the nerve sheath (the myelin) not the fibers the themselves (the axons) and the nerve will return to full function. I would be more careful on her returning to the dance floor however for the following reasons. She has a (freshly healed) fracture on the other side and she is not back 100% on the peroneal nerve lesion side, so you don't want her to fall at this point. I, personally, would wait until she got back 100% of her peroneal nerve function back before returning to the dance floor.

Abnormal foot movements after EMG & NCV; is it due to the test? Top

Question

I had an EMG and nerve conduction test done for ALS because of some minor fasciculations The EMG found fasciculations, no fibrillations, so the neuro felt I was clean. But just 4 days after the test my foot, where most of the testing was done on, (at least five separate sets) started vibrating and fasciculating like crazy. It then spread after a month to my other foot. Is this not an uncommon reaction to the test? Thank you

Answer 1

This is not a common reaction to the test; in fact I have never seen it happen. I cannot tell you what this is due to but if you feel that this is way out of the ordinary for you (and it has lasted this long) I would get in touch with your doctor and tell him/her about it.

Babinski sign Top

Question

I have a question, which I can’t find an answer in none of the medical books. A negative Babinski is when your toes crawl downward. A positive one is when your toes crawl upward

What is the meaning of no movement at all?? Does it completely o.k. (Like crawling downward!) THANKS IN ADVANCE

Answer

Neurologists always have wild discussion on the misnaming of the "extensor" sign. (Flexion shortens a limb; extension lengthens it). It is therefore more appropriate to note that the toe goes up or down, instead of using the word "flexion" or "extension" alone. A "plantar flexion" and "dorsiflexion" are equally clear. But the key muscle is the extensor hallucis longus. Babinski--a French neurologist of Polish descent and a pupil of Charcot--was the first to differentiate between a normal and pathologic response of the toes and recognize its clinical implication. To answer your question, in a mute response, check that no paresis or weakness in effector muscles (e.g. peroneal nerve palsy, severe radiculopathy or peripheral neuropathy). Make sure that the foot is not cold.

I hope you will find a lot of information in this book:

The Babinski Sign: A Centenary

By J. van Gijn. 176 pp. Utrecht, Heidelberglaan, the Netherlands, Universiteit Utrecht, 1996. $49.95. ISBN 90-9008908-X