No Back Pain But Tingling sensation in Right inner, outer and Knee

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sandeep.sutar
Member

April 23, 2014 at 2:34 am

Post count: 2

#10810

Dear Doctors.
I have problem of tingling sensation in Right foot Thigh in innar and outer side. Doctors said its meralgia paresthetica So i got Nerve block on LCF nerve, but 0% results. I don’t know what it is. this pain is continuing since 2 years. is there any report which can show nerve compression. I already taken MRI for whole spine. but no bulging in L4-L5. i am keep following doctors but no reason getting answered for tingling sensation. should i get MRI or any other report done for finding nerve compression i.e its exact location.

actually got 4th MTP and 5th MTP joint injury below foot on 29th December, 2011 while getting off from bike (Metatalsagia). Those were paining for last 2.5 years. after that injury about 6 months tingling has got started whenever i sit on chair or on bike. but goes away when stand. I feel No weakness while walking/running for last 2 years. But on 4th August, 2013 i got ankle sprain while walking on inappropriate surface. So got ATFL tear. So while walking my ankle pains. from 24th March 2014 I also got tingling sensation in left foot while sitting.

on 07.04.2014 I got done EMG/NCV but this shows

Needle EMG
The Following muscles were examined with a concentric needle electrode:
1. Right Tibialis anterior 2. Right Medial Gastrocnemius 3. Right Peroneus Longus 4. Right Vastus Medialis 5. Right Extensor Digitorum Brevis.

Spontaneous activity
Absent
All Muscles were electrically silent when relaxed.

Voluntary Activity
on submaximal effort, polyphasics of 10-14 msec in duration and normal amplitude were seen in right extensor digitorium brevis and right peroneus longus. The other muscles showed motor unit potentials of normal form, duration and amplitude. on strong effort, the interference pattern was ly reduced in right peroneus longus and borderline in right extensor digitorum brevis and complete elsewhere.

comments
1. The EMG examination showed partial ongoing denervation with no reinnervation in right extensor digitorum brevis and right peroneus longus. The rest of the muscles showed normal EMG findings.
2. All Sensory conductions were normal including both lateral femoral cutaneous nerves.
3. The right common peroneal compound muscle action potential is attenuated relatively to the left common peronel. both tibial nerve compound muscle action potentials are normal with normal motor conduction velocity.
4. All F wave latencies are within normal limits.
5. Both H- reflex responses are normal.

Conclusion
This Study shows evidence of Right L5 Root Lesion.
There is no evidence of Meralgia Paresthetica on either side.
No evidence of any peripheral neuropathy is seen on this study.

Also Neuro Surgeon and Spine surgeon given opinion that there is no Disc Bulging MRI Lumbo Sacral Spine as Normal.

Also Done Report on 30th September, 2013.
Random Glucose 84mg% —– Ref Interval 70-150.

S Uric Acid 4.8mg% —– Ref interval 3.6-7.7

Vit B12 820 pg/mL — Ref interval 187-883.

25 OH- Vitamin D More than 100 ng/mL Toxicity

Some doctors said that it is nerve damage in foot.

that is neuroma.

But got pain relief by ESWT.

also done MRI for foot – But no sign of Neuroma.

My concern is that everthing is normal but then also tingling sensation comes when i sit now in boot leg in inner outer thigh in knee upto toes.

Doctors Please help..

Donald Corenman, MD, DC
Moderator

April 25, 2014 at 8:45 pm

Post count: 8660

#10825

Meralgia paresthetica (compression of the lateral femoral cutaneous nerve at the pelvic brim) will not cause foot paresthesias. This nerve exits the pelvis under Poupart’s ligament in the groin and is a strictly sensory nerve that innervates the front and lateral aspect of the thigh.

A nerve block of this particular nerve is very difficult as the exit point in the groin is highly variable. You cannot be assured that you have blocked the nerve.

An MRI of the spine that is essentially “normal” does rule out the source of this pain being spine related. The lateral femoral cutaneous nerve originates from L2 and L3 so you would have to look higher on the MRI to make sure there is no compression here.

Any compression of L2 or L3 would not cause foot or ankle symptoms as these nerves do not descend below the knee.

EMGs are good for discerning significant peripheral neuropathy and identifying the nerve responsible for motor weakness but you have neither. An EMG/NCV will not be able to identify the presence or absence of lateral femoral cutaneous nerve compression. Subtle peripheral neuropathy will not be picked up by the EMG/NCV test.

I do not know what “got pain relief by ESWT” means.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

sandeep.sutar
Member

April 26, 2014 at 4:12 am

Post count: 2

#10829

Thank you doctor for your reply…

Actually I got injury below foot on 4th and 5th MTP Joint getting off from Bike. This was due stone bruising to MTP joint. That time entire pressure was on Metatarsal region of Right Foot as i was getting off from bike as heel was up and 2nd leg was not on ground.

So 4th and 5th MTP Joint pain got reduced with treatment of ESWT.

but after this injury pain was hell in foot. so after 6 month tingling got started whenever i sit on Bike or on chair. That doctors said that was Neuroma.

MRI shows not sign of Morton’s Neuroma in space of 3rd , 4th , 5th MTPP joint.

So after 2.5 years i came to know about ESWT. tried for 5 session so after that got very much pain relief.

But these sensation in right foot are not going any way if i sit on chair.

these sensation are coming only when i sit.

when i walk there is no problem of tingling.

but whenever i sit these sensation causes pain in the night while sleeping.

As i have sitting job. Working hours are 8-9 hours.

if i avoid to sit on chair not tingling so no pain in inner outer thigh and also in knee.

When i swim i fell better for 2-3 hours. But when i sit those sensation returns.

Tingling is in exactly in same area which is covered by anterior femoral cutaneous nerve.

i don’t know what it is ???

Femoral Nerve Compression Due to Stiffness of Ligament as movement of Foot was painful and less for 2.5 years (Right Foot) due 4th 5th Toe MTP Joint Injury.

or is there any Compartment pressure in groin region.

or Lumps in the groin region caused by swollen lymph nodes.

Please guide.

As going through this dying pain while sitting since last 2.5 years.

Doctors are prescription like gabapentin /tryptomer.

Those medication worked for some days.
but when stoped same situation returned.

Sandeep Sutar

Donald Corenman, MD, DC
Moderator

April 28, 2014 at 8:27 am

Post count: 8660

#10834

I still do not understand what ESWT is.

MRI might not note a neuroma in the foot but a diagnostic injection of the nerve might give you enough relief to diagnose this condition as a neuroma.

The tingling in your anterior thighs certainly might be meralgia paresthetica. Since the nerve travels under Poupart’s ligament in the anterior groin, flexion of the thigh (sitting) will increase the pressure in this region and you will develop onset of these thigh symptoms. Standing of course will reduce the pressure under the ligament and the symptoms will abate.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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