[Addison]

#28436

Hello doctor, I had a severe fall in January after which I have severe muscle weakness in my right leg as well as severe nerve pain in my foot. An MRI without contrast showed compression at L4-L5 and T12-L1 nerve roots, but nothing that correlates to my muscle weakness, which seems to be in the S1 distribution area.

Shortly thereafter I got an EMG, the notes of which are below:

Severe RIGHT Sciatic Neuropathy, versus Lumbosacral Plexopathy versus Multilevel Radiculopathies. These could be secondary to stretch nerve injury, given the history of trauma. The absent sensory potentials argues against radiculopathies, except if dealing with root avulsions. Would recommend: repeating the MRI of the L/S Spine w/wo contrast to evaluate for root avulsion. Also obtain MRI of the Pelvis and Right Hip (with attention to the Sciatic Nerve) to evaluate for L/S Plexus and Sciatic Nerve Lesion. Physical Therapy 2-3 x week x4-6 weeks for strengthening of the right lower extremity is recommended.

In regard to all the different things that the neurologist references here that I could be dealing with, are there any of them that cannot be treated with surgery? I’m just trying to understand my outlook. I’m dealing with the VA system so I’m still a month away from getting a second MRI and several months away from speaking again to any of my doctors about what this means, and I’m thinking/worrying about my prognosis constantly.

[Donald Corenman, MD, DC]

#28462

What does a severe fall mean? Please describe the mechanism of the fall and how your symptoms started and progressed.

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.

[Addison]

#28464

I fell from a ladder approximately six feet and landed on my tailbone onto concrete. I tried to get up but immediately had difficulty standing or even “willing” my legs to move at all. An ambulance came and took me to the hospital, where I stayed overnight. I would say for the first month and a half or two months I had a ton of trouble walking. I dropped all my classes for that semester, and basically stayed at home 24/7, struggling to do things like go to the grocery store. Eventually I started to get something like a normal gait back, although I definitely have trendelenburg gait that doesn’t seem to be getting any better (Yet, I know it’s possible that my nerves are still healing). My right calf and hamstring don’t seem to be innervated very much if at all, as I cannot raise up on my toes at all with my right leg nor can I do any exercises that target my right hamstring alone; I just can’t generate any force whatsoever. The nerve pain is pretty much all in my right foot, where I feel it mostly on the sides but also on the top and bottom.

I just wonder if my new MRI with contrast ends up showing any of the things the neurologist mentions in her notes, are any of those things “fixable” via surgery? Having read much on your website I understand what happens if a nerve is compressed, but a lot of what she mentions I don’t understand what could be done about them. It sucks because I already feel like I’ve lost a ton of time waiting for appointment after appointment; everything you might hear about the VA medical system and their wait times I now know to be true unfortunately.

[Addison]

#28465

I should also mention the skin on the bottom of my right foot on the foot pad and under the arch feels like it’s gotten really think, although I’m not sure if it actually has or just feels that way. Also I haven’t gone barefoot since the accident happened, even in the shower I wear shower shoes because I feel like I’m literally walking on the bones in my feet.

[Addison]

#28466

Thick** not think

[Donald Corenman, MD, DC]

#28468

It is hard to say exactly what happened with your fall. The impact on your buttocks from a 6 foot drop is substantial. I assume you had no fractures of your pelvis or lumbar vertebra.

Your current symptoms of gastric and hamstring weakness are an S1 nerve injury. Do you have any other weaknesses?

The “thickening feeling” is common with a sensory nerve injury. You will probably recall how thick your jaw felt with a dental nerve block. The S1 nerve innervates the bottom of the foot, so the injury fits with a global S1 root injury.

I would agree that you need a new MRI of the lumbar spine with gadolinium and an MRI of the right pelvis to look for plexus injury (the nerves after they exit from the spinal canal). This should be your next step.

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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