Viewing 6 posts - 1 through 6 (of 16 total)
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  • Pafrmboy
    Participant
    Post count: 8

    Hi. Great Forum!! I’ll add my situation to the pile!

    I developed this issue some 5 years ago when I was running and began to feel some numbness in my left foot.(I used to run about 10-12 miles per week). It was like I lost orientation of my left foot. I felt that I might trip. It was not every time I ran though. I’d slow down and it would go away.

    It progressed to having some medium type back pain attacks over the next year and then the back pain all but disapeared. Sciatica and left leg occasional numbness then developed over the next 2 years to the point that I had to sit down sometimes. As soon as I sat down for 5 mins, all was OK.

    During the last 18 months all sciatic pain is gone, but I developed left medial gastronemius weakness. It affected my gait and I could not stand on toes on the left side with the right foot elevated. Of course this led to knee pain, as the lateral gastronemius picked up the slack.
    I had atrophy in the left medial gastronemius too.

    Amazing the right leg was always OK and then suddenly a few months ago..like overnight, the right medial gastronemius was quite weak. I was alarmed! It happened so quickly. What is more weird is that the left leg is regaining strength!! ( I can stand (weakly) on toes using both feet), but feel that the left leg is doing most of the work. Both the right and left LATERAL gastronemius(s) are strong.

    Again I have NO significant back pain except some tightness and an occasional ache. I take no meds except NSAIDS and not even those daily.

    My main issues are now “push off” during my gait. If I walk long distances, I am exhausted. (My legs anyway) I feel I’ve climbed a mountain. I sometimes feel that I might fall backwards, as the plantar reflex strength is quite weak in both feet. However at times during the day, the strength suprisingly better! It’s up and down. If I do inversion therapy for 10 mins, the strength is better, but it does not last.

    I am a Registered nurse and do spend alot of time walking. I also can’t run well and get knee pain on the push down stroke, while riding my bike. I know this is form the compensation of the lateral gastro and tendons doing all the work.

    I have had (2) MRIs and the last one 7/2012 was similar to the first. Revealing:

    1. The L5 S1 disk is dehydrated and mildly narrowed.
    2. There is a 3 mm left paracentral disk protrusion of L5 S1 that compressed the thecal sac and abuts the left S! nerve root. This could account for left S1 raduculopathy.
    3. The remaining lumbar levels are normal.
    4. Note is made of a transitional s1 s2 intervertebral disk space.

    I also had a nerve conduction/EMG done and it revealed:

    1. Active and chronic denervation in L3/4 and L5 S1 myotome, suggestive of LS polyradiculopathy. Left worse than right.
    2. It also demonstrated evidence of sciatica, left worse than right.
    3. Differential diagnosis include lower LS plexopathy and multifocal motor neuropathy. Motor neuro disease is possible, but patient’s clinical presentation is not suggestive of this issue.

    I’m 48 male, not overweight, or diabetic. No other chronic diseases, no hypertension, essentally pretty healthy.

    How can this issue/disk shift from left side to right so fast? Do disks move? Maybe a loose fragment? Could a rupture have happened and spread to the right side that fast? Ideas?

    I have not had a surgical consult and really don’t like the idea of surgery. (Nurses HATE surgery and I’m an OR.ICU nurse)!! Am I a fool to NOT want surgery?

    I have tried a steroid dose pack about a year ago and it helped significantly.

    I guess I deal with this, as I have little to no back pain. But I feel the weakness, although manageable, is starting t

    Will this resolve with conservative treatment, or might this be permanent? I mean this has been an issue for years. (Hoping for resolution).

    Scared and worried!(and being a typical nurse)!

    Todd

    catmadni
    Member
    Post count: 25

    I understand that you would like Dr Corenman to respond first. However I am recovering from compression of my S1 nerve root. I am compelled to respond with some advice.

    If you have symptoms of motor weakness don’t wait to releive the compression. Mine was the same muscle as you. It came suddenly. Although I felt I reacted quickly, I continue to have weakness following discectomy. Now there is little to do but wait for the rein elevation of the muscle which could take many months

    I have received good advice from Dr C via this forum post surgery. Good luck

    catmadni
    Member
    Post count: 25

    I have a spelling mistake. Reinervation

    Pafrmboy
    Participant
    Post count: 8

    I know I am into the weakness issue 1 year. I hope it’s not too late. Having surgery with little to no improvement, would be something fun to do.

    I wish you well with your strength gains. I know that nerves are pretty resilent.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    It appears at face value that you have motor weakness from a disc hernation but I am not so sure that is the case. You first developed loss of proprioception sense in your foot (lack of position sense). This was due to running.

    This is distinctly unusual to lose proprioception even if you had foraminal stenosis (see website for description of this condition). Only about 10% of patients with foraminal stenosis develop weakness and virtually all of them initially develop pain in their leg with standing and walking (running included). Without pain and paresthesias (pins and needles) radiating down your leg, this raises a red flag for diagnosis.

    You then report intermittent back and left leg pain and paresthesias for two years, activated by standing and relieved by sitting which does associate with the diagnosis of foraminal stenosis. However, if this was foraminal stenosis, this does not fit with an S1 nerve (the nerve that innervates the gastrocnemius muscle). The S1 nerve leaves the pelvis through the sacrum (S1 foramen) and not through a foramen that can be compressed. It is the only nerve that cannot be compressed by foraminal stenosis in the body as this foramen is made up of solid bone and cannot be compromised by degenerative change.

    The fact that your right leg gastrocnemius also became weak so suddenly is an indication that this problem is a neuropathy. A neuropathy is a “sickness” of the nerve itself and not from mechanical compression of the nerve in the back. Your MRI corroborates your neuropathic condition (no compression of the right nerve and only minimal compression of the left).

    The EMG result also reenforces that this is a neuropathy as there is involvement of the L3-4 myotome where there is no compression noted on the MRI.

    I hope the neurologist that performed the EMG pointed you in the right direction. This is a condition that needs to be treated by a specialist neurologist that treats progressive neuropathy. I am no expert here but there are some medications that can possibly interrupt this process.

    Steroids that “helped” this condition probably have worked in this case because steroids interrupt the immune system temporarily. It is the immune system most likely here that is overactive and could be contributing to your nerve injury. You do not need surgery but do need a specialist neurologist that can appropriately diagnose you and lead you down the correct treatment path.

    Dr. Corenman

    Pafrmboy
    Participant
    Post count: 8

    Well, I am following up with the neurologist again next week. I will ask some additional questions. I do have an appointment with a surgeon and have the MRIs in hand on disk. I will hopefully get some more direction after these appointments.

    I really appreciate your feedback Dr. Corenman. You make some very valid points!

    So the gastronemius weakness cannot be attributed to compression due to anatomy?

    I really appreciate your feedback Dr. Corenman. You make some very valid points!

    I will report back.

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