[rypz79]

#32357

Hello Dr. Corenman,

I’ve read in this blog
https://www.huffpost.com/entry/nerve-injury-types-and-re_b_13008678
That fibrillation is only seen when there is an axonal injury. Thus when there is no indication of fibrillation on the EMG test it’s likely to be damage to the myelin sheath only.

1) Is that correct? Couldn’t find any reference for that in your article
https://neckandback.com/treatments/ emgncv-electromyograms-and-nerve-conduction-studies/

2) Is Neurapraxia essentially an interruption in the conduction of the impulse down the nerve fiber due to myelin sheath damage only with no axonal damage involved?

3) Can / is it common for Neurapraxia to occur due to a compression from disc herniation with symptoms of radiculopathy?

4) With almost no motor loss do you recommend me doing an EMG/NCV test (the surgeon told me couple of days after the surgery that it’s irrelevant)?

Thank you very much Dr. Corenman

[Donald Corenman, MD, DC]

#32367

Fibrillation potentials (FP) or positive sharp waves (PSW) only occur 2-3 weeks after nerve root injury. If there is no conduction to the muscle fiber, it will be come irritable and develop these FPs and PSWs. It does not matter why the disconnection occurs.

Myelin sheath damage is actual damage to the nerve. This is how multiple sclerosis works.

Since 80% of herniations that cause motor deficit respond (recover) with decompression, I could use that percentage to talk about axonotmesis of 20% of the nerve cells but I have never differentiated gluteus medius recovery from tibialis anterior recovery. That could further differentiate neurapraxia from axonotmesis and neurotmesis.

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.

[rypz79]

#32385

Hello Dr. Corenman,

FOA I really want to thank you for your kind help and support. In these COVID-19 closure days your website and forum really helps me a lot to understand my situation and hopefully recover from this harsh injury.

Well 35 days has passed since the operation and there are some improvements the numbness on the balls of my foot have gone and I’m able to dorsiflex my foot while my leg is stretched with little pain.

The main problems remain: the foot feels colder with less sensation then the other one. there is still irritation (pain, burning sensation) while standing, walking and sitting cross-legged. I think it’s diminishing a bit with time, but still the nerve gets irritated several times a day (depending on what I’m doing) and the only way to calm it down Is lying down on the back preferably with no shoes and just wait, that is very debilitating.

I really don’t know the pace and I really don’t know when it will stop being irritated at any position. If it’s only a myelin sheath damage we’re talking about 12-14 weeks at most with full and complete recovery?

If there is no motor loss can we rule out axonal damage? i.e if there is an axonal damage and the myelin sheath is also damaged we shouldn’t have seen any improvement which is not my case. am I right?

Thank you very much Dr. Corenman

[Donald Corenman, MD, DC]

#32392

If there is no motor strength loss (except for the EHL which commonly stays weak but causes no significant functional loss), you might be out of the woods. I will say that even with functional recovery, if you checked specific weight derived exercises (foot dorsiflexion against a weight) and measure the specific reps and time to complete the reps, you might be able to discern a slight difference even though it is not a functional loss.

No one knows how much % loss is necessary to create functional loss. I use the 10% rule but that is approximate as some individuals might function well with 20% loss and some will be so sensitive that 8% loss is noticeable.

You continue to improve. Since you are the expert in monitoring your symptoms, watch how symptomatic you get with exercise and try to stay right below the symptomatic level.

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.

[rypz79]

#32397

Dear Dr. Corenman

After further checking the physical condition of my foot using a video tutorial I did find wasting of the Extensor Digitorum Brevis i.e the muscle ball near the ankle of my right foot doesn’t feel as strong and is less visiable then of my left one I’ve also tried the test for weakness of the Extensor Hallucis Longus and passed it there is no differences with the toe power. SLR was always negative, there is no noticeable diminished sensation on dorsum of the foot.

From your tutorial https://neckandback.com/conditions/home-testing-for-leg-weakness/
On L5 I’ve passed the 20 feet duck walk test with ease but when I’ve tried the 20 straight tip toe check I immediately saw that there is a noticeable difference between the two legs I can do it with my right foot (not without sending a hand to stabilise myself) but it’s much easier to do with my left one. I will practice on that more depending on the pain produced but in general is this muscle power unrecoverable if we’re talking about axonal damage?

Is the pain I’m feeling after this exercise in the balls of my feet is meets your definition of “pain inhibition”? It gets worse when I push harder.

Is my “voluntary limping” (to minimize pain while walking normally) for several months prior to the surgery could also contribute to this muscle weakness?

Are those new weakness findings suggest anything about the type of injury I sustained and the time needed for recovery?

Thank you very much Dr. Corenman

[Donald Corenman, MD, DC]

#32398

I’m not worried about your recovery. Even if you have 5% loss of strength that is permanent, you won’t notice this weakness in day to day activity. Continue to work on strength and you eventually will adjust to your functional ability.

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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