newpakMemberJuly 20, 2013 at 11:06 pmPost count: 1
Hello Dr. Corenman,
I’m hoping you can shed some light on to why I am experiencing these symptoms as my doctors are baffled as to why I am having this pain. I have categorized as per your suggestions.
Location and Quality of Pain
Bilateral upper and lower, predominantly back of legs and some cramping in front of thighs and buttock pain
Primarily a constant, tight, aching pain or soreness in both legs. Standing or sitting exacerbates pain. Sensation of fatigue.
Occasional mid to low back pain.
No skin sensitivity.
No change in colour or thickening of skin.
Percentage of Pain by Location
Currently 60% lower leg vs. 40% upper leg. Varies in location (outside of leg and back)
Nov – Feb 50% upper vs. 50% lower
Intensity of Pain
Currently on a scale of 1-10, while taking Cymbalta – 5-6
At worst – 8 without medication
Muscles feel weakened. Tired much of the time.
Onset and Length of Time Symptoms Have Been Present
Onset of pain – November 2012
No injury. Was walking more than usual just before onset of pain
Intensity of pain has not changed but location of pain seems to vary (back to sides of legs, buttock, cramping in front of thighs)
Activity mostly limited to short walks or bike rides (20 minutes or less). Movement helps to reduce pain.
Currently pain more intense when standing vs. sitting
Not pain free during different times of day – intensity differs
Lying down with pillows under/in between knees is most comfortable position. Does not keep me up at night.
Pain intensifies when squatting, walking up stairs (do not feel discomfort going up, but when reaching top of stairs, muscles feel exhausted).
Previous Consultation & Treatment
Massage – no change
Physiotherapy – helpful with buttock pain/tightness
Acupuncture – no change
Chiropractor – Active Release – limited – some relief for buttock pain
Ice/heat (temporary 5-15 min relief), Walking, stretching
Jun 28 – Cymbalta 30 mg – Numbed pain to level of about 3-4. Could not tolerate 60 mg dosage – 3 weeks on medication pain returning to level 5-6
MRI (03/2013)– There is minimal disc degeneration of the lumbar spine. No significant disc herniations. No spinal or neuroforaminal stenosis. There is a small focal left posterolateral annular disc tear at the L5-S1 level. No neural impingement evident.
X-Ray – Lumbar vertebral body alignment and disc spaces are normal. The facet joints are normal. No fracture, dislocation or significant degenerative change is identified.
EMG & Nerve Conduction – Study is slightly abnormal and there is clear evidence of very mild peroneal compressive neuropathy at the fibular head on both sides of almost a symmetrical degree with drop in the conduction velocity on the right side from 54.3 m/s to 43.8 and on the left side from 54.7 to 41.2 m/s. These findings are consistent with compressive type peroneal neuropathy of a mild degree.
Thank you for your time. I look forward to your response.
LiDonald Corenman, MD, DCModeratorJuly 22, 2013 at 6:42 pmPost count: 8465
Your symptoms may not originate from the lower back. There are many other origins of these type of symptoms including peripheral neuropathy (see website), inflammatory conditions (myalgias and arthropathies) and tendonopathies (like tennis elbow).
Your slowing of the peroneal nerve signals at the knee suggest an entrapment neuropathy. The peroneal nerve goes through a tunnel at the outside of the knee and the nerve can be compressed here. Some of your symptoms could be attributable to this compression.
Contact my partner, Dr. LaPrade at my clinic for further information at (970) 476-1100.
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