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Treatment
following crush injury in the foot |
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2
week ago my husband managed to run over my son's foot
with the car. Very little swelling and bruising. X-rays
+ bone scan show no fracture. However he still cannot
bear weight on that foot, plus it hurts constantly, and
the slightest touch causes him extreme pain. Currently
taking Darvocet for pain, but not during the day as it
sends him to sleep (not that it helps the pain much anyway).
Saw the orthopedic surgeon yesterday, who told us to make
sure he keeps it moving, and see him in 4 weeks if it
doesn't improve. I asked if it was possibly nerve damage
(he was very patronizing - what nerve would that be? but
that's another story). He said no tests could be done
for 2 more weeks even if it was. I asked if he should
see a neurologist, told that it wouldn't be very interesting
to a neurologist at this time. My questions are these
- is it true that we need to wait a further 2 weeks? Should
we arrange for him to see a neurologist? Is there anything
more that any type of doctor could do for the pain at
this time?
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Answer |
In
instances like your son's case, it is more likely that
the pain is due to bone/tendon/ligaments swelling and
bruising rather than nerve injury, even though small nerves
in the foot might contribute to that. There may be enough
soft tissue damage to account for the whole pain however.
The remark about two weeks probably refers to the fact
that nerve damage takes about 2-3 weeks to be visible
on EMG, when this diagnostic test can be useful.
At any rate, in my own practice, I advise patients
to seek the opinions that they think might help. Some
times patients know better than doctors and it never
hurts to look.
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Comment |
Thank
you very much for your fast response. If it is bone/tendons/ligaments
damage, would not there be swelling obvious, or is there
sufficient room under the skin for this type of damage
to occur without external signs? Can I assume that if
it is this type of damage it will eventually heal without
further treatment? I have no desire to put my 11 year
old through more stress if it isn't necessary. |
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Answer |
The
swelling usually subsides within the first two to three
weeks and the pain may be caused in instances like this
by the joint movement against these structures. Orthopedic
surgeons usually see and treat a good deal of cases like
this and the recommendation of keeping it moving and waiting
it out for four weeks with everything else being negative
is in keeping with the managing of injuries such as your
son's. |
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Is
there alternative for surgery in S1 radiculopathy? |
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I
just had an EMG with the result showing left S1 radiculopathy.
I herniated L5-S1 disc 12 weeks ago and have been doing
home traction. I have improved some but there is still
talk of surgery. Does surgery always have to be done for
this? How long do I have before permanent damage might
be done? I really want to avoid surgery if at all possible.
I am 47 years old and otherwise in very good health. Any
thoughts?? |
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Answer |
Well,
these are always tough questions. First things first:
You ask about nerve damage. A combination of the information
from the EMG and MRI (as well as the clinical exam) should
indicate whether or not you have sustained nerve damage
and how much of it and whether or not it is healing. Second,
some discs, left untreated are known to heal on their
own, surgery is not always indicated. The decision for
surgery involves many different steps, such as, is there
evidence for healing (usually may take up to 6 months,
albeit not with the same intensity of symptoms), can the
patient afford to live with the pain/discomfort or incapacity
for all this time, is the subject in good physical condition,
will the damage to the nerve be irreprable if sugery is
not performed etc.. Finally, it's up to the patient, armed
with good information, to decide, and most surgeons would
like the patient to be convinced before they intervene.
Best of luck,
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Comment
from another
Patient |
So
much in common, you and I. I'm 44 and last summer I also
was diagnosed with lt. S1 radiculopathy. I'm an EMG technician,
so I was afforded the luxury of many neurologist friends
rushing to my aid. I had 6 weeks of symptoms, pain in
my back and leg, numbness down the back of my leg to the
little toe side of my foot, and weakness that prevented
me from raising up on my tip-toes. Massage, ice, heat
and traction was attempted, but to no avail. My neurosurgeon
reviewed my MRI which showed a large herniated disk--his
opinion being that it was too big to "suck back in"
on its own. I had surgery--3 hours, including recovery
room time. After about a week of recovery, I was moving
around with much less pain. The weakness gradually left
in about another 3-4 weeks. The numbness took longer...about
3 months for all of it to go away. I still have fleeting
back and leg "aches", but nothing like the radiculopathy
pain. I believe, because of nerve damage that may have
been done, that these "fleeting reminders" may
not permanently leave. My advice to you would be that
if your symptoms are pain only, and can be managed in
some other way, that surgery may not be the way to go.
BUT, I think that numbness or weakness may be the hint
that maybe surgery can at least prevent any progression.
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Possible
causes for foot drop |
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My
husband has experienced foot drop and numbness from mid-calf
through ankle on his left foot for about a month. Two
weeks ago, he had a Nerve Conduction Study, and the physician
doing the test suggested he had injured his peroneal nerve:
he said the charge "decreased from 64 to 40, calculated
over 14 centimeters". (I may have this wrong, as I'm just
reading from notes.) Today, though, my husband had a follow-up
with his internist who said his blood tests came back
border line for lupus. He was also referred to a neurologist.
I understand that the possibilities range from neuropathy
to MS or even ALS. Can you give me any guidance about
what we can expect from the neurologist? (This is the
same neurologist who treated my mother for a malignant
brain tumor, so I am terrified.) Thanks so much for your
help. |
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Answer |
I
do not think there are any evidences from your email to
suggest MS or ALS. The peroneal nerve injury is not a
serious problem. Perhaps the neurologist would reassure
you regarding the peroneal nerve after full neurological
examination. He may need to check into borderline results
of lupus. |
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EMG
and Nerve Conduction report interpretation needed |
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Please
help, Can anyone define and explain to me what this report
means? EMG: This study provides electrical evidence to
support mild chronic left L-5- S1 radiculopathy without
acute on going denervation. Nerve Conduction: This study
provides electrical evidence to support a left posterior
tibial motor neuropathy with proximal involvement. The
prolongation of the left H-reflex suggests an L5-S1 pathologic
process. |
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Answer |
Before I
do interpretation. Please let me explain that EMG reading
or interpretation depends generally on presence or absence
of certain discharges (denervation activity), which usually
suggest acute lesion in radiculopathy, and changes in
the motor unit potentials, which helps to see the degree
or duration of lesion. Therefore, if you have only motor
unit changes of chronic nature without denervation activity,
then this could explained that the lesion in chronic.
The prolonged H reflex also supports that the lesion is
in S1 distribution. I hope this is clear. I will be happy
to help further if needed. |
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Curious
about nerve conductive velocity test & EMG for ankle
neuropathy |
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I
am experiencing numbness, tingling in my right ankle and
top of foot and big toe. My doctor has me set up for a
Nerve Conductive Velocity Test and EMG on April 10. Can
you tell me what to expect? Will the EMG just be done
on the ankle area? My internist said my problems could
be bone spurs in ankle or even some problem in spine.
I am just wondering if test will cover spine too? |
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Answer |
For
more info on what to expect from EMG Nerve conductions,go
to:
http://www.teleemg.com/emgfaq.htm
The EMG will also explore problems originating from
the spine as well, not just the ankle.
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Comment |
I
just had my first NCV and EMG this week. I had reported
a problem predominantly in the lower left leg. The NCV
was performed on the left leg, front and back, but not
the back itself. The EMG was performed on the leg AND
the lower back. I suspect the EMG involved the spinal
area since it's the root of so many nerve problems. I'm
also going for an MRI follow-up per the good doc's recommendation. |
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I
have twitching in right leg. Am I considered as having
ALS? |
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I
am quite nervous about this twitching I have been having
in my right calf, along the side-front. You can see it
jumping around. It's 24/7. It's been going on for about
2 months and progressively getting worse. I also have
some twitching in my right arm and right buttocks, but
not as severe. It never lets ups. I have a crampy feeling
in the backs of both legs at times. At one time, my right
calf felt as though it had a cramp, but it really wasn't
a 'cramp'. Almost a burn. Also, my left shoulder seems
to want to pop out of it's socket in the morning. It feels
as if there is a torn tendon or something. I see no atrophy
and it feels as strong as the right shoulder. I have no
weakness that I can tell. I went and saw a neurologist
and he saw the twitching and said it was nothing to worry
about and said; "YOU DO NOT HAVE ALS!", firmly and positively.
I completely disagreed about not having an EMG, so he
finally gave in. I found this very strange. I am very
scared about ALS and my doctors ability. HE comes highly
recommended and has diagnosed about 20 ALS patients in
his life. Should I be concerned? |
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Answer |
Neurologists
rely on many symptoms and findings to diagnose or rule
out ALS. While twitching in the muscle (facics) can be
a sign of the disease, not everybody who has them has
ALS. If your doctor is familiar with the disease, the
chances are he's confident in what he's telling you and
you should feel assured. If not, you should seek a second
opinion to allay your fears.
By the way, did your doctor tell you what he suspected
as the cause of your symptoms?
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What
exactly happens to give pins and needles sensation? |
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When
you experience the sensation of "pins and needles" what
exactly is taking place? Is it a result of the healing
process of the nerve or is it a result of damage to the
nerve. I know when your foot is "asleep", the pins and
needles come after the numbness but before normalcy, as
your foot recovers......so I am wondering if the sensation
might indicate a reactivation of proper nerve impulses?
I'm experiencing pins and needles in association with
lyme disease and am wondering if this could be the reawakening
of my damaged nerves and thus a good thing.....or does
it result as my nerves are damaged, and thus a bad thing?
Thanks. Ruth. |
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Answer |
This
is quite interesting question. Any or all of the sensory
symptoms (pins and needles) and signs are considered diagnostic
for a dysfunctional sensory nervous system or point that
some thing going on with sensory nervous system. It could
either occur at start or later in the process of nerve
affection. Although pins and needles may get less with
recovery. But does not basically or necessarily be a bad
sign. |
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I
have itchy legs when exercising. Is EMG needed? |
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For
a long time I've been experiencing a symptom but can't
seem to find any reference to it. Does anyone know what
could be causing this? When I walk or run in coldish weather
(anything under about 70 degrees), the muscles in my thighs
and butt get this intense itching feeling (like a "deep
muscle itch"). Once it starts, the only thing that seems
to help is stretching the muscle, but as soon as the muscle
is contracted again, the itching returns, unless I go
somewhere warm and stretch for several minutes. I only
know one or two other people who've ever experienced this
- all women. I know I have poor circulation generally
(my hands and feet are always very cold). Is this related
to that, or is it something more specific? Is there anything
that can be done about it? (I apologize if this question
isn't directly related to the web forum - I wasn't really
sure whom to ask...) |
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Answer |
Although
your symptoms are unusual. But I feel that EMG should
be performed in your case to exclude some form of uncommon
muscle disease. Consult a neurologist beforehand. |
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Peroneal
nerve injury or knee problem? |
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I
hurt my leg skiing a year ago March. I hyperextended my
leg and felt a pop on the outside just an inch or two
below my knee. I had thought it was healing but as of
December, all the pain returned and much more. I have
had nerve conductor tests, knee strength tests and x-ray
of knee. They all check out fine, actually the neurologist
and orthopedic doctors say everything seems strong. But
I have this radiating pain down the outside of my leg
onto the side and top of my foot. At times pain also circles
around the backside of my knee, too. The doctors can't
find out what's wrong. I have done some research and it
seems to be the peroneal nerve right where it splits below
the knee that is the culprit. The pain is much worse at
night when I lay down. There is not a comfortable position.
Sleep is difficult. I am having an MRI on Monday, but
the orthopedic doctor doesn't seem hopeful that it will
show any thing. I have had it suggested to go to a physical
therapist who is familiar with many types of nerve injuries.
Can anyone shed some light on this injury? Can the peroneal
nerve produce pain without foot drop and symptoms I do
not have? I have never had back pain with this or pain
above the knee and have always felt this pull on my leg
at this spot I think the peroneal nerve splits. This pain
and discomfort has been the same from the very day I had
the skiing injury. Looking for relief. |
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Answer |
Your
description sound like a knee and not peroneal nerve lesion.
I would have thought that MRI of the knee is helpful or
at least would make sure whether the knee is affected
or not. Physiotherapy should also help. |
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How
useful EMG testing is for the diagnosis of Adhesive Arachnoiditis? |
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I
found your site while researching the question of how
useful EMG testing is for the diagnosis of Adhesive Arachnoiditis
and radiculopathies in general. I realize that an EMG
cannot identify the precise cause of a radiculopathy,
i.e. protruding disk, annular tears, etc. However, I understand
from the information presented on this site that even
routine EMG's can indicate problems with at least certain
nerve roots for both sensory and motor radiculopathies.
Arach causes multiple sensory and motor neuropathies and
the nerve roots involved are often those you mention in
regards to EMG testing. However, it is almost the rule
that the members of the support group I belong to have
normal EMG results. The only exceptions appear to be when
arach has been present for a long time and/or there is
a lot of wasting. Could you shed some light on this? Also,
are there special studies that could be done in the legs
to indicate nerve root problems in the lumbar spine? Thank
you for providing this very comprehensive site. I especially
appreciate the forum service. |
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Answer |
EMG
and nerve conduction studies can help to confirm the presence
of root lesion. It can also localize the affected root
and how many roots are affected. It can also show how
severe the lesion is. But as you said it cannot tell between
causes of such lesion. This study can help in cervical
or lumbar spine. However, in suspected case of arachnoiditis,
paraspinal muscles EMG changes may be bilateral and at
several levels. Other neurophysiological tests are less
sensitive such as somatosensory evoked potential.
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I
have a herniated disk in my lower back, L5, S1 why won't
the Dr give me something for pain? |
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I
have a herniated disk in my lower back, L5, S1 NC/EMG
showed: Bilateral S1 Radiculopathy Left common peroneal
motor axonal neuropathy Bilateral posterior tibial motor
proximal amplitude attenuated Left L5 radiculopathy cannot
be ruled out. I am in excruciating pain in my right leg...it
is constant, unrelenting and nothing they have given me
so far will relieve it. I am currently taking Robaxin
500 mg 3 times a day and Mobic 15mg. once a day. I don't
understand why there is not something they can do to give
me some relief. Is there a reason they do not like to
prescribe something to help with the pain?? |
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Answer |
To
continue the comments from previous email (same patient
I guess), consultation with a neurologist, neurosurgeon
or orthopedic doctor would help (second opinion). Sometimes,
pain is quite severe. It is however, up to the treating
doctor to try different kind of medication or alternative
approach such as surgery. |
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S1
root compression vs. Left common peroneal motor axonal
neuropathy |
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My
EMG results said I have Left common peroneal motor axonal
neuropathy. LEFT COMMON PERONEAL MOTOR NERVE Proximal
latency 13.0 ms (normal) Amplitude 1.67 millivolts (attenuated)
What does attenuated mean?? Distal latency 5.7 ms (normal)
Amplitude 2.17 millivolts (attenuated) Conduction velocity
45.5 m/sec. knee to ankle (normal) LEFT PERONEAL MOTOR
ACROSS THE KNEE Proximal latency 14.9 ms (normal) Amplitude
1.67 millivolts (attenuated) Conduction velocity 44.8
m/sec. (normal) Bilateral S1 area shows occasional fibrillation
and potential spike. Again what does this mean?? Left
H-reflex latency 36.0 ms (prolonged) Right H-reflex latency
35.5 ms (prolonged) RIGHT POSTERIOR TIBIAL MOTOR NERVE
Proximal latency 12.9 milliseconds (normal) Amplitude
1.0 millivolts (attenuated) Distal latency 4.2 milliseconds
(normal) Amplitude 12.3 millivolts (normal) Conduction
velocity 51.7 m/sec knee to ankle (normal) LEFT POSTERIOR
TIBIAL MOTOR NERVE Proximal latency 13.8 ms (normal) Amplitude
0.83 mV (attenuated) Distal latency 3.78 ms (normal) Amplitude
8.67 mV (normal) Conduction velocity 46.9 m/sec. knee
to ankle (normal) BILATERAL HAMSTRINGS, BILATERAL GASTROCNEMIUS
MEDIAL HEAD Increased insertional activity with fibrillation,
potential spike and positive sharp wave 1 to 2+ Motor
unit potential normal and polyphasic with reduced recruitment.
LEFT TIBIALIS ANTERIOR, LEFT EXTENSOR HALLUCIS LONGUS
Increased insertional activity with fibrillation, potential
spike and positive sharp wave 1 to 2+ Motor unit potential
normal and polyphasic with reduced recruitment. Any help
with this report would be very much appreciated as the
pain is increasing and is unbearable. |
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Answer |
Q1.
What does attenuated mean??
A1. It means that response amplitude is low, this may
happen with nerve damage by any cause.
Q2. Bilateral S1 area shows occasional fibrillation and
potential spike. Again what does this mean??
A2. It means that muscles supplied by a nerve(in your
case S1 nerve root) showed on EMG examination some changes
or abnormalities indicate pinched nerve.
Generally, the results of attenuated (=reduced=low) amplitude
of the nerve responses with the fibrillations and positive
sharp waves and abnormal H reflexes can all be explained
by the L5 and S1 nerve roots lesion in both sides, central
disk or cauda equina. We need to have the sensory responses.
I think the findings cannot be explained by the left common
peroneal nerve lesion. However, a consultation with neurologist
is recommended if you have not seen one yet.
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Comment |
Thank
You for your help.
Here are my Sensories
RIGHT SUPERFICIAL PERONEAL SENSORY
latency 3.7 ms (normal)
Amplitude 13.3 mV (normal)
LEFT SUPERFICIAL PERONEAL SENSORY
Latency 3.86 ms (normal)
Amplitude 10.0 mV (normal)
RIGHT SURAL SENSORY
latency 4.02 milliseconds (normal)
Amplitude 16.7 mV (normal)
LEFT SURAL SENSORY
Latency 3.96 milliseconds (normal)
Amplitude 15.0 mV (normal)
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Answer |
Thank
you for your response. These findings are in accord with
my previous impressions. Best of luck. |
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Plantar
Sensory Nerve testing |
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My EMG report reads 'right lateral plantar sensory response was unobtainable." I had one doctor tell me that nerve is on the bottom of my foot on medial side. Another doctor told me that this nerve is on the outside (lateral side) of my ankle/foot running along the underside of the bony protrusion of the ankle bone. My pain is in the later area. Which one of these doctors is right? Also what could cause the EMG reading that I have?. A bone spur was removed from the cc joint area on the lateral side of the foot 4 years ago and I have been in pain ever since. Any information would be quite welcome. |
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Answer |
The
lateral plantar sensory nerve is, as the name indicates,
on the outside (lateral) side of the foot. It is a rather
small, hair thin nerve, which supplies sensation to that
area of the foot where you have symptoms. It may very
well have been injured or damaged from the surgery 4 years
ago. One way to be sure, is I try to record the lateral
plantar sensory response from the other foot. If it is
present, then your problem on the right side is probably
due to local causes (such as the surgery). If it is absent,
then this may be due to other more generalized causes
such as peripheral neuropathy, diabetes etc. |
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