Interesting Case

[painfree23]

Had a patient today in clinic, elderly female, history of lumbar lami L3-S1 for leg pain 6 months ago. She came to me today because of continued post op leg pain (RLE > LLE), unable to walk now after surgery. Surgeons wont touch her. Neurologists don't know. EMG shows chronic L5 radic, but otherwise normal. MRI with residual L5 NF stenosis. I thought her pain was coming from the L5, but then this was on her LE MRI ordered by another physician:

-Abnormal enlargement and signal hyper-intensity of the R fem. nerve and R L4 nerve root consistent with neuritis. Asymmetric edema, fatty infiltration and atrophy of the R quads which may be secondary to denervation. Left side is normal.

She is maxed on gabapentin without relief. Any thoughts?

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[Tapspatellas]

Had a patient today in clinic, elderly female, history of lumbar lami L3-S1 for leg pain 6 months ago. She came to me today because of continued post op leg pain (RLE > LLE), unable to walk now after surgery. Surgeons wont touch her. Neurologists don't know. EMG shows chronic L5 radic, but otherwise normal. MRI with residual L5 NF stenosis. I thought her pain was coming from the L5, but then this was on her LE MRI ordered by another physician:

-Abnormal enlargement and signal hyper-intensity of the R fem. nerve and R L4 nerve root consistent with neuritis. Asymmetric edema, fatty infiltration and atrophy of the R quads which may be secondary to denervation. Left side is normal.

She is maxed on gabapentin without relief. Any thoughts?

I am guessing she is diabetic. This sounds like amyotrophy. Antineuropathics and wait, year to get better. I’m curious the muscles done on the EMG. If there is quad atrophy if they did one of the muscles there should have been denervation.

 

[Dr. Ice]

I am guessing she is diabetic. This sounds like amyotrophy. Antineuropathics and wait, year to get better. I’m curious the muscles done on the EMG. If there is quad atrophy if they did one of the muscles there should have been denervation.

Agree. Repeat the emg with someone who knows what they are doing