Pain in right leg

MEDICAL (Neurological?) PROBLEM

CAN YOU HELP ..............

Mrs. Doveton (70 years of age), has been in continuous pain for almost a decade and is desperately seeking help in identifying and remedying the cause of her pain .

The symptoms and treatment I investigations undertaken over this time as described by her doctor are detailed below.

I would appreciate if you could post any assistance onto this forum.

1 December 2003

Mrs Doveton has been suffering from pain in her right leg for, more or less, 9 years. The pain started when getting out of bed and twisting to make the bed. She immediately has pain in the right buttock and leg. The pain goes down the side of her leg to her toes in the L4/5 and SI dermatome.

For approximately the first 10 months there was, as well, loss of sensation in the L4/5 and SI distribution. The character of the pain is similar to that of toothache and some days much burning. She has good and bad days and times when walking is even painful.

The patient has seen various specialists - Neurologist, Neurosurgeon, Rheumatologist and a Vascular Surgeon. Various treatments have been done without success and are listed below:

1. Range of anti-inflammatories
2. Trepiline, Tegretol, Neurontin, etc.
3. Epidurals with inj ections of Cortisone
4. Acupuncture
5. Physiotherapy
6. Consultation with a Chiropractor

The following investigations have been done during the years:
1. MRI cervical spine, 26.09.1995 - degenerative changes from C3 to C7
2. MRI brain, 9.10.1995 - mild to moderate cortical/cerebral atrophy
3. MRI thoracic, lumbar spine - no thoracic cord tumour, no syringo-myelia, no compression
4. MRI lower limbs, 30.01.1996 - normal
5. MRI lumbar spine, 8.03.1996 - no disc protrusion or herniation, no nerve root entrapment and no spinal stenosis .
6. MRI lumbar spine, 6.08.1998 - mild disc space narrowing LI - L5, slight central bulging at L4/5. No disc herniation. Small sacral cyst within sacral spinal canal
7. Blood tests, 28.09.2000 - FBC, U&E, glucose, folate, vitamin B12, thyroid normal.
8. Right lower leg and pelvis x-ray, 30.01.2000 - normal
9. Bone mineral density, 20.01.2000 - osteoporosis, Fosamax started
10. Follow up DXA scan, 2.03.2001 - 4.4 % improvement
11. Follow up DXA scan, 12.02.2002 - no further deterioration
12. Follow up DXA scan, 12.02.3003 - improvement in hip and spine remained
the same
13. Doppler right leg - normal
14. MRI lumbar spine, 12.2001 - no structural lesion ; an MRI of the plexus was obtained to exclude a small mass lesion, e.g. meningioma, which was normal.

Yours sincerely

Dr A. Rodrigues

[Kevin Pho, MD]

There has obviously been a very comprehensive workup done, including various MRIs and X-rays, bone density studies and multiple referrals to specialists.  

Some other things to consider would be possible electrodiagnostic testing (EMG) to evaluate any nerve conduction problems.  This probably would have been considered by the neurologist.  

Another thought would be a referral to an orthopedic surgeon.  The character of the pain certainly may suggest nerve impingement that was started or exacerbated a musculoskeletal cause.  

If every test is negative and the consultations non-revealing, you may want to consider managing the pain itself.  This would involve a referral to a physiatrist and possible pain management specialist.    

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[marycap]

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