Femoral nerve damage s/p LTKR

45 F s/p TLKR in 11/10. S/P ACDF-cannot undergo MRIs

LTKR-Spinal epidural, tourniquet used. No femoral block. Tourn 101 mins. Complicated postop

EMG/NCS 12/20- L femoral neuropathy proximal to the motor branch of the iliopsoas; w/ appr 50% motor axon loss to vastus medialis.  Evidence of L sided focal femoral mononeuropathy of L iliopsoas, vastus medilis. Clouded somewhat by abnormalities thruout the rest of L lower limb and in R. Side to side CMAP amplitude comparisons of vastus medialis from the femoral nerve indicate approx 50% motor axon loss

Possible L&R L5 or S1 radiculopathy, plexoapthy, cannot r/o L lumbosacral panplexopathy

Clinical Impression – L femoral neuropathy w approx 50% motor axon loss to vastus medialis. No current evidence of axonal sprouting/regrowth

CT myelogram WNL

2/22 MUA. ROM at 110 in OR. In am I was at 85. Discharged home on a CPM. Today ROM 60 degrees, 80 w help

EMG/NCS 8/2/11- L femoral neuropathy. Evidence of a L sided focal femoral mononeuropathy as shown by abnormalities on EMG of the vastus lateralis and the decreased L femoral CMAP to the vastus medialis compared to the R.  Improved since the previous study, no longer are abnormalities seen of the iliopsoas or vastus medialis.  No evidence of wide highly polyphasic low amplitude nor high amplitude MUAPs to suggest axonal regrowth or collateral sprouting.  May be normal motor units seen are evidence of mature axonal regrowth & may account for the decreased abnormal spont activity.  Side to side CMAP amplitude comparisons similar to previous study.  Saphenous SNAP is approx 50% amplitude on contralateral limb showing evidence of sensory axon loss

No longer evidence of L lumbosacral radiculopathy or plexopathy

Clinical Impression:  Test shows evidence of some improvement. There remains a significant decrease in the amplitude in the motor study to the vastus medialis compared to the R.  This can be due to both neurogenic and disuse atrophy or a combination.

[Frustrated_in_NY]

2,000 characters was tough given I wanted to share both EMG/NCS results.  I would appreciate any insight regarding the results of these studies.  I have seen a neurosurgeon who felt there was nothing he was able to do, given the CT myelogram was WNL. I've seen an orthopedic specialist in NYC, who feels all he could offer me was more ROM, but at this point with the nerve damage, more ROM would be a detriment to me.  I've seen pain mgt doctors who wanted to diagnosis me with Complex Regional Pain Syndrome and do a diagnostic study with needles into my back.  I declined.  

The general concensus seems to be one of two things... 1) the tourniquet was on too tight, too long, or done incorrectly or 2) something went wrong with the spinal epidural.  No one of course is admitting anything. Of note, my spinal epidural was done in the OR, after I was already asleep.  When I awoke after I had severe pain in my L leg as the spinal epidural was no longer effective, and I did not have a morphine pump as it was expected that the epidural would have been numb long into the evening/night.

I am in the process of trying to get copies of my records sent to a neurologist, but I can't get in with the one I'm trying (a referral from a friend) until late Sept.  I'm concerned that so much time has passed and it doesn't look like the nerves are "sprouting".  

Your honest opinion (and I understand it is difficult to ***** having not seen me) would be greatly appreciated.  I continue with PT today.  Thank you in advance for your thoughts.