Foot drop without back or leg pain

[sukichaz]

Can you have lumbar radiculopathy without any pain?

A neurologist I consulted about foot drop (developed gradually since Fall 2009 and worsening past few months),  associated with cramping and twitches in that same leg, did EMG of both legs, focusing on muscles related to L4-5. I had MRI with slight indentation of spinal cord and a certain amount of disc bulging at that level which he'd originally said was not significant enough to cause foot drop. But based on EMG his conclusion now is L4-5 radiculopathy.

I don't like to doubt him but there was never pain (aside from the usual back strain we all get now & then from bad body mechanics which ultimately goes away) and no pain now, for sure. Also, I have good patellar reflex (not so sure of ankle reflex).  He says the EMG shows no denervation & I definitely don't have ALS. However I also have cramping and pain in both hands which hasn't really been evaluated yet (either overlooked or minimized). I don't understand the EMG results myself. A few muscles showed action potentials, otherwise it looked like right side and left side were comparable.

Thanks for any enlightenment.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Compression of the L5 nerve typically causes symptoms of pain in the lateral part of the calf that extends over into the big toe. There may also be weakness of the lifting your ankle to the ceiling and perhaps inverting your ankle (as you describe). In most people, the pain of a herniated disk (i.e., disc bulge) resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. However, you can also have injury without having pain. This depends if the injury is to the ventral root, sparing the dorsal root. These are the nerve bundles that enter and leave the spinal cord. They have specific functions such as motor or pain sensation.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[sukichaz]

This is the EMG from the report, instead of from my memory as before:
R and L peroneal
CMAP compared: Right 4.16/50.58 F wave and left: 4.33/51.40 F wave
Amplitude for R = 9.5 and L = 6.5
R: NCV below elbow 49.50 (I don't understand why elbow and not knee) and across elbow 50.8; Left NCV50.0 below elbow and 51.0 across elbow
R and L tibial CMAP:
Right 4.33/51.40, amplitude 6.8, and left 4.23/51.20, amplitude 7.1
NCV right = 52.0 and left = 52.86
R peroneal SNAP 4.4 distal latency, 9.5 amplitude and 48.5 NCV
L peroneal SNAP 4.24 distal latency, 10.12 amplitude and 50.8 NCV
Muscle testing: all these muscles were quiet and normal amplitude etc.: gastroc, peroneus longus, vastus lateralis, gluteus maximus.
These muscles all were followed by the same remark: tibialis anterior, biceps fermoris, and paraspinal (right): "1-2+ fibrillation long duration polyphasic motor unit potential.
Impression: electrophysiological evidence of L5 radiculopathy. Recommendation: spine surgeon evaluation."
The MRI report is lengthy, impression is: "segmentation anomaly with lumbarization of S1 with the last complete intervertebral disk space at S1-S2. Degen. disk disease with herniation and stenosis as above with slight interval worsening [since 2006] at L4-L5.
Within the body of the report: At L4-L5 loss of signal in the disk, bulging disk with posterior central herniation indenting the ventral thecal sac, minimal bilateral neural foraminal stenosis, no significant central canal stenosis, there are end plate reactive changes.
There was also mention of limited eval of the cervical and thoracic spine showing multilevel spondylosis with bulging disks at C3-4, C5-6 and C6-7.
Sorry about all the detail. I realize that probably most of these findings are not important, but I haven't the knowledge to sort it out for myself.Thank you for your time and patience and for any clarification on the issue.