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S1 Paraspinal Denervation
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S1 Paraspinal Denervation

Diagnosed with sensori-motor, axonal, distal peripheral neuropathy. Asymmetric with more marked changes in the left lower leg and foot.

I have questions about S1 paraspinal muscle denervation.

Orginally, diagnosed with left S1 radiculopathy primarily based on left S1 paraspinal denervation.  Frist EMG showed increased insertional activity and 1+ positive sharp waves.  At that time, pretty much the same in grastroc and soleus, too.  (NCS also showed reduced CMAPs and SNAPs.)

My questions:

How does S1 paraspinal denervation figure into a perpheral neuropathy diagnosis?  My understanding is that the paraspinals are innervated by the nerve roots only which would indicate radiculopathy.

Second EMG did not re-test left S1 paraspinal.  What might a second testing show?  Would there be reduced recruitment?  Could the results be normal since the paraspinal might be fully reinnervated from S1 nerve root?

My symptoms were rather sudden onset with extreme burning pain in lower leg and foot, pins and needles, all the usual symptoms of radiculopathy except no back pain, no pain that "ran down the leg" in any fashion, and good lumbar MRI.

My perpherial neuropathy diagnosis primarily based on a years-long mild numbness in lower left outside leg running across top of foot and a gout-like left big toe.  Have no ankle or knee reflexes on either side, but this showed up only after sudden onset.  Now I also am having light spasms in the outside fingers of both hands which lends more credence to perpheral neuropathy.

However, curious about S1 paraspinal.  Thanks.
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Pinched nerve roots (S1 being the most common) are quite common in the general population. If one of these people develops a neuropathy for whatever reason, it does not mean that they have teh same cause.

We generally do not judge recruitment in the paraspinal muscles (try to activate your left S1 paraspinal muscle!). We generally only look at insertional activity. There might be increased recruitment over time (indicating reduced nerve supply to the muscles) in muscle innervated by the nerve root, but most radiculopathies settle down after conservative treatment.

Increase dinsertional activity like positive waves is present for the first few weeks after an injruy to the root or if there is ongoing root irritation. If the irriation is resolved then the test will become normal within 4-6 weeks.
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