weak leg reflexes

[wonky]

Can anyone explain why my leg reflexes have become hard to find and very weak, particularly knee jerk?  Awaiting second opinion from neurologist but every assesment I have they need to bash me very hard with the hammer which hurts, only to elicit a tiny reflex, or none at all.  Sensation in legs is normal but they are weak and I get severe pain daily which has gone on for too long now.  Also find I can't walk far any more without pain and limping.  Only in my forties and was fine before.  Any insights?  Thanks

[Abhijeet Deshmukh, MD]

Hello.

There are a few differentials you need to consider. Reduced deep tendon reflexes are signs of lower motor neuron loss. You could be having some nerve compression.

Have you checked the thyroid functions? Hypothyroid state is also associated with neuropathy and weak reflexes.

In which part of the limbs do you have the pain?

Regards

[wonky]

Thank you for reply.  In answer to your questions I've had blood test for thyroid function and it's ok.  Pain is in groin, thighs, pubic area and also deep inside rear.  Varies from throbbing to sharp and some days worse than others.   Also more recently have been getting severe throbbing pain under my feet.  Get tingling around my knees as well.  I find I have to walk more slowly than I used to as I limp if I rush.  Sometimes I cannot walk at all and have to stop and find a place to rest.  I try to exercise daily but it only makes me feel worse.  Am putting on weight so am overweight now, which I wasn't before, but am moving less so hardly surprising.  Any further suggestions? Thanks again.  

[Abhijeet Deshmukh, MD]

Hello.

Hypothyroidism is pretty much ruled out. The other possibilities that remain are neuropathy due to some other cause (nerve compression,) or vascular disease. Have you got an Electromyography (EMG) done?

Regards

[wonky]

Sorry for delay in answering and thanks for following up.  Yes I have had EMG and it was normal, with just a few polyphasic units.  Also had lumbar MRI.  There is some disc protrusion and scoliosis and very many haemangioma.  Saw one neurologist who dismissed it.  Then went to another routine appointment with an orthopaedic doctor, who thought the MRI was significant and wanted me to see another neurologist.  Everyone agrees my legs are very weak, and my reflexes.  My balance is now very bad.  More recently have been getting increasingly severe pain in lower back and tingling in thighs and knees.  Am having physiotherapy but they are frustrated as everything causes me pain so they can't do much with my problem.  Trying to get second opinion from another neurologist, but wonder if unless things are really dramatically bad they too will not bother to look further.  There is obviously something going on as my reflexes are getting less and less.  Is this just early middle age?  Am 42, female.  My friends of the same age who were previously less active than me don't seem to be deteriorating like this.  Would like to forget about it and get on with life, but am crippled in pain and walking like an elderly drunk.  Can't stand on a bus without falling over any more.  If ever I do get to see a neurologist again, what do you think I should ask them?  I realise that compared to their seriously ill patients I must seem very well, but for me it is like I am at the top of a slippery slope and will carry on getting worse.  I really don't want this so am pushing for answers now, for what it's worth.  Any further thoughts?  Thank you for your support, you seem a very knowledgeable and concerned person which is very pleasing for all us worried people!

[Abhijeet Deshmukh, MD]

Hello.

Hope you get the new appointment soon.

You will have to consider a possibility of loss of nerve supply the the muscles. This can be related to the spinal cord or to any place where the nerves can get damaged. Please ask your neurologist to review your EMG report.

They usually do Nerve conduction study along with the EMG. Did you have one? NCS tell us which nerve are faulty.

Ask the neurologist if you could also be having some blood circulation problem, so that he can order specific investigations.

All the best. Keep me posted.