Possible sciatica?

[cougarman]

Hi Doctor, thanks for taking my question.  

I have possible Benign Fasciculation Syndrome - for about 2 yrs now I've had on-and-off widespread twitching, muscle soreness, exercise intolerance, joint pain, etc.  It comes & goes.  I had EMG done 1.5 yrs ago (on LEFT side of my body only) that found positive sharp waves in lumbar paraspinals @ lower level only, slight chronic denervation & reinnervation in tibialis anterior, vastus lateralis, & gastrocenmius muscles. Similarly, a few polyphasic potentials in biceps brachii, triceps brachii & deltoid on the left side.  CPK=265.  No myopathic units, no clinical weakness or any other clinical probs. except for nonpathologic brisk deep tendon reflexes.  EMG consistent w/ possible cervical & radicular disease.  Since this EMG 1.5 yrs ago, still no clinical weakness/any other signs. Was followed by a neuromuscular specialist.

Symptoms now:  Just my right leg. It has exercise intolerance - gets "tight" and fatigued and "burns" pretty quickly. Calf muscle injured a few wks ago with overuse (too many calf raises/running), but it doesn't seem to want to heal.  Still sore & whole leg feels "wobbly" at times.  Also feel some shakiness in lower right shin, lower right quad just above the knee, & ESPECIALLY behind the knee, just at the top of the calf muscle and at the bottom of the thigh. Twitching in those latter two areas. Also occasional tingling in right leg, and a kind of "numbness" and occasional "buzzing" that's hard to describe.  Rarely some right butt pain when sitting. Lower back aching as well, esp. at L4-L5. No symptoms in left leg.  MRI from 3 years ago showed "small diffuse disc bulges at L4-L5 and to lesser degree at L5-S1. No sig. spinal canal stenosis. Minimal right L4-L5 neural foraminal narrowing without evid. of nerve root impingement." X-ray done 2 yrs ago showed mild misalignment of L2-L3, nothing else.

Any ideas?  Sciatica? Why would foraminal narrowing disappear on X-ray? Thanks!

[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.

In most people, the pain of a herniated disc resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people ever require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muslce relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications.

In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there is evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery include muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.

Your constellation of symptoms may require you to have your low back re-evaluated. If you have not done so already, I would suggest you follow up with your neurologist for a neurological examination to determine if you have an identifiable localizable lesion and to differentiate from muscle overuse. You may need repeat imaging and/or EMG/NCS. Lastly, there is a condition called fibromyalgia. Fibromyalagia is a medical condition that leads to whole body pains. Its cause is unknown, but it is characterized by diffuse aches, sometimes GI symptoms similar to irritable bowel, sleep abnormalities, low pain threshold, and other features. It is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.  Again, I suggest you follow up with your neurologist.

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

[cougarman]

PS - I should be a little more clear - the calf mostly has a sharp pain when I use/flex it or stand on my toes, but it's not always there.  Also, the "wobbly" feeling comes and goes - it's not always there.  Thanks!