Calf weakness/atrophy -L5/S1 radiculpathy due with no pain

@bigmuscle72 Welcome to Connect. I follow a physical therapist from Europe on facebook, and he talks of conditions where there seems to be a disconnect of symptoms and trying to define if something is a spine issue or a muscular issue causing a compression. I agree, that before you do surgery, you need to be reasonably sure that it will address the cause of the problem. Here is an article on his website that may shed some light on what is called Lumbar plexus compression syndrome. Of course there could be spine issues, but there can also be other muscular issues and since you have had surgeries and not bearing weight equally on both your legs, that certainly could favor muscle spasms causing problems and differences in strength across both sides of the body. You can connect with the author on facebook and comment on one of his posts. He has responded to my comments before.

"How to identify and treat lumbar plexus compression syndrome (LPCS)"
Posted on March 30, 2017 by Kjetil Larsen
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/

Thank you very much for the information! I have had an MRI done of the pelvis throughout lumbosacral plexus compression. Didn’t find anything wrong, but there was motion artifact. I’ve had so many MRIs this year.

Have you made any progress or gotten any answers to your issues? I’ve experienced something similar with my neurologists and neurosurgeon as far as them being “confused” about what’s going on. I actually had a herniated disc at L5-S1 back in 2010, and though it took a while to improve, I was pretty much left with just lateral 4th and 5th toe numbness on my right foot. About two years ago now, I noticed right calf atrophy, and an inability to perform a single leg heel raise on my right leg/foot. I’ve had two MRIs in the last 4 months, and two EMGs and NCTs, indicating moderate tibial nerve damage denervation, but I guess since I’m not walking around in pain or a limp, no one wants to do anything about it except me.

@somewhereinco Welcome to Connect. I love your member name as I imagine a beautiful place in Colorado, a favorite place of mine!

I have had very similar symptoms also in my right foot and calf that came from a bad ankle fracture 4 years ago. I am still working to regain muscle mass lost, and I can see a place with a bit of a recess on the outside of my calf as compared to my uninjured leg. I am progressing. Single foot heel raises are hard, and I just work toward that in baby steps until it fatigues. I've also recently figured out that fascial tightness in my calf and leg has contributed to resistance to the muscle working properly. I have done lot of work with a physical therapist who does myofascial release, so I have been able to improve my leg function with some of that that I've been doing on my own. I don't know if there was nerve damage, but at the time of the fracture, I felt a nerve firing that was being stretched because the ankle was also a bit dislocated, so I straitened my ankle enough to stop that pulsing, but not to absolute straight foot forward. I did have some numbness in the 4th and 5th toes while in the cast, and I'm sure that was exacerbated by inflammation in the injured joint.

It sounds like you may have had a spine condition acting on the same nerve that I damaged with the fracture. Was there something on your imaging report showing nerve compression from the L5/S1 level? I am a spine patient too and had cervical stenosis and surgery to fuse C5/C6. Have you considered rehab doctor? They are an MD version of a physical therapist and may have a hands on approach to rehab.

This is the Myofascial Release therapy that I mentioned. We have a discussion with lots of links to information about it. MFR has helped me a lot. I don't know if it can help you, but it does address physical issues of tight tissues and those can cause nerve compression.

Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

Jennifer

Thank you! Yes, we're really enjoying living in Colorado.

Yes, I had a lumbar sacral MRI and a sacral plexus MRI, both showing moderate degenerative disc disease at L5-S1 with focal posterior annual tear, resulting in mild canal stenosis and approximation of the traversing bilateral S1 nerve roots.

Now, I get that it appears to be only mild canal stenosis, but the nerve is getting contacted by the disc bulge, and I didn't think you'd ever want that to happen, regardless of how mild or severe the contact is. What I'm also intrigued by is the fact that I don't have atrophy anywhere else on my right leg. It is just my calf. I'm not a doctor, nor do I play one on television, but logic would dictate that if atrophy is only occurring in the calf area, there is probably an issue with one of the nerves or several nerves between my toes and my knee on my right leg. Yet no one has suggested using an ultrasound in that area to look at the nerves and look for any entrapments or impingements of any of the nerves. From my reading, I am suspecting it is going to reveal something with the tibial nerve. Another interesting item to note is that the MRIs show that the annular fissure and disc bulge is pressing on the left S1 nerve root, but my symptoms are occurring on my right side.

One more test they could try is taking a sample tissue of my calf muscle to see how it looks. Is it healthy? Is it not? Can it be healed/repaired?

I've actually never heard of a rehab doctor or MFR therapy. I am currently in PT, and my current guy is a DPT, trying to strengthen and rebuild mass, and I haven't noticed any real improvements with it yet. I've only been going to just over a month, so perhaps I need to give it more time. I don't know. Really what I'm looking for is an answer as to whether or not the time and effort to do all of this is going to result in fixing anything. I've read about permanent nerve damage and fatty atrophy that are permanent and scary because no amount of work or effort to repair/reverse them is going to work. I need someone to find out what the status of my calf muscle and nerves are.

I'll think about looking into MFR, but that may have to wait until I can get the answers to my questions above. I don't have an endless amount of money to keep throwing at treatments that "may" help resolve the problem. This is the 21st century, and I'm certainly not the only person this has happened to, so I can't understand why this appears to be so difficult to solve.

Given the uneven, originally non-symmetrical onset and progression of your symptoms, it certainly seems like radiculopathies may be at the base of this. You should get a nerve ultrasound and perhaps you have already had the skin biopsy test? There are minimally invasive disc procedures you might consider. Physical therapy is definitely a good idea if you can find the right therapist. If you are not getting any help after three months I would switch to another therapist. They vary tremendously in terms of efficacy. Acupuncture (again, very practitioner-dependent) has been useful for some. TENS also helps some. Red light therapy is controversial but there is some experimental, pre-clinical and a few clinical studies in support of it, though with generally mixed results.

@somewhereinco
It sounds like you are doing the right things. Sometimes muscle atrophy does get better when the nerve compression is removed. I had that with some muscle loss on the back of my arms and shoulder that was caused by spinal cord compression in my neck and since my ACDF, most of it has come back. What also happens when there is an annular tear and the jelly like nucleus spills out is it causes inflammation, and the spine in an attempt to stabilize things can start to grow bone spurs. That was happening in my neck from a herniated C5/C6, and I saw the amount of bone spurs double on MRIs that were 9 months apart. That may be something to watch for because bone spurs would make this worse if it was compressing nerves.

Sometimes symptoms do switch sides. Because the spine moves and bends, it can cause other symptoms. If there is instability of the vertebrae because the disc is not strong enough to prevent that movement, a vertebra can slip past another for a little bit, and that can close down some of the spaces where the nerve roots exit the spine. With a collapsing disc (like mine), I was able to side bend and hit the nerve roots and my disc height had collapsed by 50%. I did not have narrowing around the nerve roots in the foramen, it was simply that the vertebrae were closer together with a thin disc between them.

Jennifer

Same basics here. Right calf suddenly useless. Got better for a few months, then back to useless now after a longer walk in February. Useless means I cannot support my weight on my right leg. No nerve pinch pain whatsoever. History of sacroiliitis with osseous fusion. History of left side sciatica. Lower left anterior skin numbness (L4 I think). "Mild degenerative changes" noted in 2021. I am TT at rs1800587.

@gogopher6 Welcome to Connect. Did you have a recent surgery or are you consulting a spine specialist about the recent changes in your leg strength? That must be concerning to have a sudden loss of function.

Jennifer

No surgery. I've had a number of xrays and an MRI due to a singular attack of sciatica in 2010 (left leg) and more recently the onset of bilateral sacroiliitis and even more recently walking-induced numbness in the left leg. The sudden loss of strength in my right calf first happened July of 2023, and there was zero pain associated. It came back however, relatively quickly. It was a historical item at my Nov physical. Recurred in March after a relatively long walk with my family. I responded to the other person's note because he (?) too lost muscle strength without suffering the pain of a nerve pinch. That's what is confusing...where's the pain? That's a long answer. The short answer is I am not yet seeing a spine specialist.