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Category: Neurology
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I’ve been told I have lumbrosacral plexopathy which is

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I’ve been told I have lumbrosacral plexopathy which is causing pain in my foot when I walk. I have tried all medications and foot wear but can find nothing that helps. It’s only walking that causes discomfort. I be also tried steroid treatment and seen several therapists. Do you have any other suggestions?
Assistant: How long have you had the pain? What seems to make the pain better or worse?
Customer: It started 3 years ago. There is only pain when I am walking
Assistant: Anything else in your medical history you think the Doctor should know?
Customer: I had bowel cancer 8 years ago and the neurologist did tests and said that they believe the radiotherapy caused some nerve damage
Hello-

Just to be sure, have your doctors had a recent MRI of the lumbar spine, and ordered EMG tests?
Customer: replied 1 month ago.
I had an mri of the lumber spine last year and emg in January 2018

Did the MRI show anything at the L5 or S1 level?

Did the EMG show anything concerning L5 or S1?

Customer: replied 1 month ago.
This is the emg report
Customer: replied 1 month ago.
I can’t remember what the mri showed

OK, the EMG report does suggest "nerve damage" to some of the nerves that go to the right leg.

 

But the muscles affected could be related to an issue at the L4, L5, or S1 level in the lumbar spine. I would want to make sure that there is nothing on the MRI report that suggests a "pinched" nerve at the L4, L5 or S1 level before writing this off to lumbosacral plexopathy.

Because if it is plexopathy -- there really is no good treatment for this, as that represents damage to the nerves.

Neuropathic pain medications like gabapentin, Cymbalta can be helpful.

Customer: replied 1 month ago.
I have tried gabapentin which made no difference. I will try and find a copy of the mri report. My trouble is with my left foot. It feels like internal swelling and internal bruises but ultrasound, X-ray and mri show nothing.

Well, the EMG did not test the left leg, and if you have new symptoms into the left foot, it may be helpful to consider repeating MRI of the lumbar spine.

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Customer: replied 1 month ago.
I also have loss of feeling in my big toe and some other areas. With difficulty in bending the toe so making it difficult to grip things. E.g towel with my foot

That could be an issue with the S1 nerve there.

Customer: replied 1 month ago.
This is the mri report for my back. It’s from 2017, not last year as I thought

Well, it might be worth repeating the MRI to make sure nothing has happened to the L5-S1 level in the past 2 years.

Customer: replied 1 month ago.
Does it still sound like lumbrosacral plexopathy? Or could it be something else?
It sounds like part of this is lumbosacral plexopathy, but with new symptoms, I would want to make sure nothing else has happened.
Customer: replied 29 days ago.
The EMG did test the left leg as well. It says the left common peroneal motor responses are of low amplitude
Customer: replied 28 days ago.
Having looked up the area in the foot where the discomfort is is seems that the S1 could cause this pain and loss of feeling. However my question is, if the mri doesn’t show any damage to this nerve would having an epidural steroid injection give any sort of relief?

If there is inflammation of the S1 nerve -- then the epidural steroids can help with this inflammation, and help with the pain.

Customer: replied 27 days ago.
If the radiotherapy had damaged the nerves wouldn’t this show up on the mri? And seeing as it doesn’t could it mean that there maybe damage further down the nerve?

No it would not show radiation damage.

 

There could be damage anywhere along the nerve.

Customer: replied 27 days ago.
And how can we determine where along the nerve the damage is and what could be done for relief of the pain when walking and loss of sensation?

That would be with the EMG and MRI scans, as well as your symptoms.

But issues with internal injury to the nerve (like with radiation damage) may be difficult to pinpoint.

Customer: replied 27 days ago.
And who should I take the emg report and scan to? Neurologist?

Yes, a neurologist.

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