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Suggest Treatment For Severe Pain In Thigh And Leg In An Elderly Patient
Question: Hi please let me start from the beginning.
Dad approximately 2 months tried to get up and simply couldn’t. Dad has always been an independent man with no mobility problems. We took Dad to the hospital who thought Dad had had a TIA. After assessment TIA was ruled out.
Dads main symptoms were severe pain in left thigh and leg and when he tried to stand up his legs would just collapse underneath him. Dad does have some numbness in his leg. This all started in his left leg but has now developed to the right leg (right leg is now much worse than the left with exactly the same symptoms, numbness, pain and legs collapse underneath him. Numbness in left leg has now resolved but still has it in his right leg. Dads feet are always stone cold and he says he cant tell himself without touch whether both feet are hot or cold. Dad has no upper limb symptoms.
At the moment Dad can’t get from a sitting to standing position yet his left leg now has full power and can leg raise with full range of movement. The right leg however he can hardly lift it up, Dads left leg was like this at first but now the leg seems to be resolving though Dad can still not walk or stand.
We have had a follow up appointment with the Stroke Team who have now discharged Dad as they say his condition is not stroke related.
We have seen a Neurologist and are awaiting EMG studies plus MRI scan and Occupational Therapy input. Neurologist gave us no hope what so ever and said there is no treatment and reversing what is wrong with Dad. I am sure medicine these days there must be something.
Please find below the letter we got from the Neurologist:
Diagnosis: likely diabetic motor sensory neuropathy
Thank you for referring this 68 year old right handed gentleman to the Neurology clinic. He has had Diabetes since 2000. His control was previously poor though has improved in the last 9 months. Mr Bridge has a previous history of osteomyelitis for which he was treated long term antibiotics (18 months of antibiotics). He now describes a 2 month history of progressive weakness of both legs. He also described numbness in the legs. His arms bowel bladder speech and swallowing is unaffected.
On examination today his cranial nerves were unremarkable. Examination of limbs revealed normal tone. Power was normal in both arms and legs. Hip flexion was reduced to 3/5 bilaterally. Reflexes were absent in the legs but present in the arms. Sensation to pinprick was reduced distally in the legs but was present in the arms. Vibration sense was absent up to the hips. There were no fasciculation’s visible.
I suspect this gentleman has quite a severe axonal motor sensory neuropathy secondary to his diabetes. I have explained that this is not a treatable condition but we need to exclude any more treatable condition but we need to do some further investigations to exclude anymore treatable causes. I am arranging MRI scan of lumbar spine to make sure there is no cord pathology or nerve root compression and some nerve conduction studies to quantify the extent of his nerve damage.
Questions:
1. Do you have any idea what is wrong with my Dads legs?
2. How can we get Dad XXXXXXX even with a Zimmer (Dad still falls with a frame)
3. Do you think this condition can resolve or get better?
4. If Dad can move legs freely whilst sat down why can he not stand up without legs collapsing or him falling?
5. What is axonal motor sensory neuropathy and do you agree this is what is wrong? Can it get any better?
6. What treatable causes are there?
Dad approximately 2 months tried to get up and simply couldn’t. Dad has always been an independent man with no mobility problems. We took Dad to the hospital who thought Dad had had a TIA. After assessment TIA was ruled out.
Dads main symptoms were severe pain in left thigh and leg and when he tried to stand up his legs would just collapse underneath him. Dad does have some numbness in his leg. This all started in his left leg but has now developed to the right leg (right leg is now much worse than the left with exactly the same symptoms, numbness, pain and legs collapse underneath him. Numbness in left leg has now resolved but still has it in his right leg. Dads feet are always stone cold and he says he cant tell himself without touch whether both feet are hot or cold. Dad has no upper limb symptoms.
At the moment Dad can’t get from a sitting to standing position yet his left leg now has full power and can leg raise with full range of movement. The right leg however he can hardly lift it up, Dads left leg was like this at first but now the leg seems to be resolving though Dad can still not walk or stand.
We have had a follow up appointment with the Stroke Team who have now discharged Dad as they say his condition is not stroke related.
We have seen a Neurologist and are awaiting EMG studies plus MRI scan and Occupational Therapy input. Neurologist gave us no hope what so ever and said there is no treatment and reversing what is wrong with Dad. I am sure medicine these days there must be something.
Please find below the letter we got from the Neurologist:
Diagnosis: likely diabetic motor sensory neuropathy
Thank you for referring this 68 year old right handed gentleman to the Neurology clinic. He has had Diabetes since 2000. His control was previously poor though has improved in the last 9 months. Mr Bridge has a previous history of osteomyelitis for which he was treated long term antibiotics (18 months of antibiotics). He now describes a 2 month history of progressive weakness of both legs. He also described numbness in the legs. His arms bowel bladder speech and swallowing is unaffected.
On examination today his cranial nerves were unremarkable. Examination of limbs revealed normal tone. Power was normal in both arms and legs. Hip flexion was reduced to 3/5 bilaterally. Reflexes were absent in the legs but present in the arms. Sensation to pinprick was reduced distally in the legs but was present in the arms. Vibration sense was absent up to the hips. There were no fasciculation’s visible.
I suspect this gentleman has quite a severe axonal motor sensory neuropathy secondary to his diabetes. I have explained that this is not a treatable condition but we need to exclude any more treatable condition but we need to do some further investigations to exclude anymore treatable causes. I am arranging MRI scan of lumbar spine to make sure there is no cord pathology or nerve root compression and some nerve conduction studies to quantify the extent of his nerve damage.
Questions:
1. Do you have any idea what is wrong with my Dads legs?
2. How can we get Dad XXXXXXX even with a Zimmer (Dad still falls with a frame)
3. Do you think this condition can resolve or get better?
4. If Dad can move legs freely whilst sat down why can he not stand up without legs collapsing or him falling?
5. What is axonal motor sensory neuropathy and do you agree this is what is wrong? Can it get any better?
6. What treatable causes are there?
Brief Answer:
Treatable Causes are Cauda Equina Syndrome, Vitamin Deficiency
Detailed Answer:
Hi,
Welcome to HealthCareMagic.com
I am Dr.Bruno Mascarenhas. I have read your question with care and understand your concern. I feel that the diagnosis cannot be finalised without seeing the reports of MRI Spine and EMG Studies which are crucial. Similarly Plan for Further Management needs input from the Occupational Therapist. Let me try to help you with your questions, but I should add that all we say at the moment are provisional and are subject to change depending on the results of (1) EMG (2) MRI (3) Occupational Therapist Input
Question 1.
Do you have any idea what is wrong with my Dads legs?
Answer
From what you have narrated, your dad suffers from Asymmetric Motor Weakness. The Treating Neurologist has suggested Diabetic Motor Sensory Neuropathy. These are problems in the peripheral nerves.
But, I would also likely to rule of Cauda Equina Lesions / Conus Lesions / Cauda Conus Lesion. These are problems in the Spinal Cord. They too can present like what you have narrated. To Diagnose or Rule out these conditions, you need to do MRI of Dorsal Lumbo Sacral Spine
--
Question 2.
How can we get Dad XXXXXXX even with a Zimmer (Dad still falls with a frame)
Answer
We need to address the cause of his Neuropathy + Simultaneously Start Physiotherapy and Occupational Therapy
By Addressing the cause, I mean treating the Primary Cause
For Example,
(a) If the present problems are due to Cauda Conus Syndrome, we have to treat that
(b) If the present problems are due to Diabetic Neuropathy, we have to control Diabetes
(c) If the present problems are immune mediated, we have to give immuno suppressants / immuno modulators
(d) If the present problems are due to Vitamin Deficiency, we have to give Vitamin Supplements
--
Question 3.
Do you think this condition can resolve or get better?
Answer 3
This depends on the Cause
If this is a Vitamin Deficiency or Cauda Equina Lesion, Proper Treatment will usually give dramatic recovery
If this is a diabetic Neuropathy, then you may not expect 100 % recovery
--
Question 4.
If Dad can move legs freely whilst sat down why can he not stand up without legs collapsing or him falling?
Answer
Muscle Power has six grades
0 - No Movement at all
1 - Flicker of Movements
2 - Minimal Movements, but can't move against Gravity
3 - Moves against gravity, but cannot move against resistance
4 - Moves against resistance, but not full power
5 - Full Power
Now, the legs are probably in Grade 3
To Stand up, you need Grade 5 Power
--
Question 5.
What is axonal motor sensory neuropathy and do you agree this is what is wrong? Can it get any better?
Answer
Axonal motor sensory neuropathy basically means that there is a problem in the Axons of the Peripheral Nerves.
As I had specified in Answer to first question, I would first want to Rule out Cauda Conus Lesions and look at EMG before agreeing to this diagnosis
Axonal motor sensory neuropathy can get better, but if it is Vitamin Deficiency or Cauda Equina Lesion, Proper Treatment will usually give dramatic recovery
--
Question 6.
What treatable causes are there?
Answer
There are many treatable causes. For example, if it is Vitamin Deficiency or Cauda Equina Lesion, Proper Treatment will usually give dramatic recovery
Hope you found the answers helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.
Treatable Causes are Cauda Equina Syndrome, Vitamin Deficiency
Detailed Answer:
Hi,
Welcome to HealthCareMagic.com
I am Dr.Bruno Mascarenhas. I have read your question with care and understand your concern. I feel that the diagnosis cannot be finalised without seeing the reports of MRI Spine and EMG Studies which are crucial. Similarly Plan for Further Management needs input from the Occupational Therapist. Let me try to help you with your questions, but I should add that all we say at the moment are provisional and are subject to change depending on the results of (1) EMG (2) MRI (3) Occupational Therapist Input
Question 1.
Do you have any idea what is wrong with my Dads legs?
Answer
From what you have narrated, your dad suffers from Asymmetric Motor Weakness. The Treating Neurologist has suggested Diabetic Motor Sensory Neuropathy. These are problems in the peripheral nerves.
But, I would also likely to rule of Cauda Equina Lesions / Conus Lesions / Cauda Conus Lesion. These are problems in the Spinal Cord. They too can present like what you have narrated. To Diagnose or Rule out these conditions, you need to do MRI of Dorsal Lumbo Sacral Spine
--
Question 2.
How can we get Dad XXXXXXX even with a Zimmer (Dad still falls with a frame)
Answer
We need to address the cause of his Neuropathy + Simultaneously Start Physiotherapy and Occupational Therapy
By Addressing the cause, I mean treating the Primary Cause
For Example,
(a) If the present problems are due to Cauda Conus Syndrome, we have to treat that
(b) If the present problems are due to Diabetic Neuropathy, we have to control Diabetes
(c) If the present problems are immune mediated, we have to give immuno suppressants / immuno modulators
(d) If the present problems are due to Vitamin Deficiency, we have to give Vitamin Supplements
--
Question 3.
Do you think this condition can resolve or get better?
Answer 3
This depends on the Cause
If this is a Vitamin Deficiency or Cauda Equina Lesion, Proper Treatment will usually give dramatic recovery
If this is a diabetic Neuropathy, then you may not expect 100 % recovery
--
Question 4.
If Dad can move legs freely whilst sat down why can he not stand up without legs collapsing or him falling?
Answer
Muscle Power has six grades
0 - No Movement at all
1 - Flicker of Movements
2 - Minimal Movements, but can't move against Gravity
3 - Moves against gravity, but cannot move against resistance
4 - Moves against resistance, but not full power
5 - Full Power
Now, the legs are probably in Grade 3
To Stand up, you need Grade 5 Power
--
Question 5.
What is axonal motor sensory neuropathy and do you agree this is what is wrong? Can it get any better?
Answer
Axonal motor sensory neuropathy basically means that there is a problem in the Axons of the Peripheral Nerves.
As I had specified in Answer to first question, I would first want to Rule out Cauda Conus Lesions and look at EMG before agreeing to this diagnosis
Axonal motor sensory neuropathy can get better, but if it is Vitamin Deficiency or Cauda Equina Lesion, Proper Treatment will usually give dramatic recovery
--
Question 6.
What treatable causes are there?
Answer
There are many treatable causes. For example, if it is Vitamin Deficiency or Cauda Equina Lesion, Proper Treatment will usually give dramatic recovery
Hope you found the answers helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.
Above answer was peer-reviewed by :
Dr. Prasad
If it is due to diabetic neuropathy even though dad may never walk independently again can we improve mobility so he can walk safely with a zimmer/walking stick?
Thank you so much for your help
Thank you so much for your help
Brief Answer:
He Can Walk Safely after proper treatment, even without Zimmer
Detailed Answer:
Hi,
Welcome Back !
Even if it is due to diabetic neuropathy, there are ways in which we can improve mobility so he can walk safely with a zimmer / walking stick.
What we need to do is
(1) Strict Diet Control
(2) Proper Management of Diabetes with routine Blood tests
(3) Drugs to improve nerve function
(4) Drugs to improve Micro circulation (that is drugs which increase blood flow in small blood vessels of the nerves)
(5) Physiotherapy and Occupational Therapy
But
Since the complaints are only for 2 weeks, and since once side has recovered, I do feel that there is something else other than Diabetic Neuropathy which is causing his present symptoms and that something is easily curable. Once fully and properly treated, he can walk even without Zimmer / Walking Stick.
I sincerely hope that, after complete evaluation and treatment, your dad will be back to his normal routine.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.
He Can Walk Safely after proper treatment, even without Zimmer
Detailed Answer:
Hi,
Welcome Back !
Even if it is due to diabetic neuropathy, there are ways in which we can improve mobility so he can walk safely with a zimmer / walking stick.
What we need to do is
(1) Strict Diet Control
(2) Proper Management of Diabetes with routine Blood tests
(3) Drugs to improve nerve function
(4) Drugs to improve Micro circulation (that is drugs which increase blood flow in small blood vessels of the nerves)
(5) Physiotherapy and Occupational Therapy
But
Since the complaints are only for 2 weeks, and since once side has recovered, I do feel that there is something else other than Diabetic Neuropathy which is causing his present symptoms and that something is easily curable. Once fully and properly treated, he can walk even without Zimmer / Walking Stick.
I sincerely hope that, after complete evaluation and treatment, your dad will be back to his normal routine.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you so much for your help I will send reports when I get them
Brief Answer:
Waiting for the reports :)
Detailed Answer:
Best Wishes for Total Recovery and your dad getting back to his normal routine
I will get back to you after reviewing the reports
Waiting for the reports :)
Detailed Answer:
Best Wishes for Total Recovery and your dad getting back to his normal routine
I will get back to you after reviewing the reports
Above answer was peer-reviewed by :
Dr. Yogesh D
If dad has diabetic neuropathy can dad walk again. I did manage after a struggle to get dad stood uo last night and he shuffled a few steps. This was difficult but we got there is this a good sign?
Brief Answer:
If dad has diabetic neuropathy, he can walk again
Detailed Answer:
Hi,
Welcome Back to HealthCareMagic.com
Question :
If dad has diabetic neuropathy can dad walk again.
Answer :
If dad has diabetic neuropathy, he can walk again
History :
I did manage after a struggle to get dad stood up last night and he shuffled a few steps. This was difficult but we got there is this a good sign?
Opinion :
That is a very good sign that he is on the road to recovery
Hope you found the answers helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Total Recovery and your dad getting back to his normal routine
Let me know if I can assist you further.
Take care.
If dad has diabetic neuropathy, he can walk again
Detailed Answer:
Hi,
Welcome Back to HealthCareMagic.com
Question :
If dad has diabetic neuropathy can dad walk again.
Answer :
If dad has diabetic neuropathy, he can walk again
History :
I did manage after a struggle to get dad stood up last night and he shuffled a few steps. This was difficult but we got there is this a good sign?
Opinion :
That is a very good sign that he is on the road to recovery
Hope you found the answers helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Total Recovery and your dad getting back to his normal routine
Let me know if I can assist you further.
Take care.
Above answer was peer-reviewed by :
Dr. Sonia Raina
dad has lost all mobility in legs today cant stand at all as no strength please help can dad get better and what do I do to get him to commode this is awful I am heartbroke
Brief Answer:
Please do MRI Dorso Lumbar Spine as Soon as Possible
Detailed Answer:
Hi,
If the weakness have increased, the you need to Please get him admitted in Hospital and Complete all the Investigations and get the reports as soon as possible. We need to do the Blood Biochemistry to check for any abnormalities
I would also likely to rule of Cauda Equina Lesions / Conus Lesions / Cauda Conus Lesion. These are problems in the Spinal Cord. They too can present like what you have narrated. To Diagnose or Rule out these conditions, you need to do MRI of Dorsal Lumbo Sacral Spine
Hope you found the answers helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Total Recovery and your dad getting back to his normal routine
Let me know if I can assist you further.
Take care.
Please do MRI Dorso Lumbar Spine as Soon as Possible
Detailed Answer:
Hi,
If the weakness have increased, the you need to Please get him admitted in Hospital and Complete all the Investigations and get the reports as soon as possible. We need to do the Blood Biochemistry to check for any abnormalities
I would also likely to rule of Cauda Equina Lesions / Conus Lesions / Cauda Conus Lesion. These are problems in the Spinal Cord. They too can present like what you have narrated. To Diagnose or Rule out these conditions, you need to do MRI of Dorsal Lumbo Sacral Spine
Hope you found the answers helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Total Recovery and your dad getting back to his normal routine
Let me know if I can assist you further.
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
i have just called gp out thanks
Brief Answer:
Best Wishes !
Detailed Answer:
Best Wishes for Total Recovery and your dad getting back to his normal routine
Let me know if I can assist you further.
Take care.
Best Wishes !
Detailed Answer:
Best Wishes for Total Recovery and your dad getting back to his normal routine
Let me know if I can assist you further.
Take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
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