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Suggest treatment for numbness in the knee

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Posted on Sat, 2 Jul 2016
Question: Progressive (over the years) dull ache, heaviness, surface numbness from knee to top of foot, weakness of right leg. Sleeping is fine. Walking with limp due to discomfort. Front of leg, only. Total hip replacement 04-02-2015. Some hip involvement, but not primary known source of problem. Condition was present for years prior to replacement, but not at this level. EMG shows nerve engagement. Several L-2, L-3, injections (3) along with bur sac injections (2). Some relief, but short-lived. I've noticed beginnings of varicose veins on right thigh. Father had PVD resulting in amputation of both legs to mid-thigh level. I am 68. My father presented at 65 and died at 68.
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Answered by Dr. Dariush Saghafi (3 hours later)
Brief Answer:
Investigations to be considered

Detailed Answer:
Good evening. Thank you very much for your question on this network. My hope is that we can help add some information and ideas to what you may already know or have discussed with your doctors in order to get things going the right way. The way you are presenting the case with the numbness traveling from knee to top of the foot and WEAKNESS of the right leg as well as a discomfort in the right leg causing a limp is consistent with an L4/L5 type of radiculopathy. I don't see why L2, L3 should've been injections based on the presented information. Those dermatomal levels are strictly ABOVE THE KNEE and more specifically involve the lower 2/3 of the inner thigh. You've not said anything of painful or paresthestic sensations in those dermatomes therefore, the injections make no sense in the first place. In the second place, I am not a fan of steroid injections (especially in 68 year olds) in part because they have a very short duration of effect in many people which means they have to reinjected frequently and as well for the fact that the simple injection of steroids can and does debilitate and accelerate deteriorative effects of body tissues such as muscles, tendons, and ligaments. This means that over time the very symptoms of pain and weakness could be made by worse due to destabilization of the supporting tissues that keep the column straight.

I don't think PVD in your father necessarily means you are destined to having PVD. It depends upon your risk factors such as cholesterol and triglyceride levels, weight, activity levels, and other important parameters. Therefore, I wouldn't be as concerned about that as trying to determine causes for the paresthesias if not an L4/L5 radiculopathy. For example, Vitamin B12, thyroid hormones such as FREE T4 and TSH, Vit. D, D2, and D3.

You also have not said anything of an MRI of the lumbar spine which I would definitely recommend in order to correlate with the EMG and clinical findings.

I do not know what you mean to say "EMG shows nerve ENGAGEMENT?" That is not a term we use to describe findings in an EMG study. Please refer to the report and either upload it to this network as a .pdf file or copy it out word for word. Perhaps it says, "nerve IMPINGEMENT?" but then, if it says that it should usually tell you at what dermatomal level the nerve is impinged (pinched or compressed).

If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?

Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 58 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2473 Questions

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Suggest treatment for numbness in the knee

Brief Answer: Investigations to be considered Detailed Answer: Good evening. Thank you very much for your question on this network. My hope is that we can help add some information and ideas to what you may already know or have discussed with your doctors in order to get things going the right way. The way you are presenting the case with the numbness traveling from knee to top of the foot and WEAKNESS of the right leg as well as a discomfort in the right leg causing a limp is consistent with an L4/L5 type of radiculopathy. I don't see why L2, L3 should've been injections based on the presented information. Those dermatomal levels are strictly ABOVE THE KNEE and more specifically involve the lower 2/3 of the inner thigh. You've not said anything of painful or paresthestic sensations in those dermatomes therefore, the injections make no sense in the first place. In the second place, I am not a fan of steroid injections (especially in 68 year olds) in part because they have a very short duration of effect in many people which means they have to reinjected frequently and as well for the fact that the simple injection of steroids can and does debilitate and accelerate deteriorative effects of body tissues such as muscles, tendons, and ligaments. This means that over time the very symptoms of pain and weakness could be made by worse due to destabilization of the supporting tissues that keep the column straight. I don't think PVD in your father necessarily means you are destined to having PVD. It depends upon your risk factors such as cholesterol and triglyceride levels, weight, activity levels, and other important parameters. Therefore, I wouldn't be as concerned about that as trying to determine causes for the paresthesias if not an L4/L5 radiculopathy. For example, Vitamin B12, thyroid hormones such as FREE T4 and TSH, Vit. D, D2, and D3. You also have not said anything of an MRI of the lumbar spine which I would definitely recommend in order to correlate with the EMG and clinical findings. I do not know what you mean to say "EMG shows nerve ENGAGEMENT?" That is not a term we use to describe findings in an EMG study. Please refer to the report and either upload it to this network as a .pdf file or copy it out word for word. Perhaps it says, "nerve IMPINGEMENT?" but then, if it says that it should usually tell you at what dermatomal level the nerve is impinged (pinched or compressed). If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction? Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. This query has utilized a total of 58 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.