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Dr. Mark
Dr. Mark, Doctor (MD)
Category: Health
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Experience:  U.S. Physician/Surgeon in Neurosurgery
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When I walk I have pain in my right hip. inner thigh, knee

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When I walk I have pain in my right hip. inner thigh, knee and calf are numb; 4th toe always numb, all toes get numb with increased activity, then both right and left hip muscles hurt. Nerve tests negative; vascular intervention in May with angioplasty in both L & R iliac artery, plus stent placement in R iliac artery. Doctor says I have good blood flow, but right foot gets cold off and on and pain and symptoms as described above continue. Pressure on back of right thigh results in entire leg becoming numb. What can be the problem? What kind of doctor should I consult?
Submitted: 5 years ago.
Category: Health
Expert:  Dr. Mark replied 5 years ago.
You had an EMG test of the lower extremities?

And the MRI of the lumbar spine did not show anything at all?
Customer: replied 5 years ago.
MRI revealed 2 bulging discs in L4 & L5, but was told not enough to be causing this. Is an EMG testing of the nerves? Add'l information: calf muscle is tender to the touch and I get a shooting pains in the numb area of the inner thigh and knee and get a burning sensation when I rub it lightly. This all began the middle of May this year.
Expert:  Dr. Mark replied 5 years ago.
No, a EMG test is when they stick needles into your legs and check the electrical stimulation of the nerves and muscles. Is this something that was done?

And does this pain seem to be all related, e.g. back of thigh, back of knee, to calf, and bottom of foot?
Customer: replied 5 years ago.

Yes, they stuck needles into my legs. Yes, the pain seems to be all related. (Onset was rising from the sofa to go to the bathroom and experienced severe pain in right leg and numbness and nearly fell. Then, to hospital and all the other things I previously stated. I have a problem with balance and use a cane now. I seem to walk into things a lot. . . cut a corner short or go into a wall. (The symptoms in calf of leg are very similar to intermittent claudication which I was diagnosed with a few years ago, but subsequent catherizations and angioplasties relieved it.) The pain in my legs will abate when I sit down or just stand still for a few moments. On the other hand, the pain will sometimes begin when standing in one place. When I walk about 60 or 70 feet the pain in my hips is almost unbearable and I can hardly even walk. There is some pain in a full knee bend.

 

Expert:  Dr. Mark replied 5 years ago.
If your doctors assure you that your blood flow to the lower extremities is good, then the symptoms of worsening pain in the hips with walking seems very strongly to be related to nerve compression in the lower back.

I wonder what the results of your EMG were exactly -- perhaps you should get those results, along with a recent MRI of the lumbar spine and see a neurologist for an examination, since your symptoms are very suspicious for neurogenic claudication:

http://www.spineuniverse.com/displayarticle.php/article2766.html
Customer: replied 5 years ago.

The neurologist is the one that performed the EMG after reviewing my MRI films and report. Beginning approx a year or more ago, when I walk about 60 or 70 feet my legs feel as though I've walked a marathon. Could this be something more, like MS or another muscle disorder/disease?

Expert:  Dr. Mark replied 5 years ago.
While it could be a disease of the muscles itself (a myopathy), those changes should have also been seen on the EMG testing.

But common things being common, it really does sound as if this is related to possible nerve compression in the lower back, and I would want my neurologist to continue their evaluation for your apparent claudication.
Customer: replied 5 years ago.

Dr. Mark, my low back is not hurting. To reiterate, the pain I've described is not constant. The ache in my calf and back of my thigh can occur if I'm standing for a prolonged period of time or walking. The numbness in my inner thigh and knee as well as the 4th toe is constant and upon walking, the numbness spreads to all toes. If I stomp my right foot (like to get dirt off shoes or something) I get sharp pains in the numb area of the inner thigh and knee. The numbness also sometimes comes down the outside of my thigh from my hip to my knee. The calf of my leg is tender to the touch and feels strained.. I have a very "tight" feeling across the instep (like there is a strap across it when I flex my foot). When sitting, if the chair seat hits the back of my thigh just right, my entire leg and foot will go completely numb. The weakness that occurs in BOTH hips occurs upon walking mostly, but at other times, too, when just standing, and the muscles feel like I have just walked in a marathon. Also, whenever I bend forward it makes my hips hurt, the muscles in that area feel very "strained" (like bending over a desk to write something, getting something out of the oven, bending over to pick something up, etc.). Sometimes my back feels like it is going to break in two. This is not muscular? (My primary physician suggested I might want to see an orthopedist.?

 

Add'l background: 12/1981 - back surgery L4 & L5, laminectomy, full recovery; 1/25/08 - hospitalized with Atrial Tachycardia, EPS and ablation (unsuccessful); 2/1/08 hospitalized with pulmonary embolism, right lung (put on coumadin and aspirin, taken off Plavix); 3/08 hospitalized w/tachycardia that wouldn't convert to normal rhythm for several hours (medication changed to Amiodarone, now controlled); 3/08 Severely anemic, Iron infusion. Blood transfusion (G.I. bleed due to aspirin regimen w/coumadin, this was discontinued and I was put back on Plavix); 4/08 - Congestive Heart Failure, pneumonia; 5/08 current problem began - hospitalized, MRI of spine, Scan of head, arteriogram, angioplasties, stents placed in right iliac artery -- sent home after 10 days since no improvement whatsoever. And here I am.

Expert:  Dr. Mark replied 5 years ago.
With lumbar stenosis, most patients tell me that their back does not hurt; it is their hips and legs that are 90-100% of their problem.

This is because it is not the joints or discs of the back that are the issue, it is the nerves that go into the legs. When these nerves are compressed, there may be minimal to no back pain, but the pains feel as if they are in the hips / buttocks / thighs / calves.

Your pains, because of the way you describe them (pains in certain areas, with numbness) sound like nerve related pains - muscle pains would not typically be so precise (and probably not have numbness associated with it).

Unfortunately, this is a much more complicated situation than I can help with over the Internet; seeing an orthopedist for a second opinion may be of benefit to you.
Dr. Mark, Doctor (MD)
Category: Health
Satisfied Customers: 11946
Experience: U.S. Physician/Surgeon in Neurosurgery
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