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Hi. My wife has been having issues for the last 6 months with her lower back, upper buttock area with shooting pain from about mid calf, down to the ankle. She also has occasional numbness in toes. She has had a spinal mri that two doctors have said is negative for any problems. She has also had xrays which have been good. She has been to many chiros and three physical therapists, with not much relief. Today she had such sever stabbing pain in the lower calf that I took her to the emergency room. There was nothing they could do but give her muscle relaxers. She goes through times where her pain is only 1 or 2 out of 10. This might last for several days or a week or two, but then hits a bad period like she is in now. Any idea what the problem might be?
She has fallen a few times, but not sure if that caused or added to the problem. She had been doing good the last week or two, so we started walking for an hour or so a day. About this time she also fell in the kitchen. Also during this time things started to go down hill again, so not sure if the walking or the fall caused it. A few days ago we had to take a three hour drive out of town, which irritated things more, she had several stabbing pains in the lower calf during the trip. We drove home yesterday, and then this morning she had the worse stabbing pain that she has had since this all started, about 6 months ago.
Does she feel stabbing pain at certain positions?
Is she overweight?
Associated swelling on lower calf?
Are both legs involved?
Which medicines are she taking now?
Any relief from physical therapy?
Any other medical illness?
Has she undergone any bloodwork?
Have you consulted a neurologist?
The first othopedic surgeon first thought it could be a disc problem. His mri showed no disc problems. At first he said it was not piriformis syndrome, but after the mri came back negative, he said it could be piriformis after all, and gave her some stretches to do, which greatly increased the stabbing pain. Another orthopedic doctor thought it was a labrel hip tear in the cartilage, and wanted to do an mri of the hip, which we refused due to the cost and will most others saying there is no way it is a labrel tear. She has also had an ultra sound of her pelvis, which showed no problem. We have heard a different story from everyone we have gone to, including a disc issue, a hip issue, an si joint issue, piriformis syndrome, etc.
The pain can happen at anytime, but if she bends over to far, she can trigger it. Also, if she is close to getting the stabbing pain, if she puts her leg straight, that can cause it. She is probably 20-30 pounds over weight.
No swelling that we have noticed. Everything is on the right side only. She is taking loritab, maybe 1/2 to one full pill daily, and just started taking muscle relaxer today. Not sure if phyiscal therapy or chiros have helped or not, since it can be sporadic, and not sure if they are helping, or if just time passing is helping. She has had blood work and everything seems good, except that her triglycerides are a bit high. We are planning on seeing a neurologist of Wednesday, to have a nerve test done.
Hi,Thanks for providing more information.
Sorry to hear about her pain and still undiagnosed.
As per your description,chances of Hip labral tear are less.
As her MRI is negative for herniated disc so chances of Piriformis syndrome are still present.
I want to discuss Piriformis syndrome first to give you a clear picture.
Piriformis syndrome is neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg.
There is no definitive test for piriformis syndrome.
In many cases, history of trauma to the area, repetitive, vigorous activity such as long-distance walking/ running, or prolonged sitting are contributing factors.
Diagnosis of piriformis syndrome is made by the patient’s report of symptoms and by physical exam.Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc, lumbar stenosis, and mass lesions in the region of the piriformis muscle.
Sometimes MRI also comes inconclusive.
As it has been seen that the muscle did not impinge directly on the nerve at the time of MRI, and the sciatic nerve seen on preoperative MRI was normal in size and signal characteristics.
This could be due to the fact that piriformis syndrome is a functional entity in which the nerve becomes compressed during prolonged sitting, walking, running, or other exercise.
It is possible that the sciatic nerve was not compromised by the piriformis muscle while the patient was lying comfortably on the MRI table.
Nerve conduction test with EMG can be helpful in her case and a clinical examination by a neurologist gives you a proper diagnosis.
I also suggest her to continue physical therapy as well.
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The thing is that she really does not get pain down the thigh. There is not any pain between the upper buttock, and the about mid calf, when she gets the stabbing pain. Not sure if with piriformis, if the pain can completely jump past the thigh and hit the calf? Should also mention that I believe both physical therapists did not feel it was piriformis from their exams, but both, along with some chiros talked about her pelvis being rotated. Should also mention that her right leg come up about 1/2" or more shorter than the left when laying on her stomach. Some have also talked about how locked up her right side si joint is.
Also, she has not had an mri of the piriformis area, because we have also heard that it usually would not show piriformis syndrome. Maybe an mri of the area would be good though to see if there are any other obstructions in that area. As far as the EMG on Wednesday, my concern is that if the pinching or the stabbing pain is not happening at the time of the EMG, will it still show where the problem might be coming from?
Thanks for the follow-up.
Firstly it may be possible than sciatic nerve roots supplying buttock and calf are irritated at their path while passing through piriformis muscle.
And it can result in pain in buttock and calf.
Other possible cause can be Neurogenic claudication.
As she feel one leg shorter than other so possible cause may include the pelvis is "tilted", and when that occurs-then the spine is thrown off a healthy position. Along with that the muscles and ligaments in the spine are bent and stretched in unhealthy ways. Other potential differential diagnosis may include muscle dystrophy.
So NCV and EMG can help in determine the underlying cause.
Nerve conduction velocity (NCV) test is done to study speed of electrical signals through a nerve.Often, the nerve conduction test is followed by electromyography (EMG), which involves needles being placed into the muscle and you contracting that muscle.Electromyography (EMG) is a test that checks the health of the muscles and the nerves that control the muscles.
It can detect where the nerve is irritated.
It's good to see a neurologist for further evaluation.