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induced small electric shock
hello dear colleagues,
I need your help to move forward in a situation. I have difficulties to put the neuropathic condition.
A patient operated in 2014 for a herniated L5-S1 disc:
I see him recently following an increase in his nighttime insomnia discomfort in the form of annoyances on the external malleolus and irradiations on the big toe. A recent MRI shows a foraminal narrowing L5-S1.
There is no hypoaesthesia at 0.7 g and no allodynia, but electric shocks on the territory of the lateral sural nerve and superficial peroneal on palpation of the skin and muscle.
Not knowing what to do in the area with small induced electric shock, I propose a DTCS on L2. In L4 irradiations in the big toes are perceived.
See you soon.
Laure
Comments
Dear Laure,
Sorry for the late response.
1)Can you identify (name) the branches that are possibly affected?
2)Do you remember the norm (g) for each territory? (remember to use 0,1g more than the norm: 0,7g for the body, 0,4g for the dorsal of the foot, and 0,2g for the plantar region).
3)Have you tested/compared the sensitivity of the skin with a tissue on both feet? Is it the same sensation or does the person feels it less/more?
4)Do you remember what are the four tests to confirm hypoesthesia? Have you tried them?
Good luck,
Sarah Bouchard, CSTP and president of the somatosensory rehabilitation of pain network
Dear all,
"irradiations on the big toe" means efferent throbbing sensation along the the medial terminal branch of superficial peroneal nerve (common fibular nerve / sciatic nerve) page 82 (Atlas of cutaneous nerve territories - Sept 25 2020) until the most distal point of the largest territory of cutaneous origin.
The territory is always numb, strange and perhaps tender to touch. This is our oxymoron: Paradoxical HYPO-aesthesia painful to touch. Both together or neither numb nor tender.
I hope that this answer is helping your clinical reasoning. Personnaly, i woul start with: Rehabilitaitno of underlying hypoaesthesia 8 times a day during one minute of less long.
Best regards
cJ
Thank you Sarah and Claude,
The neuropathic condition is intermittent femoro-popliteal neuralgia with discreet allodynia of the medial branch of the superficial perineal nerve and the lateral calcanea branches of the sural nerve (stadium lll of axonal lesion Abéta).
We are in a root compression confirmed by MRI. The compression will stay, can we stilled do something as therapist of sensitivity.
Thank you
Laura
Hi Laura,
We can still do something. The neuropathic pain emerges from a region external to / slightly further from the root compression (dorsal horn if i remember correctly at this late hour). Using the method will still help to calm those symptoms. However, if nothing is done about the root compression, it can cause the neuropathic pain to come back again in the future as well.
But, in the meantime, yes you can still help.
Good luck
Thank you Amandeep,
Yes in the meantime, I carry on with a distant counter-stimulation on TH12 with very slight improvement but still improvement.
Take care