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Dear all,

I was hoping to pick some of your brains,

I saw a patient in clinic today and have been unable to forget about them, 50 year old man, with previous hisotry of a fibula fracture in the affected limb History of asthema and a smoker. Bascially their clinical presentation was uni-lateral distal muscle atrophy in the gastroc-soleus complex, with fasiculations and localised hypotonia. The limb is apart from what i described otherwise healthy in comparison to the other, same hair growth, healthy skin, etc.

Patient was offered steriod injections to stop the the pain accompanied down the route of the common peroneal nerve. I will be seeing patient again in a week for a full biomechanical and neurolgical examination, (more neurolgical) From my perspective i feel all that can be done is to refer on to their g.p reporting my findings and suggest the futher course of action to him,

To me my first thoughts have been CPRS (hhowever i found this problem pre-dated the fibula fracture he suffered) Nerve root compression, or at least an entrapped nerve, or more worringly a LMN,

Any of your thoughts would be appreciated

Chris

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Chris-

You probably have considered this as one of your differentials:
S1 nerve compression from L5 disk herniation / subluxation / stenosis affecting the posterior and lateral leg is a common finding with the absence of lumbar pain.

hi,
yes i have and that is the root i am going down at present, i hope this is the case, good job the practice is within a chiropractors clinic.

many thanks

chris

I am a little confused. fasiculations are typically an upper motor neuron finding. Wheras hypotonia is a lower motor neuron (LMN?) finding.

Fasciculation: Involuntary contractions or twitchings of groups of muscle fibers.

Did he get the fracture as a result of muscle weakness. At some point he deserves a brace / AFO. Probably after the cause of the nerve deficit is found.

Regards,

Eric

Hi Eric,

Many thanks for your post, regarding the fasiculations as a sign of umn, this is what i find interesting as i fortunate enough (after assessing this patient) to see for myself the evidence of this, i find it hard to believe that his previous visits to his GP and Physiotherapist, both did not appear to even assess or address the sever atrophy, and hypotonia clearly eveident, or even the underlying cause of this, they just offered steroid injections.

Chris