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Old 03-27-2012, 09:27 PM   #1
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Piriformis problems

Hi all-
I have an unusual problem and would like to know what you all think. I'm having peroneal nerve involvement that has shown up on my EMG. I am concerned that things might get worse and cause foot drop. I also have a disease called Synovial Chondromatosis in my left knee. Thru the years I have had multiple surgeries (synovectomies) for this disease. Unfortunately a few pieces of SC of been left in my knee which makes for a still uncomfortable knee. One piece in particular sits right next to my nerve behind my knee which my OS thinks is irritating the nerve causing my symptons of tingling, buzzing in foot, aching ankle, foot falling asleep etc. He is worried that the nerve will shut down and cause foot drop. But I am also having problems with my piriformis muscle and an aching butt! Often feeling a definite connection to my symptons in my calf and foot to when my butt hurts. I also have arthritis in my back with a moderate foraminal stenosis. But right now my back is pretty much under control with my meds. So OS sent me to Spinal OS who agrees with Knee OS that my back does not look to be the problem with my nerve. EMG also states the nerve problems are below my knee. But I am just not convinced even with the cards all stacked that it is the knee causing this problem. So Spinal OS has sent me to PT for the past month and we have been working closely trying to narrow it down to the knee, back or piriformis muscle. I am at the end of my month and PT agrees with me that my symptons do not seem to be coming from the knee.

Sorry this is so long. But I'm wondering if any of you have actually had nerve damage from the piriformis muscle and what your symptons were. My body is telling me a different story than the OS's. I see my Spinal OS in a week with my PT results and I think I am going to ask for a shot to the muscle to help with some diagnostic results. If I have a good reaction to the shot I think this might help us all know that it is not the knee. Has anyone had a shot to their piriformis muscle? I also go to an ortho oncologist now for removal of the remaining disease but I don't want another knee surgery unless I am in jeopardy of damaging my peroneal nerve for good. He has also told me that surgery is very risky and could cause drop foot too. I think I'm between a rock and a hard place.

Any advice would be appreciated. Thanks so much.
Martha

 
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Old 03-27-2012, 10:27 PM   #2
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Re: Piriformis problems

I don't know where you are located, but there is a new form of visualizing nerve issues called MR Neurography that was developed by Dr. Aaron Filler. Until recently, it was only available at a couple places on the West coast, but he is now licensing the technology and facilities have been opening up around the country. If interested in learning more, you can look online to see where the centers are located, and read about various case histories, see samples of the imaging, etc. There is a section on piriformis syndrome...or at least there was, last time I checked, which has been awhile. It might be helpful to you to read through the information provided on the website, even if you aren't interested in pursuing having a neurograph.

 
Old 03-27-2012, 11:00 PM   #3
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Re: Piriformis problems

At what level is your facet arthritis located, or is it all through the lumbar area?

I've had piriformis issues in the past, but never felt confidant that any medical personnel was able to tease out what was being caused by piriformis, what might be caused by the SI joint and what was coming from my lumbar spine issues.

I still do not know in the case of drop foot how they determine if the nerve is being compressed, damaged or irritated in the spine or down below where it branches off the sciatic nerve.

I suppose if you have all that damage at your knee, it would make sense that the peroneal nerve is damaged at some point at the knee or below. But I know all too well how facet arthritis can cause symptoms of nerve pain, numbness, etc in the lower leg, ankles, feet and toes.

My EMG showed chronic L5 and S1 radiculopathy in both legs, but right more than left. This was after a fusion at L4-L5 and my MRI after fusion did not show any nerve compression. The L5 and S1 nerves appeared to be totally clear and free. No one could figure out why I had these issues that clearly followed the L5 and S1 dermatomes.

I think it is entirely possible that your symptoms could be coming from both sources. What I learned from my experience is that sometimes things that are not readily identifiable on imaging or testing can still be happening within the body -- and that you and your PT are probably better at knowing where the problem is coming from or not coming from that the doctor, who only sees you for a couple minutes and doesn't have his hands on your body.

I'm sorry I don't have any good tips on how to separate the symptoms.

 
Old 03-28-2012, 05:42 AM   #4
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Re: Piriformis problems

teteri has some good tips for you. We are just getting back to my SI joint and piriformis area. My pain management doc did diagnostic injections (numbing agent only) on some of my facet joints, followed up with RF Ablation at three levels bilaterally. That took care of some of my problems, but the SI joint has been flared major for the last three months, and we just did the fist diagnostic injection on that Monday. Still waiting to see if the steroids the doc decided to use are going to do anything. The anesthetic did it's job. 8 hours pain free, so that definitely shows the SI joint as a problem. Will need another injection at some point in the near future to confirm, since there is a chance of a false positive result on the first injection.

There can definitely be multiple sources for problems when it comes to the body in general and especially in the back. The problem in the knee could definitely be behind some of your problems, but some of them could also be coming from elsewhere. My facet arthritis is mild, but I have additional issues contributing to things.

Good luck with the hunt for additional sources of the pain and other symptoms!

 
Old 03-28-2012, 10:04 PM   #5
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Re: Piriformis problems

Thanks for responding Left and Teteri. Today I feel like it is likely that both the knee and piriformis muscle are causing the problem. I don't know what would be causing the piriformis to be giving me problems but I suppose having a bum knee for many years I am walking a little screwy at times and could be affecting that muscle. Nerves seem to be like the electrical system in a car. Very hard to find out what and where the problem is. Luckily I'm not in horrible pain. It is mostly just nerve sensations but it does seem to be affecting the nerve that the EMG picked up on. That one hunk of SC sits right next to the nerve behind my knee right at the point where it crosses over to the front of the leg. So I am getting both peripheal and motor nerve involvement. Only the peripheal showed up on my EMG. Nothing showed on my EMG from the back down to the knee. But I sure feel it. But can a tight piriformis muscle actually damage a nerve? I can understand a sensory problem but can it really damage it enough for foot drop?
Well my plan anyway is to work on the piriformis muscle and see where it takes me. That will be the least invasive procedure
Martha

 
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