Help - Deep Low & L5 Nerve Issue

Hi all.Really need some help here as im hitting a very deep low.After a good week or two of getting on with stuff and putting up with the issues, things have relapsed quite badly.My employers wanted me to go for physio as part of a return to work plan. So on Wednesday i popped off to the appointment. The physio went through my history, in particular the L5 nerve issue. He then started testing my legs, and within a couple of minutes was checking my feet. He could see, and i could feel, that the muscle that lifts the big toe on my right foot was noticeably weaker than my right. He explained that L5 is the nerve responsible for this.This sent my heart through the floor. This foot has continually twitched, cramped and felt odd for weeks. Also the right shin has been incredibly sore.this prompted me to obtain a copy of my recent EMG which i posted about a couple of weeks ago. Having read this my anxiety has gone off the scale.The neurologists report states " His EMG certainly does not show any evidence of anterior horn cell disease" The professor who carried out the test states " Extensive EMG was normal today except for mild changes of denervation in right extensor hallucis longus, consistant with a mild subclinical L5 radiculopathy."His report says " Right Extensor hallucis longus. No spontaneous activity, mildly reduced discrete inteference pattern to 3 mV. Units mainly normal but a mild excess of polyphasia or notching"I thought denervation was a red flag sign?What does this mean? This is the muscle which lifts the toe and foot and often where things show themselves. Its also where all of my twitching and cramping has been. Any thoughts advice / experience would be greatly appreciated. Dave.Dave.

Dave,Denervation can be a bad sign, but in your case your Doctor can see that yours is due to back issues. Based on your emg, why would you be worried about anything other than your back? Trust your Docs!Take care,Gary

Denervation can be caused by many things... You were told it is L5 radiculopathy. You said there was a pain, well the pain itself is what differs ALS from other pathological states as with ALS, there is none. No spontaneous activity (no fasciculations or fibrillations) is an excellent sign. Was this ALS, there would be some spontaneous activity along with other signs. That is why your report said ". certainly does not show any evidence of anterior horn cell disease'. I really feel for you, I wish nobody suffered from ALS or anxiety that even possibility of having this monster could cause, but you are fine. MRI of the spine could help to find out the cause of issues at L5.

Your EMG report clearly states: "His EMG certainly does not show any evidence of anterior horn cell disease". This means: "It's certainly not ALS". Then: "Extensive EMG was normal today except for mild changes of denervation in right extensor hallucis longus, consistant with a mild subclinical L5 radiculopathy.". This means: "It looks like the patient has a compressed nerve root from back-problems, but it's not causing any symptoms yet".So you have the classical nerve-root-compression symptoms (fasciculations, weakness, and most importantly soreness (which would not be present in ALS)).If this is where all your twitching and cramping has been: Congratulations, you have your diagnosis! It's not ALS and not even BFS.

Aw Dave, you were doing so good. I agree with these fine folks, your results CLEARLY say that it is your back issue. Don't let that black hole pull you in!

Dave, My sister-in-law had a major herniation at L5 three years ago and the first thing that happened is she developed foot drop and cramping in her foot. She had surgery but the nerve damage was done and she wears a brace to keep from dragging her toes. She is totally numb down the front of her shin and top of her foot. The pattertn of your symptoms are CLASSIC for L5 injury and NOT anything more sinister. My own issues with my L5 have caused a myriad of symptoms from twitching, to cramping, to pain in the exact same areas. Please listen to what I'm saying from two personal experiences. You have a back issue, not a MND issue. Hang in there,Frances

This may interest you: I haven't been able to find the entire paper, but I'm still searching...

As a fellow sufferer of a disc bulge at L5, plus a spinal cyst at L5/S1, I understand your concerns. I have leg weakness, difficulty walking, and pain and parasthesias in both legs, with the worse being in the right leg. I often have to use a cane to walk. A visit with a PT last year proved minimally useful. ALS doesn't worry me in the least. It just doesn't fit. ALS is ascending, progressive, affects arms as well as legs, and bilateral. As DesertKnight said, it's a back issue, nerve-root impingement, and completely different from ALS or a similar motor neuron disease. Best test of this will be physio. If that helps you improve, you'll have even more evidence it's not ALS. Hope you'll do well with it.

English Dave,Message from English Pete relax. Classic sign off sciatic nerve irritation. Probably all from your lumbar area. I suffered from it.

Tha nks to all those who have taken the time to reply..I am really struggling with this at the moment. I just Dont understand why the denervation would be that part of my foot... Ive never injured myself there. EVER. The cramping and twitching in the area is awful. The weakness in that muscle definite. Too many coincidences.

Yeah, denervation is from an injury. Reinervation is what you muscle does to compensate and heal. It's the signal wiring version of scar tissue, a compensating but imperfect body repair technique. With lower mnd this would happen continuously and progressively, which creates a distinct Emg signature.Your emg said they saw the equivalent of an incidental nerve signal 'scar'. Just a scratch on your mortal story. Nothing to do with mnd.

Thank you everyone. Your comments mean an awful lot. It just all seems such a coincidence that all of these things have happened at once... the cramps / twitching / weakness / denervation etc. I feel like Im now playing a waiting game, praying that foot-drop doesn't start etc.My head is almost locked in a battle between polar logic.Thank you.Dave.

EnglishEddie, there is no coincidence..you still have not gotten it:Hope this will help you:L5 denervation due to radiculopathy----->cramps, twitching--->weakness--->atrophy. All these issues ARE consequences of denervation, not happening at the sime by coincidence. Also pain should be present as this is not purely motoric involvement.

My sister in law's leg issues hit just like yours. She does have foot drop too though. I was at the first stages of my ALS fears when her problems started. I was visiting with her wondering how in the world she wasn't terrified of ALS...she he'd never googled her symptoms and was content to listen to her neurologist. (Imagine that...lol)

At the risk of stating the obvious, we all use Dr. Google. But we need to use it correctly. When googling a sign or symptom, check all the possible causes, not just the first few. Signs like foot drop and symptoms like pain or fasciculations have dozens or even hundreds of possible causes, making a diagnosis tricky. Check an orthopedics textbook, or even Harrison's Internal Medicine, if you want to see how many conditions have these signs or symptoms.Also, when using Dr. Google, I suggest that when you find a disease or disorder that you think you may have, get onto a reliable medical information site, and then check for the signs or symptoms that rule out that possibility. In other words, don't just figure out why the diagnosis fits you, but also figure out why it can't fit. Doctors do this so quickly and almost unconsciously during the process of a differential diagnosis that it's sometimes hard for them to explain to a patient why they know ALS or whatever has been ruled out.For those of you who haven't discovered PubMed (the National Library of Medicine's online searchable database of medical articles and reference material), use that in tandem with Dr. Google. And never forget that Google's search algorithms are inefficient in many regards, and subject to manipulation by people who want their pages to appear high up in the results. Anyone can easily be fooled by Google search results.Separately, I shamble and shuffle around using a cane, with a bit of a foot drop, and lots of weakness in both legs, particularly the right. A l-spine MRI last Sep. found some disc bulges at L5/S1, and a pea-sized cyst there, too. Brain MRI was normal. A neurosurgeon I saw about these results felt that the MRI findings did not explain my gait abnormality, and that this is not a "surgical issue" (his words). For now it's meds and a cane while they monitor me to figure out what is going on. P.S.: It's not ALS. All my docs agree on that. As do I.

Many many thanks once again.I do try and keep away from Dr. Google. honestly.A question to those that might know, as i Dont and i Dont want to research the answer.;;Can " mild changes of denervatiom " be an old injury??? Or would that show as something else.???Secondly... I have never injured my foot to my knowledge (which is where this has been noted ) why would an injury in my back cause denervation in the foot? Sorry for the stupid questions. id rather asked here than go in searching a web provider.Dave.