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Lower Motor Neuron Lesion??

Discussion in 'General Issues and Discussion Forum' started by TH93, Mar 9, 2018.

  1. TH93

    TH93 Welcome New Poster


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    Hi, this is my first post so am a little uncertain how this all works, but here goes!

    I am a 2nd year student Podiatrist and today a male patient (60 yo approx) arrived in clinic with a referral from his GP regarding toenail pain. But anomalies were found during a routine new patient assessment

    Medical Hx:
    - knocked off bicycle by car, 2017: r/shoulder pain. Full extent of further damage unknown.
    - arthrodesis b/1+2; leaving patient feeling unstable on feet

    New patient assessment findings:
    - sensory neuropathy associated with 10g monofilament: 5/10 and 7/10
    - biphasic pulses, although not palpable by hand
    - calf bulk: reduced despite being an active person
    - power: 1 on MRC scale b/f for inversion, eversion, p. flexion, d. flexion.
    - unable to raise heels when weight-bearing
    - reflexes: b/knees: 1+. B/Ankles: 0. Pl. Reflex: Babinski response absent
    - no signs of foot drop in gait, but walks with wide base due to instability stated above

    Pt said he sometimes feels his feet are not a part of him, and that he feels he is "clumping" his feet as he walks.

    Pt still often rides his bike but shorter distances due to a lack of confidence since the accident.


    We have contacted his GP to arrange for further testing and to see if they can shed some more light on the bike injury, but was wondering if anybody had any ideas of what this could be? I have found it to be a really interesting case and added it to my clinical case load so will be able to provide updates as it progresses. But as it stands, researching the condition in relation to the patients status as a whole is so far proving difficult! Any pointers/advice/thoughts etc?
     
    Last edited: Mar 9, 2018
  2. efuller

    efuller MVP

    There's a couple of different levels here. One level is what is this guys problem. In a learning environment you could play neurologist and try and figure out what a neurologist would do. If you know this you can at least make intelligent referrals. So, you should look up dermatomes and the differences in physical exam between upper and lower motor neuron lesions and which nerve roots supply which lower extremity muscles.

    By the way not everyone in the world uses the same grading scales or abbreviations.

    A different level is what can you do for this guy to improve his life. Is his instability due to muscle weakness or is it a sensory problem? You can send him to someone to teach him muscle strengthening exercises. You already mentioned no foot drop, so it is unlikely that a brace can help him. I'll stop here and let your clinical instructor do his/her job.
     
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