Tuesday, June 9, 2009

STI: Ask the experts

June 4, 2009

Ask the experts


Q: My 19-year-old son has been diagnosed with lumbar sacral plexopathy. Could you please explain what this is? What causes this illness, will he recover and are there complications? Also, will he be able to exercise, such as run and play basketball? Does he need medication to control the condition?

A: Plexopathy means a disorder involving a network of nerves. The different location of these branches (or plexus) of nerves will determine the location of the symptoms.

Our bodies have many networks of nerves. These include the lumbar sacral plexus, which controls the branches of nerves that principally control lower limb, bladder and bowel functions.

Symptoms of plexopathy range from pain, tingling sensations, pins and needles to weakness of muscle groups. The symptoms can be mild, moderate or intractable pain.

There are many causes of plexopathy. These include disc herniation (commonly known as 'slipped disc" which can lead to irritation and compression of spinal nerves resulting in back and leg pain), trauma, diabetes, haemorrhage, neoplasm (cancer) and complications following surgery (iatrogenic cause).

Tests are needed to investigate the cause. The most useful are an electromyography (EMG) - a test where the function of the nerves are assessed by using electrodes and sensors to study the transmission of nerve signals to certain muscle groups - and a nerve conduction study (NCS).

The patterns of the findings of the EMG and NCS can help locate and determine the cause of the condition and its prognosis.

Radiological investigations like an MRI, plain X-ray and CT scan will be able to help diagnose traumatic or neoplastic causes (the underlying cause may be due to trauma or cancerous growth pressing on the spinal nerves).

Treatment-wise, the primary goal is restoration of normal nerve function. However, where there is already progressive lesion, preservation of the nerve function for as long as possible is the main goal. Treatment include pain medication, nerve stabilising medication and supplements and, in some instances, surgery to treat the underlying cause.

In your son's case, once the cause has been determined, the physician or surgeon managing his condition will be able to assess the severity of his illness and advise you on whether and how well he will be able to recover and return to his normal activities.

Dr Razmi Rahmat is a consultant orthopaedic and spine surgeon at Gleneagles Hospital


Q: I am a 69-year-old woman.

Lately, the bone which juts out from the middle of the top of my right foot has been hurting quite a bit. This happens regardless whether I walk, sit or lie still. At times, there is no pain.

A doctor told me that it might be tendonitis. When there is pain, it feels like a hammer is pounding my foot. Is it arthritis, tendonitis or something else?

A: The various common possibilities include improper footwear causing metatarsalgia (pain over the balls of the feet) and inflammatory causes such as gout, which result from too much uric acid in the blood.

Gout is one of the most painful types of arthritis and the attack is often intense and sudden and most commonly on the first toe. With lifestyle modification and certain medications, the condition can be treated.

Other possibilities include osteoarthritis of the small joints of the feet and tendonitis. In osteoarthritis, the cartilage - which is the protective tissue that cushions the ends of bones in a joint - starts to wear away over time. This limits a joint's range of movement.

Tendonitis is an inflammation or irritation of a tendon and this can cause pain outside a joint, commonly around the shoulders, elbows, wrists and ankles. Rest and medication can reduce the pain and inflammation.

I suggest that you visit an orthopaedic specialist to determine the cause of your pain. A blood test, X-ray, physical examination and history taking will enable the doctor to plan suitable treatment for you. 

Dr Kevin Lee is a consultant at the division of adult reconstruction, university orthopaedics, hand & reconstructive microsurgery cluster of the National University Hospital

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