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Senior Health

Tandem walking difficulty

06/26/2008

Question:

I am a female (age 55). I have severe pain and stiffness across the bottom of my spine, between my hips. I also have trouble walking, for several years, and it is getting worse. My symptoms start AFTER I use my muscles. (My leg muscles will stiffen up, and get sore. And my legs will start feeling very heavy, and it is hard to move them.) I can not squat down and get up, or walk up too many steps, either. Recently the same symptoms started happening to my upper arms, after daily chores (and sometimes my hands will tremble). My doctor had me tandem walk, and I could NOT do this. I also had trouble standing on one leg. So she sent me to a neurologist who ordered an EMG test of my legs. (But when they did the test they were testing my toes! And I wondered why?) The EMG test showed my tibial nerve response was 0.38, and the reference range was >4.00. And the test also showed "chronic motor axon loss in the right abductor hallucis muscle...and absent medial & lateral plantar nerve responses." What does this mean? I have been waiting for my neurologist to tell me what is wrong with my leg muscles for two weeks. Yesterday her nurse called and said all my tests were normal. I asked her how the tests can be normal, since I purchased the records, and read the abnormal results to her over the phone! She said the abnormal results “probably were due to my age,” (since I am only 55, I became upset.) I told her about my walking problems, and that it was getting worse. I asked her why toes were tested, when my symptoms are in my legs. I also asked if nerve compression in the back of my pelvic area would show up on the tests of my toe nerves. But she said “my neurologist was on hospital duty and was unavailable” for several weeks. Should I ask my doctor for any specific tests, when she returns? Because I do not think she knows what to do! Thank you so much! (Also, could my symptoms relate to anything contagious? Because, I feel ill all the time.) My questions are for NetWellness are: 1-Would the nerve function tests of my feet show if I have nerve function loss in my legs? 2-What is the significance of “motor axon loss and absent medial & lateral plantar nerve responses?” 3-What is the significance of tandem walking difficulty?

Answer:

The findings of EMG probably are in the normal range for age. The electrode placement is in the toes and legs for EMG studies where electrical conduction in nerves and muscles are studied, so it is not unusual. Back pain and weakness in legs may be due to spinal problems. An MRI of the spine may be helpful. It is not clear if this was done in the past or recently. See you primary care physician if problems persist.

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Response by:

Arvind   Modawal, MD, MPH, MRCGP Arvind Modawal, MD, MPH, MRCGP
Professor of Family & Community Medicine, Geriatrics and Palliative Care
College of Medicine
University of Cincinnati