Neurology was able to get him in for testing today. NCS showed low amplitude of the superficial peroneal nerve, so they moved on to the EMG. EMG showed nerve damage to the motor function, but not sensory function of the SPN. It is in the process of healing, but the neurologist said it takes about a month per inch of nerve to recover. No real treatment except continued physical therapy as tolerated. It's kind of discouraging because there's no short cut out of this, like with a nerve entrapment that can be released. But, at least no surgery is needed, and I think (?) with type 2 CRPS there's not a risk of spread. That's a huge relief, because I have a teenager chomping at the bit to go full speed again when he's better, on bikes, rollerblades, etc. The thought of new injuries and spread is terrifying, knowing that's taken off the table lets me breathe a little easier.

He has an appointment coming up with a pediatric physical medicine rehab doctor. Hopefully, they can come up with a more specific treatment plan to move him forward.

I'm so thankful for a safe place to vent and talk about this mess.

Hay hay! Great news to hear.
Hopefully the healing goes good and rapid. Teens need to play..

Hi Swimtime,

I am so sorry to hear about the nerve damage. I am going to be a butt-in-ski with suggestions having gone through a nerve injury myself. Forgive me for being more forward than usual. I do not want to add to any anxiety, just want to be sure bases are covered. Nerve injury is a weird thing to deal with.
I am very glad they were able to bump up his eval so you know what is going on. Also glad physical medicine is going to be on board. They will be a big help.

My questions, How do they know it is regenerating? He might need serial EMG to determine that. If atrophy is worsening that is a concern. Were they able to pinpoint where the lesion is? this is traditionally difficult to do with NCS/EMG. Are they sure it is not hardware or scar impingement? How the heck can they tell without looking? I am assuming they maybe determined some of this from the sensory function being intact but not the motor? That is actually kind of surprising as those fibers run together.

Physical medicine with ultrasound credentials may be able to follow that nerve with an ultrasound machine and see where there is a problem and if anything needs to be done.

Plastic surgery that does peripheral nerve work (if they do scratch collapse testing) can figure out exactly where the issue is.

I ask all this because TIME LOST IS MUSCLE LOST. If he needs any kind of repair or release so that nerve can heal there is a window for that after which motor function recovery is much less, or unlikely, to recover. Nobody wants him to miss the window. There are amazing things that can be done should he need intervention besides time. Hopefully he just needs time.

Maybe go see a peripheral nerve specialist. The plastics people with fellowship in nerve evaluate and treat exactly this kind of problem. It never hurts to get information just for back up. God knows it is justified at this point. Peripheral nerve is an odd enough thing not every specialty knows enough about evaluating or treating it.

You are right on the spread issue, from literature I have looked at says the problem does tend to stay more local.

I am sending hugs and Kleenex,

Your suggestions are very welcomed! I was hoping you would "butt-in-ski", since you're always a wealth of information.

I don't know how they can tell if it's regenerating. Something on the EMG perhaps, or the fact that he has much less pain than before and has regained some muscle mass. I'm sure the pool has had a lot to do with that. I hope serial EMG is not needed, since he was white as a sheet by the time this one was done. The doctor made him lay down for a while to make sure he didn't pass out. It was quite painful, but afterwards he was okay.

Not sure about the pinpointing, etc. either. That may be something to address with ortho. All good questions to ask!

I will find out if the PMR dr. does ultrasound. U of M has the peripheral nerve specialists, but they can't get him in till next year. Something about a really long wait list for second opinion appointments with neurology. I can try again to see if his ortho dr. there can pull some strings to get him in sooner.

Thanks for your input!

Thanks! I am so glad I didn't offend.

at Ann Arbor, Plastic Surgery Reconstruction for nerve would be who he needs to see. I don't know that neurology would even need to be involved. When I had to get in with plastics they worked me in within a week due the potential need for quick action for motor nerves. Neurology was not part of any of those consults.

My PM&R guy took a look with US at multiple nerves to make sure nothing had really obviously scarred back down post-op. He was even able to peek at the small branches. It was nice to have them looked at and have that reassurance.

Gaining muscle mass is a great sign! That is a good solid signal of healing. I hope he doesn't have to have repeat EMG too. If he is making steady progress that is measurable it should be avoidable.

What a brave young man! It is hard going through all that. Please tell him to keep up the good work and that I said his courage and Persistance will get him through this. That and a lot of support from Mom and Dad.

Courage, persistence, and a sense of humor in particular that he's managed to hang onto. Once the test was over and he had a little time to recover, he was amused at the little emg clips that reminded him of itty bitty car jumper cables, haha.

What a brave young man! It is hard going through all that. Please tell him to keep up the good work and that I said his courage and Persistance will get him through this. That and a lot of support from Mom and Dad.

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