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Severe nerve pulling, waddling gait, and
Hello Doctor,
My mother (Age 47, Weight 70 kg) has been suffering from severe knee and leg pain for 8 months. Recently, her condition has worsened. She has to stand for long hours at our shop, and at night, she experiences severe nerve pulling/spasms in her legs. Her walking balance has completely changed (she walks with a waddling, penguin-like gait).
Her recent blood reports show:
Vitamin B12: 221 pg/ml (Low)
Homocysteine: 22.30 µmol/L (High)
TSH: 7.89 µIU/mL (High)
Past Treatment:
An Ortho diagnosed mild Knee OA andsaying for opration. A Pain specialist prescribed Pregabid CR 75 and Etoshine MR, but no relief. Currently, an MD Physician started her on Tab Thyrox 50 mcg and Tab Becosules Z.
My questions:
Is her abnormal waddling gait and night-time nerve pulling due to Lumbar Spine nerve compression + B12 Neuropathy, rather than just Knee OA?
Should we get an MRI of the LS Spine and Knee joint?
Which specialist should we primarily consult now for a non-surgical approach?
Answers (20)
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Thank for posting your query
Sorry to hear about your mother’s Condition and I understand your concern
First of all on what basis she has been diagnosed as OA
Your orthopedician must have done X rays / Blood test etc
If it is severe then surgery may require but as you mentioned that it’s Mild OA
Her Vit B12 is also low so that may cause Neuropathy
Here are few suggestions
1. She need to loose some weight
2. Avoids long time standing
3. Some mobilising exercises to knee need to add in daily routine
4. She need to continue Thyroid medicine and VIT B12 Replacement
5. Need to continue Pregabaline as prescribed plus you may add Some Painkiller SOS
6. You may do MRI LS spine along with KNee but only after Visiting a Orthopedician
7. Do some Blood work like Autoimmune profile/ANTICCP/CRP/RA factor/ BUN/ Uric Acid /CBC and KFT
Next Steps
Take a second opinion with another Orthopaedic and Neurosurgeon for spine things as there are option of giving intra- articular steroid injection for immediate pain relief
If Surgery require then you must consider
Health Tips
Ask her to avoid standing ling time it will give stress to LS spine
Do not forward bend too much before doing MRI we don’t have idea about condition of LS spine ( eg Compression etc)
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consult orthopedic and do mri spine she is 47 it might also be due to her age
As is complaining of nerve spasms and not reducing with medication
Better take xray and mri lspine
Next Steps
consult orthopedic and do mri spine she is 47 it might also be due to her age
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Need few more details for proper understanding of your issue.
You can consult with me online on Practo or whatsapp on eight three one eight four six nine eight eight six for proper diagnosis, conclusion and management
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Need further assessment and one neurologist opinion as well
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Need clinical evaluation by orthopedic surgeon and need vit D and serum calcium test
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Consult neurosurgeon
Next Steps
take help of orthopedic for OA and phsiotherpy.
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Consult me for further evaluation
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I am DR Javed currently working as senior resident in orthopaedic in corporate hospital in delhi . As per your history given the gait u r decribing is likely because of medial compartment of likely both side knee
The neuropathic pain u r describing seems like due to old degenerative spinal disc bulge disorder
Next Steps
Get xray done Ap standing and lateral view
MRI LS SPINE
Health Tips
Avoid prolonged standing
Avoid Sitting cross legged squating
Limit climbing stairs
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The walking you are referring to is due to OA and Non surgical options for OA is Lifestyle modifications dietary changes and Physiotherapy. You should Consult an Orthopedic surgeon.
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It would be due to multiple reasons at her age. Consult a physician for clinical evaluation.
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Consult superspecialist
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You can take her to an orthopedist,who does the knee joint work,for a second opinion,He may suggest for the MRI of knees if required or may refer to a spine surgeon
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You should go to a Neurologist for the consultation as they can better go ahead with examination of your mother and decide what imaging and further investigations she needs.
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Dr. Gaurav Jaiswal
General Physician
6 yrs exp
Jhansi
Kindly do connect and consult
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Dr. Chaithra H
General Physician
5 yrs exp
Bangalore
Do consult
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Dr. Vetsa Sri Krishna Chaitanya
General Physician
7 yrs exp
Rajahmundry
Need a few more details please consult for further evaluation and treatment
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Dr. Suraj Sharma
General Practitioner
4 yrs exp
Jaipur
Do consult
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Dr. Anuj Mothsra
General Physician
6 yrs exp
Jhunjhunu
Can help you, kindly consult and provide detailed history for proper diagnosis and further management
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