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Forum Name: Neurology Topics

Question: Unilateral limb atrophy in a young male


 Dr Haisook - Fri Jun 19, 2009 5:16 am

Hello. I'm a 22-year- old medical student. I've been suffering from left ankle pain for 2 years. I have a talipes valgus deformity in my left foot. I only started to wear arch supports recently. Over the past 2 years I've had a lot of tests in an attempt to know what could be causing the pain, including x-rays and ankle MRIs. All were normal.

A couple of weeks ago I looked at my legs, and noticed that my left leg is obviously smaller in size than the right. I measured the circumference of both at different points, and the left was narrower by around 2 cm. Just above the knee, there's also atrophy in the left thigh, but it's less profound. Around 0.5 cm difference. By looking at photographs from 4 years ago, I could see that I had equally sized legs, so I acquired this atrophy recently.

Just before this discovery, I'd been suffering from weakness/cramping-feeling in my left limb. It would feel weak and cramped after only a few minutes of walking. This coincided with a new home trademill we got. May be I overdid it, and my left limb was weak in the first place.

I went to a neurologist, and he examined the tone, power, and reflexes. All were normal. The left limb showed no weakness or lost reflexes. He ordered a lumbar spine MRI, which came out unremarkable as well.

I had a tibial nerve conduction study a year ago, and it was normal.

Now the question is: what caused this atrophy? Could it be reactive atrophy due to the ankle pain? or disuse atrophy due to the same reason? Could I be compressing the sciatic nerve while sitting? I can feel a bit of dull-aching pain in my left thigh while sitting. But could such compression cause this profound leg atrophy?

I'm at a loss.
I'd appreciate your opinions.
 John Kenyon, CNA - Sun Jun 28, 2009 2:13 am

User avatar Hello --

There are so many possible causes of this complaint it would be impossible to list them here and pointless as well, since many require specific evaluation and testing to identify them. For that reason and because you are a medical student, I am going to provide a link to a web page that may help you to narrow down the possible causes of this peculiar presentation. You will find considerable general information here: http://emedicine.medscape.com/article/1170572-overview

I'm not clear from your post on whether or not your doctor had performed EMG and nerve conduction testing, but if not these would certainly be indicated and might help narrow down the possible causes.

I hope this is helpful to you. Please do follow up with us here as needed. Good luck to you.
 Dr Haisook - Sun Jun 28, 2009 5:08 am

Thank you very much, John, for your reply, and for the link.

I've had a nerve conduction testing of the Tibial nerve. That was a year ago, and the result was unremarkable. When I visited the neurologist recently he examined my limbs and back. He said there was slight wasting of the left leg, but no fasiculations, and the reflexes were normal. He also said that there was no weakness when he performed the traditional 'push/pull against resistance' technique. He ordered a lumbar spine MRI only to exclude a disc prolapse or a tumor. When I suggested an EMG, he said there was no weakness or any sign suggestive of myopathy, so it was not needed. I'm not sure if this is correct.

There's one thing that's bothering me, though. Every doctor I go to (I visited a podiatrist and rheumatologist, in addition to the said neurologist) tells me it could be all in my head, and mentions something about the 'medical student syndrome' (http://en.wikipedia.org/wiki/Medical_student_syndrome). They say I even look more sensitive than usual. I can't deny I've been very stressed out ever since I went to medical school. This stress was probably multiplied by hundreds when I failed an exam in my 3rd year. It was devastating to me. Just a few months later this problem began. My father - who is a consultant physician - commented once that he thought there's a relation between that incident and my complaints. I'm an introvert. I rarely tell anyone about my problems, or about what I think about.

My question is: could this be some kind of a somatoform disorder (http://en.wikipedia.org/wiki/Somatoform_disorder)? Sometimes I think about that, but then again, what about this atrophy?

It's very frustrating to have such vague complaints. People don't understand this. Sometimes I question the efficacy of our medical knowledge when I see that even a medical student, a consultant physician, and a specialized neurologist are not able to diagnose such case. Sometimes I wonder: How good are we? and is medicine really effective as we say it is?

Thanks for your time.

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