Expert: Dr Ian Jackson - please note UK based - 4/18/2008

Question
QUESTION: I am a new practitioner.  Upon exam my patient has absent vibration sense at the L5 dermatome bilaterally(right over his big toe and second toe)  he was shot above the right knee and rods to stabilize the femur were inserted through the glutes. why do I find this on both sides when the trauma was only to one side?

ANSWER: Hi there
This is outside my expertise and I suggest you discuss with a neurologist. If you do then I suggest he/she would need to know what symptoms is the patient exeriencing that led you to examine him neurologically? How old is the patient? Does the patient have any other relevant past medical history e.g. diabetes? Current and recent drug therapy? Results of neurological examination before surgery?
All the best
Dr Ian Jackson

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Jackson,
I talked to a pod mate today, I can challenge the staff doctor but should be prepared to defend myself. thanks for the pointers.  Is inflammation setting up scar tissue?  Bilateral, think spinal cord.  MRI?  This patient has been at our clinic for a very long time receiving chirpractic adjustments (we do the 8 page form on everyone)He has been to the clinic in a long time so I did a physical.  My third patient ever. but why can't he feel.  Is this a variation of phantom pain? Has the rod migrated?  this is a 16 year old battlefield injury. thank you very much.  I do wish chiropractors had residency after school.Kristina

Answer
Hi Kristina
As an anaesthetist this is well out of my experience and you really need to discuss with someone with neurology background. I can only give a few pointers.
Unless there has been a change in what the patient is noticing (eg a new problem with balance) the fact that you have discovered this at a routine examination does not mean it is new. I do not think there is any likelyhood that the rod has moved. I suspect that your diligence has just found an issue that has been there since the original injury or perhaps the surgery.
You do not need to defend yourself against the staff doctor. You have found something that you should bring to their attention and should discuss with him/her. This is about team work for the benefit of the patient - we should all play to our own strengths and use the strengths and experience of others where appropriate.
For what its worth from the information you have provided I do not believe there is any need for further investigation - just monitoring to ensure there is no progression.
I end as I started - I am no expert in this field and my comments should be seen in that context.
Kind regards
Dr Ian Jackson