Matthew Mollica wrote:
> What are some of the differential diagnoses when considering profound
> unilateral tibialis anterior and long extensor weakness. No digital
> extension or ankle dorsiflexion at all on resisted testing. The patient
> I'm seeing has no sensory deficits whatsoever. No pain either, just
> concern.
>
> I've thought of spinal cord lesion, PNS lupus, MS and some others.
>
> I'm a little lost on further tests and management.
Some diagnostic EMG testing would probably give you some definite
information about the nature of the problem. It's not clear from your
description whether or not you get movement without resistance. If you get
some movement, what's it like? Both muscles can be palpated from one end to
the other. What do you feel, and how does it compare to the other side?
Have you specifically established that the other muscles innervated by the
deep peroneal nerve are all intact? Check also a small patch of skin on the
dorsum of the foot in the vicinity of the first and second toes, the only
cutaneous area innervated by the deep peroneal nerve (I believe).
Perhaps you have done much or all of the above, which would at least rule
out a bunch of things if you get only negative results. Hope to hear more
about this case.
Paul Andrew
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