Rare Muscle Pain: Causes and Solutions for Thigh Discomfort - Rare Disease

Dr. Chen Shunsheng reply Rare Disease

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The symptom description closely resembles spondylolisthesis at the fourth and fifth lumbar vertebrae.
There are many causes of low back pain, which vary with age, gender, occupation, and the medical specialty consulted, leading to a phenomenon where different specialties offer differing opinions.
A brief classification of common causes is as follows:
1) Low back pain due to lumbar and sacral vertebral disorders:
- Various types of spondylitis (lumbar spondylosis, spondylolisthesis, ankylosing spondylitis, etc.)
- Osteoporosis, which may be accompanied by vitamin D deficiency leading to myalgia
- Compressive spine fractures
- Lumbar stenosis
- Lumbar sacralization
2) Low back pain due to lumbar and sacral nerve root disorders:
- Neuropathies caused by the aforementioned vertebral disorders compressing nerve roots, accompanied by low back pain
- Vascular nerve root disorders, such as those caused by diabetes or calcified abdominal aorta leading to vascular changes within the nerve roots
- Space-occupying lesions
3) Low back pain due to pelvic bone disorders:
- Pelvic joint disorders (iliitis, iliococcygitis, etc.), often occurring postpartum
- Metastatic lesions in the pelvic bones
4) Low back pain due to retroperitoneal disorders, often space-occupying, primarily tumors or cysts, frequently invading the lumbosacral plexus
5) Visceral diseases causing referred pain in the low back:
- Urinary tract disorders: such as kidney or ureteral stones, obstruction, or inflammation causing referred low back pain
- Gynecological disorders: such as lower pelvic inflammatory disease, endometriosis, pregnancy, etc., leading to referred low back pain
- Other visceral diseases: such as gastrointestinal disorders, aortic diseases (aneurysms or dissections)
Conclusion: First, see a doctor to determine the diagnosis, then discuss treatment.
Do not rush into long-term analgesic therapy or rehabilitation without proper evaluation.
Many possibilities exist, including disc herniation, lumbar spondylosis, lumbar spondylolisthesis, lumbar spine fractures, lumbar sacralitis, etc.
It may not simply be a muscle strain; spinal joint and neurological examinations, as well as lumbar spine X-rays, should be performed for further diagnosis and treatment.
Additionally, researchers have found that in individuals without low back pain, the growth of nerve fibers within the intervertebral discs is evenly distributed in the outer one-third to one-half of the disc; whereas in those with low back pain, 46% of nerve fibers are found in the inner one-third of the disc, and 22% have penetrated into the nucleus pulposus at the center of the disc.
Therefore, preventing nerve fibers from penetrating deeply into the disc may help prevent or treat low back pain.
Of course, blocking pain transmission to the brain is also crucial.
Regarding occupational spinal nerve root disorders, I conducted an analysis of peripheral nerve examinations on 32 sanitation workers who visited the neurology clinic.
Among the 32 workers, 31 were female and 1 male, with an average age of 51.5 ± 4.4 years, all having served in the sanitation team for over ten years.
Their main complaints included numbness in the extremities, particularly in the upper limbs (100.0%), persistent low back pain (75.0%), pain in major joints of the limbs (75.0%), and atrophy of the abductor pollicis muscle (37.5%).
These symptoms are related to long-term overload damage to the lumbar and limb joints, as well as compression of the median nerve at the wrist and lumbar nerve roots.
Consequently, nerve conduction studies revealed that over 60% (62.5%) of the workers had carpal tunnel syndrome, which may occur alone or in conjunction with single or multiple peripheral neuropathies (60.0%), as well as prolonged wave reflex latency caused by lumbar nerve root disorders (40.6%) or sacral nerve root disorders (18.8%).
When compared to normal individuals, these workers exhibited prolonged or slowed response latencies and nerve conduction velocities in their upper and lower extremities.
In addition to the neurological diagnosis, X-ray examinations were arranged to assess the extent of lumbar and sacral disorders, revealing significant lumbar spondylitis, lumbar spondylolisthesis, disc herniation, or vertebral fractures among these workers.
The most common finding was spondylolisthesis between the fourth and fifth lumbar vertebrae (46.9%), followed by spondylolisthesis between the fifth lumbar vertebra and the first sacral vertebra (15.6%).
Other findings included spondylolisthesis between the second and third lumbar vertebrae (9.4%) and between the third and fourth lumbar vertebrae (6.3%).
Additional findings included disc herniation from the fourth and fifth lumbar vertebrae (6.3%) and fractures of the lumbar vertebrae (12.5%).
These X-ray findings may be associated with the damage caused by long-term heavy lifting during waste collection.
The discussion regarding peripheral nerve diseases indicates that the excessive load borne by environmental sanitation workers due to long-term waste handling is a significant concern for the damage caused to their peripheral nerves and lumbar-sacral vertebrae.
We recommend implementing a "no littering" policy to reduce unnecessary heavy loads on workers.
If possible, convenient mechanical equipment should be used to assist workers in transporting waste.
Heavy or special waste should not exceed a certain weight during packing.
If feasible, workers should be rotated regularly in their tasks.
Additionally, wrist, knee, and lumbar support braces should be provided to help protect their joints.
To facilitate early detection of peripheral nerve disorders, annual health check-ups for sanitation workers should include assessments of nerve conduction velocities in the limbs and lumbar X-ray examinations.

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Reply Date: 2005/11/13