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Back Problems Message Board

Back Problems Board Index

Re: Annular tears
Mar 10, 2012
If you do have an annular tear in the disc between the lumbar 3 and lumbar 4 vertebrae, it is a problem that originates in your lumbar spine. Due to the nerve distribution, the nerve carries signals of sensation and motion from the lower back down to the foot. It runs down the front of the thigh, down the front of the knee and calf and innervates the medial ankle into the big toe.

An annular tear refers to a tear or hole in the annulus fibrosis which is the outer bands of the disc, which wrap, like a belt on a radial tire, around the gel-like center of the disc. When there is a tear, sometimes some of the "gel" from the nucleus of the disc leaks out and is not longer contained inside the disc. This can cause the adjacent nerve or nerves to become irritated or, in some cases, compressed (pinched). This results in nerve pain which can be felt at any point along the "route" of the if your big toe goes numb, the probably cause is an issue coming from the L4 nerve.

The nerve does not have to have so much damage that it would register on an EMG as "diseased" or damaged. In other words, you can have a normal EMG and still suffer from nerve pain.

In addition to seeing a neurologist, I would suggest you consult with a "spinal specialist." This could be either an orthopedic spine surgeon or a neurosurgeon whose practice is limited to the neck and back. Even though their specialty says "surgeon," rest assured that their first task is the accurate diagnosis of a problem with the spine. They then offer a plan of treatment that begins with conservative methods, often referring to physical therapy, and pain management.

In your particular case, it is likely (or at least possible) that you may have some permanent nerve damage around the knee that causes the leg pain, and now, in addition, may have leg pain coming from the annular tear.

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