I'd be very grateful for any experience or advice in this situation.
Young male body builder with suspected but undisclosed anabolic steroid abuse. Initially seen for left foot drop and sensory disturbance in fibular distribution and found to have fibular neuropathy with block and slowing across fibular head. Represents several months later with patchy sensory disturbance over right hand (radial and median nerve distribution) and pain at biceps insertion and in to forearm. Reports some wrist extensor weakness when it first occurred but now has pain with giveway weakness in right deltoid, biceps, wrist extensors and finger extensors. Reflexes all in tact.
UL studies: normal radial SNAPs, both median SNAPs borderline small with no slowing, right ulnar SNAP small but not slow, left ulnar SNAP normal. Median motor studies - normal DMLs, but CV 45 and 44m/s in R and L forearms respectively. Median F waves prolonged at 30ms on both sides (height 172cm). Ulnar motor studies normal (no slowing around elbow on right, left only stimulated below elbow) but F waves both prolonged for height (R 32.34ms, L 31.09ms). Radial-EIP motor studies difficult - unable to elicit response in EIP with elbow stimulation, but response present with stimulation at spiral groove. Amplitude 3mV on right but CV (forearm-spiral groove) slow at 33m/s. Left radial-EIP CMAP 3mV at forearm but then 6.6mV at spiral groove. Suspect submax stimulation in forearm due to muscle.
EMG: slow very sparse fibs seen in right triceps, biceps and EDC. Reduced recruitment in triceps, but others normal. some long duration units in right FDI but recruitment normal and no spontaneous activity. Long, large units seen in right APB. Deltoid and EIP normal.
Could his body building be causing chronic compression of his nerves in his forearms leading to the small sensory responses and slow motor velocities? Does (extreme) body building or anabolic steroid use give you sparse fibrillations on EMG without other features of denervation (i.e.reduced recruitment)?
Any comments/insights very appreciated!