Abstract
In 2011, a patient with dense distal sensory loss from diabetic neuropathy and 4/5 ankle dorsiflexion power was treated with subcutaneous injection of D5W in the region of the interdigital nerves. Upon injection completion and coming to stand, the patient remarked, "I can feel the floor and move my toes more." Great toe and ankle dorsiflexion could not be overcome by manual testing after injection. Further empirical observations by three authors trialing the method (KCM, BM, KDR) have suggested frequent gains from 4/5 strength (active movement against gravity and resistance) to 5/5 strength (normal power) within 3 minutes after subcutaneous injection of related muscle insertions in patients with motor weakness from distant upper or lower motor neuron conditions. We have not observed a similar improvement with injection of normal saline or sterile water over muscle insertions, or with D5W injection subcutaneously over muscle origins or bellies. This treatment will be referred to as Dextrose Muscle Insertion Therapy (DMIT). Five case reports are presented, with videos showing within-session restoration of 5/5 strength in an ischemic cerebrovascular accident (CVA) patient with chronic ankle dorsiflexion weakness 30 years post event, a relapsing-remitting MS patient with deltoid weakness one year following an exacerbation of MS, a diabetic patient with deltoid weakness six years post cervical radiculopathy, a patient with post-injury disuse-related wrist extension weakness 14 years post injury, and a patient treated for left upper extremity weakness at time of an apparent plateau seven weeks post ischemic CVA. These videos are not time-stamped, nor are these observations controlled. The specificity of the injection site, rapid response, single treatment sufficiency, magnitude of response, and observation of similar responses by multiple physicians argue against a placebo response. This discovery, if confirmed, may challenge the long-held belief that motor recovery or muscle recruitment plateaus permanently after injury and prompt additional research on the neurophysiology of muscle recruitment limitations after distant events. Confirmatory case series with time-stamped video confirmation and controlled clinical trials should follow to confirm these observations, their frequency, responsive diagnoses, and optimum time periods for treatment following the onset of weakness.