ARM LEG PAIN
The anatomy of the spine includes both the bony vertebrae and the compressible intervertebral disk. Over time, the disks can develop degeneration, leading to loss of the disk's internal water content and compromising it's integrity. This can result in a bulging or herniated (ìslippedî) disk. Because of the spinal anatomy, the close proximity of the spinal nerves can result in pain along the course of the nerve, in the case of the cervical spine typically pain down the arm, and in the case of the lumbar spine pain running down the leg.
Arm or leg radiating pain, burning, numbness, tingling, or weakness are common symptoms associated with nerve compression and inflammation. In the cervical spine, problems dropping objects or with functional dexterity also may occur causing impairment of the delicate functions of the hand. In the lumbar spine, weakness in the foot and ankle can lead to ìfoot drop,î where weakness can cause trips and falls.
Rarely, numbness, weakness, or pain down the arm or leg can represent much less common neurological problems. Problems with vision or sight, swallowing, balance dysfunction, or vertigo should be immediately brought to the attention of your physician. In addition, and impairment of bladder or bowel function, either inability to start or stop could constitute ìcauda equina syndromeî which is an absolute emergency necessitating immediate attention in the Emergency Department.
LOW BACK PAIN
Neck pain can commonly occur as a consequence of muscle strains, ligament sprains, or as a consequence of spinal arthritis. A traumatic injury to the neck can also produce cervical whiplash, in which all of the muscles, ligaments, and tendons of the cervical spine are subjected to significant damage. Causes of neck pain can be the following; Neck muscle strain, ligament sprain, whiplash, spinal arthritis Symptoms associated with neck pain can include stiffness or difficulty with range of motion, cracking or crepitation with motion, headaches, or referred pain to the shoulder or shoulder blade. Symptoms may also radiate down to the arm or hand and may be associated with numbness or weakness of the hand and arm. Additional Points Pain radiating to the arm or hand, associated with numbness, tingling, or weakness should be evaluated by a spinal specialist immediately.
Neck Pain Associated with Whiplash: Common complaints noted in Whiplash associated dysfunction (WAD ) include neck pain, both localized as well as spreading out in a diffuse fashion to the shoulders. Additionally posterior region headaches, fatigue, dizziness, jaw pain, photophobia as well as complaints of impaired ability to concentrate are all commonly noted. Subjective sensation of numbness and tingling in the hands has also been described.
As one can see the above symptoms are fairly non distinct. The diffuse and somewhat vague nature of the complaints presents unique challenges in the evaluation and ultimately the management of this syndrome.
During the course of history taking not only will the above complaints be targeted, but specific questions of bladder function, such as urgency and frequency of urination may be asked by your physician. Urinary urgency / frequency and occasional accidents may be a sign of a more significant issue, such as cervical spinal cord injury, which can be seen in older patients who were involved in relatively low speed, low energy, whiplash type injuries.
Although neck pain can have many sources, there are some questions that may help your doctor make the correct diagnosis and select appropriate treatment.
Did your neck pain begin following an injury?
- If you had a recent injury, your neck may be painful due to a sprain of ligaments or a strain of cervical muscles. Either of these problems may cause neck pain with neck range of motion especially posterior neck pain with bringing the chin to chest.
- Pain radiating from the neck down the arm and into the hand may be as a result of cervical nerve root injury. The pattern of numbness and tingling may help your physician localize the level of root injury. Evaluation of reflexes may also reveal absence of a reflex, not uncommonly seen in nerve root injury.
- Headaches are a common complaint noted by cervical whip lash syndrome patients. They may also be associated with a sensation of dizziness. This may be secondary to muscle strain and associated muscle spasm.
- Urinary urgency and frequency can occur after whip lash type injuries and may be the sign of a subtle spinal cord injury. You physician will perform a detailed neurological exam and obtain appropriate imaging studies to evaluate this complaint.
SENSORY LOSS / NUMBNESS / TINGLING
Cervical sprains and strains are common disorders of the musculoskeletal system. Acute sprains and strains may occur as a result of strenuous lifting and pulling activities and not uncommonly as a result low speed / low energy impact type injuries. They can occur secondary to recreational as well as vocational activities. Acute sprain / strain syndromes are typically self-limiting and generally resolve in days to several weeks. Acute and chronic sprain /strain syndromes can also be referred to as whiplash associated disorders (WAD), when the mechanism of injury includes a component of rapid acceleration/deceleration of the posterior as well as anterior neck musculature.
Symptoms associated with whiplash include:
- Neck pain
- Upper back / shoulder pain
- Jaw pain / swallowing dysfunction
- Sensation of numbness / tingling in hands
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