Creator: Dr. Akshay Kumar Saxena
Published: 2016-10-25T12:15:07-04:00

Patient's Query

Hi doctor,

I have a herniated disk in the neck area. Later, my right hand started tingling and the numbness grew more pronounced. I also started having burning pain on the back of both thighs. I have had some muscle twitching down my right arm. I am having accuracy issues with typing now. I had another epidural and trigger point injects four weeks ago, but it does not seem to have done much this time. This week, I started having numbness in my toes and some burning there. My legs just do not feel quite right and maybe a little heavy. The thighs are still burning on and off. Do you think it is possible that my cervical issues at C4-C5 or C6-C7 could be responsible for both the hand and legs? Do you think I might have a lower back issue?

Answered by Dr. Akshay Kumar Saxena

Hello,

Welcome to icliniq.com.

You have mentioned herniated disc in your neck region with right upper limb symptoms and also associated bilateral thigh symptoms, which we call as paresthesias.

But, my main focus is on the symptom of difficulty in writing, including accuracy issues, which definitely needs in my opinion a detailed clinical examination including neurological assessment of your motor power, sensory examination and evaluation of deep tendon reflexes. This can either be done by a physical therapist or a spine doctor.

Now, you have actually not mentioned any issues with your back pain. So, it is unlikely that your lower back may be causing these symptoms. But, it cannot be completely ruled out.

In any case, if there is a proximal pathology like in your case, there is any issue in your neck region, we have to treat it first and keep you in intensive physical therapy for your back.

Can you tell me the exact cause of your symptoms, as in what was the cause of onset if you can recall? Are you also experiencing difficulty in walking, and doing activities like wearing clothes, etc?

Do you also feel any significant numbness or weakness in your involved limbs? Is there any issue with passing urine or stools?

What medications do you generally take and what has been the past significant treatment?

Also, I want you to send me if possible your MRI images, especially of your cervical spine and a detailed neurological examination as I have written earlier.

Investigations to be done:

MRI cervical spine with images, neurological charting of extremities, vitamin D and B12 levels.

Treatment plan:

Will advise once a provisional diagnosis is established.

Regarding follow up:

Revert back with the reports to an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Patient's Query

Thank you doctor,

I just woke up and had a very bad pain and was unable to move my neck side to side. However, this gets better when I put my head backwards. The tingling starts in my right thumb. About a week ago, I had more tingling and burning sensation in my toes than my feet and ankles. There is no weakness or difficulty with urine. I am not taking any medication. This only presents when lying down on my spine. Thank you.

Answered by Dr. Akshay Kumar Saxena

Hello,

Welcome back to icliniq.com.

Since your symptoms have started recently and after an overnight sleep, there is definitely no history of injury to your cervical spine region.

So, in your case I can advise you with the following. Consult your specialist doctor, discuss with him or her and take the medicine with consent.

I suggest you tablet Pregabalin or Gabapentin in the basic dosages for two to three weeks. These medications are for neuropathic symptoms like in your case, they are for tingling and other paresthesias.

Secondly, I suggest tablet Methylcobalamin 1500 mcg once a day for two to three weeks, which acts as a neurogenerator.

TENS (transcutaneous electrical nerve stimulation) as a physical therapy modality is useful for such symptoms.

If you are still feeling any neck pain with restriction of movements, then an anti-inflammatory medication like tablet Ibuprofen or Paracetamol can be initiated along with a muscle relaxant for five to seven days.

I normally advise patients of your age group a course of three months initially of Calcium and Vitamin D supplementation.

You will also have to avoid straining your neck region and follow principles of neck ergonomics especially at work.

I believe you should be relieved of your symptoms if you can follow these instructions. Also, it is advised to get yourself thoroughly evaluated, so that no specific pathology is missed.

The Probable causes:

Disc degeneration with acute exacerbation of symptoms.

Regarding follow up:

Revert back after three weeks to an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

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