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HomeAnswersSpine SurgerynumbnessI have numbness and muscle tightening from the abdomen to the toes after an accident. Why?

What could cause numbness and muscle tightening from the abdomen to the toes following an accident?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Anuj Gupta

Medically reviewed by

iCliniq medical review team

Published At March 8, 2023
Reviewed AtJune 15, 2023

Patient's Query

Hello doctor,

I have attached my MRI reports. No significant narrowing of the cord after the accident last year. What are treatment options? Symptoms include numbness and muscle tightening from the abdomen to the toes; all motor functions and strength are intact.

Kindly help.

Answered by Dr. Anuj Gupta

Hello,

Welcome to icliniq.com.

Thank you for your query. You need to send me images of the MRI. Also, tell me do you feel instability while walking? Do you have a change in your writing? Are your symptoms progressive when you compare them with last year? Please send me images.

I hope this has helped you. Thank you.

Patient's Query

Hello doctor,

I do not have the images. I had a broken leg and arm, so I was immobile for a long time. The numbness and muscle tightness have always been there because I am mobile, walking, and doing PT. Walking good for 12 weeks, had rod and screws. Have brachial plexothapy, so hard to judge writing. They use the term myelomalacia or softening.

Answered by Dr. Anuj Gupta

Hello,

Welcome back to icliniq.com.

Since you do not have images, so let us consider that your problem is because of the cervical spine. Now, in your case, there are multiple other issues. So you must be carefully evaluated if the cervical spine is so symptomatic. If you have any doctor's notes mentioning your clinical examination, then it will be helpful for me. Otherwise, I would suggest you wait and watch as if now. Get yourself recovered from other injuries and then see how symptomatic you are because of your cervical spine. The only absolute indication of surgery in the case of cervical spine myelomalacia is bladder and bowel incontinence.

I hope this has helped you. Thank you.

Patient's Query

Hello doctor,

I have shared my test results below.

Answered by Dr. Anuj Gupta

Hello,

Welcome back to icliniq.com.

As I suggested in my previous answer, your cervical spine does not seem to have gross compression. Also, your report does not mention anything about myelomalacia. So I suggest focusing on physiotherapy, and you do not require any intervention for your cervical spine.

I hope this has helped you. Thank you.

Patient's Query

Hello doctor,

Here are my reports.

Answered by Dr. Anuj Gupta

Hello,

Welcome back to icliniq.com.

These reports are really helpful in understanding your condition. Well, due to trauma, there is an injury to your cervical spinal cord, which is the reason for myelomalacia. Also, there is a fracture of the spinous process at that level which is a sign of instability. You have weakness in one of the upper extremities, and your lower limbs are more or less fine. Now in this situation, I feel if there is ongoing compression or instability (fracture of the spinous process is indirect evidence of this), you should get operated on. The surgery will stabilize your cervical spine so that it does not cause further damage to your spinal cord. What is the treatment protocol your doctor is following? Complete immobilization and cervical collar? Or are you sitting up and moving using a wheelchair?

Patient's Query

Hello doctor,

I am living normally. No collar. No wheelchair. I use a cane for the healing leg fracture. I am going to an amusement park in a few weeks. I am told to avoid jerky rides. They said no surgery was needed. They told me my cervical fractures were healing and I did not need a collar. I wore a collar for six weeks after the accident. It is now 12 weeks post-injury. I also have a pelvic pubis fracture. Could this be contributing to my leg numbness and tightness?

Answered by Dr. Anuj Gupta

Hello,

Welcome back to icliniq.com.

That is great if you are moving around. Then surgery is not required. Yes, a pubic rami fracture can also cause numbness, or any fracture, like the tibia in your case, can cause numbness for a long. It will settle down on its own. Get your vitamin B12 checked, and you can start tablet pregabalin for numbness.

Patient's Query

Hello doctor,

I found Gabapentin did not do much. We are discontinuing. We are trying Cymbalta 30 mg. And Baclofen for muscle tightness which is extreme. What do you think? And how worried should I be about the tightness?

Answered by Dr. Anuj Gupta

Hello,

Welcome back to icliniq.com.

Tablet Cymbalta is also a nice and effective medicine. Gradually you can increase its dose upto 120 mg in a day in divided doses. You should take Baclofen if muscle tightness is too much and bothering you. Otherwise, a little spasticity is good and helps in walking and standing. Bending the neck forward and then you have tingling is typical of spinal cord compression or myelomalacia. But it would be best if you kept a watch on your symptoms. If they increase, you should consider getting them operated on. It is not normal to have this.

I hope this has helped you. Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

They told me this was not a progressive condition but I am so worried. Today I woke up with a lot of tingling and stiffness. I walked a lot yesterday around the neighborhood. Could over-exerting cause this muscle tightness? Could my spinal cord injury be considered a bruise? Do you think this will get somewhat better over time? I read that it could. What do you think?

Thank you.

Answered by Dr. Anuj Gupta

Hello,

Welcome back to icliniq.com.

You can have more muscle tightness usually after too much exertion and when you rest, that is normal and it will be relieved with gentle exercises. Myelomalacia is edema or swelling in the spinal cord. You can call it a bruise. As seen in the rest of the body, the swelling subsides with time. In this case, too, it will. But it may or may not have a residual effect on nerves. So let us see. I feel you should repeat the MRI after three months. Continue your exercises till then and you will improve

Thank you.

Patient's Query

Hello doctor,

I would like to think it will heal somewhat but not get worse. I do not want to be paralyzed. Does neuroplasticity work on sensory as well? You have been very helpful. I have to remain positive. I am a teacher and am planning to get back to work but I need to feel better. Hopefully, the new Cymbalta will start working. I have only taken it for three days. I am weaning off Gabapentin. Now I am wondering if the symptoms are feeling worse because I am in the middle of changing medications.

Thank you.

Answered by Dr. Anuj Gupta

Hello,

Welcome back to icliniq.com.

It has been almost two and a half months if anything worse had to happen, it would have been by now. So chances of paralysis are remote now. Neuroplasticity is the word used for regeneration or you can say healing of nerves. Sensory also shows neuroplasticity but lesser than the motor and the good thing is the body adapts to sensory symptoms nicely. Motor weakness is not adaptable. So we are more worried about motor recovery instead of sensory recovery. Going back to work will help you as it will keep you busy, will help you to get back to your normal life, and will keep you positive. It might be a possibility that your symptoms are worse as you are stopping Gabapentin. But I did not get why are you stopping Gabapentin when you can take Cymbalta and Gabapentin together. There is no harm in that.

Thank you.

Patient's Query

Hello doctor,

I thought I would reevaluate and update you. After our last interaction, I got a second opinion from a prominent neurosurgeon. His assessment was cervical spondylitis with myelopathy. He said I would not have another spinal cord contusion unless I had another traumatic event. I do not need surgery as I have enough latency in the spine, it will not progress, and I can expect gradual remission of symptoms over 12 to 24 months. I have been taking Cymbalta, but I did not think it was helping with numbness and tingling, so I stopped. It has been a week. I went back to 2.5 mg Lexapro which I was on at the time of my accident. I still take Gabapentin (200 mg) thrice daily and not too much Baclofen (I try to stretch more). I have not returned to work yet but will return in some time. I did a lot of work for the last three days, so now my nerves are super excitable, tingly, and stiff. I hope it is from working a lot, not because I stopped Cymbalta. What do you think? I do not want to go back on that drug. I am looking into thc or CBD as an alternative. Most of my doctors and physical therapists say I am making great progress and will continue to improve these symptoms, but it takes a long time. I get so discouraged because I feel it is two steps forward and one step back, and I do not see any lessening of the altered sensations in my body. Should I not see something, or is it so gradual it’s not noticeable? It has not spread, but it has not returned to normal sensation in the affected areas. Some days I think it has its spots, but it is hard to tell. I have read that nerve healing results in changes and that super-excitable nerves could signal nerve repair. What do you think?

Thank you.

Answered by Dr. Anuj Gupta

Hello,

Welcome back to icliniq.com.

Thank you for getting back to me.

As we have discussed before, it is a time-consuming process. Our nerves are very delicate. They cannot bear even a small amount of trauma. And when it comes to recovery, they take a lot of time and sometimes do not recover completely. As advised by your neurosurgeon, it may take up to two years to recover. As far as medicine is concerned, no medicine can fasten this process. Instead, medications are to alleviate your associated symptoms. You can take whatever drug suits you, but you need to take care that you should not be habitual to any medicine. You can give a medicine holiday for a few days in between and start it again. I hope to answer your query with this.

Hope this helps.

Thank you.

Patient's Query

Hello doctor,

Thank you. I was wondering if, in your opinion, this current excitability would be from stopping Cymbalta for a week (sort of soon), or is it more from the amount of work I have been doing the last few days? Also, I understand the time factor and the uncertainty (even though I am going for a 100 % recovery). When the spinal cord engages in neuroplasticity, does that also excite the nerves? I read that the brain enters this high neuroplasticity between six to nine months. Is that true?

Thank you.

Answered by Dr. Anuj Gupta

Hello,

Welcome to icliniq.com.

Cymbalta is nothing but a drug used for neuropathic pain. There is no harm in taking it for years. We give it to our patients for very long., so there is no harm in taking it. Moreover, the maximum dose you can take is 120 mg. I hope you are taking less than this. So I advise you to continue with that. Yes, when the nerve recovers, then there is an increase in excitability. That is a known fact. I do not know about the brain entering it after six to nine months. If you can share the link, I can go through that and explain it to you better.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Anuj Gupta
Dr. Anuj Gupta

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