Neck

Arm & Leg Pain

The anatomy of the spine includes both the bony vertebrae and the compressible intervertebral disc. Over time, the discs can develop degeneration, leading to loss of the disc's internal water content and compromising its integrity. This can result in a bulging or herniated (slipped) disc. 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 foot drop, 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, an impairment of bladder or bowel function, either inability to start or stop, could constitute cauda equina syndrome which is an absolute emergency necessitating immediate attention in the Emergency Department.

Low Back Pain

Pain in the lower back, or the lumbar spine region, can affect most people on occasion. Most commonly, low back pain is muscular and associated with improper form with heavy lifting or is caused by sitting long periods with poor posture. Severe, chronic low back pain can have a number of causes, from pinched nerves to vertebral damage. 

Neck 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?

1. 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.
2. 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.
3. 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.
4. 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

Lack of sensation in the back or extremities is often a sign that something is wrong with the nervous system. Tingling sensations are also associated with nerve problems. Either through acute injury, repetitive use, or musculoskeletal degeneration, spinal and / or peripheral nerve damage is serious. Loss of sensation, numbness, and / or tingling are serious symptoms that require expert examination.

Whiplash

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
• Headaches
• Upper back / shoulder pain
• Dizziness
• Jaw pain / swallowing dysfunction
• Sensation of numbness / tingling in hands

Click here for specific neck pain information.

Whiplash

Conditions associated with whiplash include:

• Cervical muscle spasm
• Cervical nerve root injury
• Spinal cord injury
• Spinal fracture

Lumbar Spinal Stenosis

Lumbar spinal stenosis has been defined as any type of narrowing of the spinal canal, nerve root canals, or intervertebral foramen. This narrowing can put pressure on the contents of the spinal canal (spinal cord and nerve roots) resulting in symptoms of lumbar stenosis. It can present at any age but usually presents in patients over the age of 50. The most common levels of lumbar spinal stenosis are L3-4 & L4-5. Nearly 15% of the patients with degenerative lumbar spinal stenosis also have cervical spinal stenosis.

The Causes: The narrowing can be caused by soft tissue abnormalities (e.g. disc herniation, ligament enlargement), bony abnormalities (e.g. facet enlargement or bone spurs), or a combination of both. The resultant nerve root compression leads to nerve root ischemia, which gives the clinical picture of lumbar spinal stenosis. The narrowing of the spinal canal structures can be congenital and or acquired (more common). The primary cause of the acquired spinal stenosis is degenerative disc disease. Less common causes are spondylolisthesis, scoliosis, trauma, and rarely, spinal tumors.

The Diagnosis: A thorough medical history and physical examination are the keys to the correct diagnosis. If no relief is achieved with conservative care, other workups or studies may become necessary, including X-rays, MRI, and CT scans.

X-rays of the lumbar spine are usually the first diagnostic study and give an assessment of the degenerative spine disease, disc space narrowing, spur formations, spine instability, foraminal narrowing, and other bony abnormalities.

MRI studies use the magnetic field and radiofrequency waves to give detailed pictures of the lumbar spine, including disc herniations, bone spurs, the extent and level of narrowing in different planes, and horizontal or vertical cut sections.

CT scans give detailed information regarding spine structures, especially bony structures, but are limited in the evaluation of soft tissues. This can be of significant help in clinical situations where MRI studies are not indicated, e.g., patients with pacemakers or surgical clips. A CT myelogram is rarely needed in clinical situations when the MRI study is limited due to metallic artifact from spine implants and fusions.

Electrodiagnostic studies involve the electrical study of nerves and muscles, which is helpful in the diagnosis of nerve damage or irritation. Nerve root blocks or transforaminal epidural injections are commonly used to make a focal diagnosis of the spinal pain or are used prior to spinal surgery. Points: On rare occasions, numbness, weakness, and/or impairment of bladder or bowel function—either the inability to start or stop—could constitute cauda equina syndrome, which is an absolute emergency necessitating immediate attention in the emergency department.

Neck Pain

Treatment for neck pain typically follows a conservative course with the employment of anti-inflammatory medications, muscle relaxants, early engagement with physical therapy, and occasional employment of a cervical collar. Physical therapy involving stretching, exercises, and traction may be recommended, along with modalities such as moist heat, ultrasound, and electrical stimulation. Generally, the prognosis is positive with improvement or resolution in days-weeks. Severe whiplash injuries can take a considerably longer period for recovery.

Arm & Leg Pain

Fortunately, the vast majority of leg and arm pain sufferers gain significant improvement over time with conservative care alone. In the absence of progressive worsening such as worsening weakness or numbness, the symptoms usually resolve within four-six weeks. Medications such as anti-inflammatories, muscle relaxants, and occasionally corticosteroids in combination with early stretching, exercises, and traction can be helpful in keeping the symptoms at bay until resolution occurs.

Lumbar Spinal Stenosis

Conservative or nonsurgical treatment is often sufficient to control symptoms and remain functional. General fitness and conditioning exercises are usually sufficient including cycling, pool exercises, treadmill exercises as tolerated. Medications used are acetaminophen (maximum dose not to exceed 2000mg/day), anti-inflammatory medications, medications to help with neuropathic pain (gabapentin).

Try our home remedy exercises provided. Stop if they cause an increase in pain or symptoms. If no relief with home exercises, formal physical therapy involving therapeutic William flexion exercises, functional stabilization exercises may be helpful.

After failure of conservative treatment, epidural steroid injections or selective nerve root blocks are commonly used in nonsurgical management of lumbar spinal stenosis.

Surgical treatment is needed for patients with symptomatic severe spinal stenosis who do not respond to conservative management. Surgical treatment commonly consists of spinal decompression to remove structures (lamina, bone spurs, ligamentum flavum and hypertrophied facet joints, herniated discs) causing narrowing of the spine and causing compression of spinal cord or nerve roots).