multiple back problems

    
      Re: multiple back problems
    


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Posted by CCF Neuro MD on July 09, 1997 at 20:04:23:

In Reply to: multiple back problems posted by M. Rupp on June 30, 1997 at 12:48:32:
  I am a 42 year old female and am experiencing multiple problems that can't seem to be resolved.  I will start with my symptoms and then list my treatment history.
  My symptoms include:
  1. an ability of lift more than a few ounces, even lifting a full soda can is beyond my ability.
  2. I experience long spells of muscle spasms, mainly in my back and shoulders.
  3. I can't turn my head more than a few degees in any direction (up, down, left or right) without discomfort.
  4. I can walk, but not far (say about 1/2 mile).
  5. I can walk up stairs but only using my right leg.
  6. I can't ride in cars for two reasons.  First I can't get in or out of the seat.  And even after help getting into the car, I experience muscle spasms when the car goes over even the smallest bump.  Unfortunately the spasms don't end when I leave the car but can continue for days.
  7. I can't sit for very long and spend most of my time standing.
  8. I am not in much pain as long as I avoid sitting, lifting anything, turning my head, riding in cars, etc.
  These symptoms started about three years ago.  At that time I visited a neurologist who ran some blood and nerve conductivity tests.  All were negative.  I then visited Strom memorial (maybe Strong memorial?) in Rochester NY.  Much more extensive testing but again all negative.  Back to the original neurolgist who suggested physical theripy.  I tried it, but it made things much worse.  Spend the next year (or so) visiting various neurologists, orthopedics and back specialists.  Many tests but all negative.  Basically the neurologist said to see an orthopedic and the orthropedic said to see an neurolgist.  Probably saw 10 to 12 doctors in all, without even an diagnosis.  Again tried physical theripy and again got much worse.  Slowly recovered (over the next year) but have now settled in at my current condition.
  I am looking for any help in how to proceed.
  Thank you,
  M. Rupp
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Hello, M,
  Your condition does sound very complicated.  To put all of your symptoms into perspective, I would like to summarize as the following.  For the past three years, you have been experiencing muscle weakness (arm muscles mainly); muscle spasms involving back, shoulders, and legs; and fatugue (not able to walk more than half a mile).  So far, work-ups have all been negative.  Physical therapy has not been beneficial.  
  Although not that many neurological condtions can do all of the symptoms at one time, there are several diseases may present themselves with some of them.  The spasms triggered or worsened by movement and significant proximal muscle weakness (lifting a soda on the arm muscles and climbing up stairs by leg muscles) suggest some sort of muscle disease, such as polymyositis.  However, polymyositis usually is progressive with abnormal blood test (increased CK--a kind of muscle enzyme).  Another condition that I can think of is some problem with your spine.  With a narrowed spinal canal, usually secondary to a herniated disc, you could have leg weakness and spasms that get worse with moving legs or sitting for long time.  However, If your neurological examination was completely normal, this would be another less likely possibility.  Your lack of ability of walking longer than half a mile makes me suspect some kind of neuromuscular conduction problem.  Again, this usually would have been accompanied by some abnormal findings on neuro examination, such as getting much weaker when using the muscles repetitively.  Another condition that may present with significant weakness and spasms is a demyalinating process.  However, the exam would reveal some other findings such as the ones involving vision, speech, and swallowing.
  Given the fact that you have had extensive workup, and still come up with no clue, you may want to consider some other more definitive tests, such as MRI, spinal tap, and repeat electrical muscle testing (EMG).  But before you do all that, consider visit a referral center.  Several centers in NY area are nationally known, such as Columbia University and Rochester University.  If you happen to have a chance to visit Cleveland area, we will be happy to see you at our department at Cleveland Clinic Foundation.  Keep this number with you: [phone] from out of state, or [phone] inside Ohio, ask for ext.45559.  Good Luck!
  This information is provided for general medical education purposes.  Please consult your primary physician for the diagnosis and treatment of your specific condition.