Unexplained Arm and Leg Symptoms

This post is about Central Cord Syndrome; please see the article from my last post for reference.

There is one diagnosis that is often not discovered until it is too late. It is called central cord syndrome or central cord compression. Your spinal cord is being compressed within a part of the neck, so you experience not only neck/arm symptoms but other symptoms in the lower body as well.

Neck Pain
Usual neck problems can cause neck pain and/or refer pain to the shoulder or down the arm. If this is your only symptom, you likely do not have anything compressing your spinal cord in the neck. You may have a neck diagnosis that can be treated with usual medical treatments such as medicine, Physical Therapy, injections, surgery, or other alternatives.

Back Pain
Similarly, low back problems can produce back pain and symptoms radiating into the buttock(s), hip(s) and/or leg(s). If this is your only symptom, you likely do not have Central Cord Syndrome. I highly recommend you request a prescription for Physical Therapy from your doctor in order to treat your back/leg symptoms.

Neck/arm AND Back/leg Symptoms
If you have neck/arm symptoms AND leg symptoms at the same time, you may need further medical attention quickly! Some leg symptoms are: difficulty walking, progressive loss of balance/falls, leg pain, and numbness/tingling in the leg. Other symptoms include loss of bowel/bladder control/function and/or loss of sensation in the pelvic region.

Examples:
1. You have a neck injury that appears to have resolved. But now you have progressive weakness in one or both of your legs.
2. You have knee pain that started without a knee injury. Actually it started around the time that you were in a car accident and hurt your neck. It keeps getting worse despite treatment for knee pain.
3. You have what feels like carpal tunnel syndrome in your hand(s). It has been going on for several years but is not improving with treatment. Also, your neck hurts and you have numbness in your leg(s) during the same period of time.
4. You have been treated for neck pain and it is mildly improving, but you recently notice that you cannot control your bladder like usual.
5. You have a neck injury that radiates pain and tingling down your arm. You did not notice at first, but you feel the same symptoms in your leg(s), which began at the same time.

Neck/Back Pain
If you have both neck/arm symptoms and back/leg symptoms that began at different times, then you may have 2 different problems that need to be diagnosed/treated separately. In this case, be sure to inform your doctor about all your symptoms so he/she can rule out a more serious problem such as Central Cord Syndrome.

Central Cord Syndrome: Arm/Leg Pain Coming From Neck

The following article is from NIH, and it summarizes a serious condition that can go undiagnosed for several months-years. So if you experience any or all of these symptoms, get medical attention immediately! I have seen this many times, and when symptoms are ignored for too long, they can become permanent.

What is Central Cord Syndrome?

Central cord syndrome is the most common form of incomplete spinal cord injury characterized by impairment in the arms and hands and to a lesser extent in the legs. The brain's ability to send and receive signals to and from parts of the body below the site of injury is reduced but not entirely blocked. This syndrome is associated with damage to the large nerve fibers that carry information directly from the cerebral cortex to the spinal cord.  These nerves are particularly important for hand and arm function. Symptoms may include paralysis or loss of fine control of movements in the arms and hands, with relatively less impairment of leg movements. Sensory loss below the site of the injury and loss of bladder control may also occur, as well as painful sensations such as tinging, burning, or dull ache.  The overall amount and type of functional loss is dependent upon the severity of nerve damage.  Central cord syndrome is usually the result of trauma that causes damage to the vertebrae in the neck or herniation of the vertebral discs.  It also may develop in persons over the age of 50 due to gradual weakening of the vertebrae and discs, which narrows the spinal column and may contribute to compression of the spinal cord when the neck is hyper-extended. 

Is there any treatment?

There is no cure for central cord syndrome although some people recover near-normal function. There is no standard course of treatment, although drug therapy, surgery, and rest are often part of the program.  Magnetic resonance imaging (MRI) is used to indicate the degree of spinal cord compression and vertebral instability.  Vertebral instability due to acute traumatic injury or cervical disc herniation is often treated by surgery to prevent further damage to the spinal cord.  Recent reports indicate that earlier surgery may improve chances for recovery.  Numerous recent studies suggest that surgery also can be beneficial in individuals with persistent compression of the spinal cord and ongoing neurological deterioration.

What is the prognosis?

The prognosis for central cord syndrome varies, but most people whose syndrome is caused by trauma have some recovery of neurological function. Evaluation of abnormal signals on MRI images can help predict he likelihood that neurological recovery may occur naturally.  Those who receive medical intervention soon after their injury often have good outcomes.  Many people with the disorder recover substantial function after their initial injury, and the ability to walk is recovered in most cases, although some impairment may remain.  Improvement occurs first in the legs, then the bladder, and may be seen in the arms.  Hand function recovers last, if at all.  Recovery is generally better in younger patients, compared to those over the age of 50.

Reference: NIH: National Institute of Neurological Disorders and Stroke. <http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm>