Loss of balance, neck pain numbness tingling R hand thumb 3-4 fingers both hands

by Michelle

Hello Doctor,

I am a 42 year old nurse that is four months post fusion L3 L4 ,Aug 2013. I am now experiencing an increase loss of balance. I feel like my body is leaning forward to right to fall, I have to stop myself from falling all the time for last few weeks.

I notice my right foot big toe seems to drag lately. I have serve neck pain esp when turning right side. Some numbness and tingling in 3rd-4th fingers both hands. I will try to make this nightmare short.

I have a history of 3 falls with chronic low back pain X 5yrs. The first fall 2008 at work, in which my knees were twisted under me, I used my right arm to break my fall and save my head. I thought I had broken my back/hip. I held on to walls for months. My knees would buckle/jerk I felt like I would fall at the time. I didn't see a orthopedist until more than a year later. I was told by a work comp DR that I had arthritis, bulging disks (he said everyone has those) needed to lose weight and little arthritis in knees, a few baker's cyst (that's common he said). I was brushed off and left with chronic severe back pain.
My car was bumped from behind, I had whiplash and some neck pain. I when to a chiropractor a year later for a nagging stiffness in my neck and back pain.

In 2010 I tore my Right Rotator cuff at work trying to stop a patient from falling. Later had three repairs about six months apart. I had nerve pain,numbness and tingling in right arm, inside to elbow, thumb and 3rd-4th fingers after 1st surgery. This doctor order aggressive physical therapy during which I felt something pinch in my right bicep. That's when nerve pain started when reaching or pulling. After my second repair, I also was DX with mild carpal tunnel in right hand.
My second fall was in Feb 2012 in a dog attack, I fell straight back and my back took the worst of it. Back pain increased. In the fall, I began to have a back spasms so bad I couldn't walk or move for hours. I had a nerve block done in October.

But had my third fall at work in November 7, 2012. I clipped the corner of a chair, tumbling into steel frame glass doors with my head turned left. Hitting a head and right shoulder into the glass and on my knees. This accident was the day before my second nerve block! I reported everything as I always have done. I had the nerve block it didn't work.
The last straw for me was one month later, I had a lifting incident with a patient at the doctor's office. I had to assist cause there was no one else to help put her into the chair. I had debilitating pain, muscle spasms, nerve pain in low back on both sides but esp.in right buttock to knee cap. I haven't been able to work since December 2012 after that.

I had five nerve blocks. physical therapy, MRI then finally I had a myelogram on my back. Then I had surgery in August 2013, my doctor discovered when he got into my back that my disk had collapsed, which explained the severe Radicular pain.
My pain is not excruciating, but moderate. It is severe with increased walking and standing or stooping or bending then standing up. Pain goes to my right in my hip at times to front of knee. I have physical therapy two days a week since 4 weeks after surgery. But the increase loss of balance, now I constantly feel about to fall several times a day, but no dizziness or vertigo noted in the last six weeks. No falls since Nov 2012.

Gosh, Michelle, you've been in the wars.

Two big concerns. Firstly the large toe is controlled by the L5 nerve root, and most unlikely to be affected by the L3-L4 disc. Standing, raise your big toe, and ask someone to press down on your toe. Compare right and left. Is there a distinct difference? If so there's likely to be another disc complaining. Type Slump test into the search function at chiropractic help. Do you have pain tightness in the leg and back?

Certainly a week big toe, the muscle is the extensor hallucis, would make you feel unstable. It's a major muscle used in the toe off phase of walking. The medial hamstring reflex would be reduced, and you would probably have some sensory change in the L5 dermatome. Bending forwards, I would expect tightness or pain at the back of the thigh.

Very occasionally, not in your age group, a problem in the neck can affect the muscles in the lower leg, and that would certainly make your legs weak, and possibly jerk and buckle. The lower leg reflex would be increased.

My advice would be to go back to the surgeon who treated you a few months ago. Time for a new assessment of this progressive weakness and loss of balance. Perhaps a neurologist too.

If you need to lose significant weight, get it off, or face major disability. Cutting back hard on carbs, those with a high glycemic index, is the way to go.

Try and get into some gentle exercise programme. Perhaps aquarobics, gentle back exercises. Do them faithfully, daily.

Good luck, I hope this has contributed.

Dr b

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