Question
Hello Sir,

About a month ago I had a horrible spill off of my horse.  I got tossed into the air and landed flat on my back.  The radiographs of spine and ribs were clean and the ER doctor  said I had bruising of the ribs and the muscles between the ribs (mostly on left side).  About two weeks after this fall I started to experience the fingers on the left hand "falling asleep" anytime I engaged in any sort of physical activity that required me to use my hands.  This tingling/numbness has now spread to both hands and then to both arms and not has become a major problem not only during physical exercise but also while I am sleeping.  I found this very disturbing and went back to the ER -- they prescribed me Motrin and sent me home.  Obviously something is going on and I am not sure if I need to follow up with more doctors, see a chiropractor, etc....  What direction would you suggest I go in solving this issue?

Thank you for your time!
Miranda

Answer
Dear Miranda,

I am so sorry to hear of your tumble off the horse!  I have a couple of thoughts for you regarding the symptoms in your arms and hands.

First of all, did they take any x-rays of the neck?

The nerves that enter the arms and hands leave the spine at the lower part of the neck. Landing hard on your back can cause injuries to the neck similar to a whiplash. Whiplash injuries often involve the discs between the vertebrae of the neck region, usually the lower part of the neck. When the discs of the neck are injured, they can bulge into the spinal canal area and put pressure on the spinal nerves and/or spinal cord.

If you landed hard onto the neck itself, there is a possibility of fracture/dislocation in the neck, although I doubt this somewhat because of the time that has lapsed since the incident.

I have to assume that the ER did a good evaluation on you, and that therefor you are relatively "stable", in that you are not at risk of further spinal injury...  

I do feel, however, that the ER dropped the ball in that they did not refer you out for additional testing/imaging, such as a CT or MRI.

But, I believe that your next step is probably with a neurologist. You want to rule out any occult or hidden neck fracture and/or disc problem in the neck, probably through CT or MRI, if warranted.  If the neurologist finds that you are suffering from a disc problem in the neck, I believe that you need to take that information and go and find a very good chiropractor. I say that with some hesitation because I know that some chiropractors are manipulation happy, meaning that they can be too aggressive with manipulation.  When you find your good chiropractor, ask him/her what he wants to do. I would probably start you with simple therapy, such a electrical stimulation, ultrasound, and maybe some traction (if indeed it were a disc injury). I would NEVER adjust you until a neurologist cleared you for neck fracture... and even then, I would probably only use NON-force adjusting.

Please remember that all of this is guess work. I have never seen you and I know nothing of your case other than what you have told me. The advise of a doctor who has seen and evaluated you is infinitely more valuable than any information and advise that I can give you.

Again, I hope that you heal quickly and completely!

Good Luck,
Keith Biggs, DC
Arizona Chiropractic Physcician
http://www.eastmesachiropractor.com