Question
QUESTION: A week ago I woke up with my right leg very tight and stiff and my knee was swollen huge ! I called my Dr., and because it was a holiday, I was sent to ER for a dopplar ultrasound of my leg. They wanted to make sure I did not have a blood clot. No blood clot was found. I was then followed up by my regular Dr., and sent to an Orthopedic. He did x-rays on my leg and found nothing. There was some fluid behind my knee and he gave me a cortisone shot in the knee, some medication for inflammation and leg exercises. The leg now seems to be doing some better, but is still somewhat numb around the knee. Recently in the past 2 days, I have noticed some numbness on the right side of my face. My right nostril and under my eye and my cheek. Sort of feels like your face after you've had dental work done and the numbness is wearing off. It even felt like my head was rather numb as I was drying my hair. I do not have ANY idea what is causing this! In reading your questions, I did remember that I do have scoliosis that was diagnosed years ago after a mild car accident. I have never had any trouble with my back though related to that. I was also diagnosed with a form of tendonitis in my right foot about a month ago. I am on medication for that for inflammation. The numbness in my face and on my head concerns me and I have no idea what to make of this. Please help !  Thank you.

ANSWER: Dear Susan,

The main concern I have for you is the possibility of Multiple Sclerosis (MS).  Neurological symptoms such as numbness and tingling that appear for no reason are suspect for MS, and it is much more prevalent in women than in men.  This disease usually manifests in the 20's and 30's and 40's, and will have bouts of symptomatic neurological issues and then remission.  It is due to destruction of a substance called myelin which insulates nerves and brain structures.  Like the covering of a wire so that the electrical impulse do not get mixed up.

A few questions:  Have you had other tingling, numbness or hot/cold symptoms in your hands or feet?  Have you had any unexplained visual disturbances? Have you been overly tired or had bouts of dizziness?
Here is a list of common symptoms:

Fatigue
Fatigue is one of the most common symptoms of MS, occurring in about 80% of people. Fatigue can significantly interfere with a person's ability to function at home and at work, and may be the most prominent symptom in a person who otherwise has minimal activity limitations.

Numbness
Numbness of the face, body, or extremities (arms and legs) is one of the most common symptoms of MS, and is often the first symptom experienced by those eventually diagnosed as having MS.

Walking (Gait), Balance, & Coordination Problems
Problems with gait (difficulty in walking) are among the most common mobility limitations in MS. Gait problems are related to several factors.

Bladder Dysfunction
Bladder dysfunction, which occurs in at least 80% of people with MS, usually can be managed quite successfully

Bowel Dysfunction
Constipation is a particular concern among people living with MS, as is loss of control of the bowels. Diarrhea and other problems of the stomach and bowels also can occur.

Vision Problems
A vision problem is the first symptom of MS for many people. The sudden onset of double vision, poor contrast, eye pain, or heavy blurring is frankly terrifying-and the knowledge that vision may be compromised can make people with MS anxious about the future.

Dizziness and Vertigo
Dizziness is a common symptom of MS. People with MS may feel off balance or lightheaded. Much less often, they have the sensation that they or their surroundings are spinning, a condition known as vertigo.

Sexual Dysfunction
Sexual problems are often experienced by people with MS, but they are very common in the general population as well. Sexual arousal begins in the central nervous system, as the brain sends messages to the sexual organs along nerves running through the spinal cord. If MS damages these nerve pathways, sexual response梚ncluding arousal and orgasm梒an be directly affected. Sexual problems also stem from MS symptoms such as fatigue or spasticity, as well as from psychological factors relating to self-esteem and mood changes.

Pain
Pain syndromes are common in MS. In one study, 55% of people with MS had "clinically significant pain" at some time. Almost half were troubled by chronic pain.

Cognitive Function
Cognition refers to a range of high-level brain functions, including the ability to learn and remember information: organize, plan, and problem-solve; focus, maintain, and shift attention as necessary; understand and use language; accurately perceive the environment, and perform calculations. Cognitive changes are common in people with MS梐pproximately 50% of people with MS will develop problems with cognition.

Emotional Changes
Emotional changes are very common in MS梐s a reaction to the stresses of living with a chronic, unpredictable illness and because of neurologic and immune changes caused by the disease. Bouts of severe depression (which is different from the healthy grieving that needs to occur in the face of losses and changes caused by MS), mood swings, irritability, and episodes of uncontrollable laughing and crying (called pseudobulbar affect) pose significant challenges for people with MS and their family members.

Depression
Depression is common during the course of multiple sclerosis. In fact, studies have suggested that clinical depression, the severest form of depression, is more frequent among people with MS than it is in the general population or in persons with other chronic, disabling conditions.

Spasticity
Spasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms (sustained muscle contractions or sudden movements). It is one of the more common symptoms of MS. Spasticity may be as mild as the feeling of tightness of muscles or may be so severe as to produce painful, uncontrollable spasms of extremities, usually of the legs. Spasticity may also produce feelings of pain or tightness in and around joints, and can cause low back pain. Although spasticity can occur in any limb, it is much more common in the legs.

The diagnosis of MS is largely clinical, but the hallmark is an MRI of the brain to check for areas of plaquing. These areas often affect the cranial nerves and sensory portions of the brain.  I wouold suggest that you speak with your doctor and try to recall any additional symptoms that you may have had over the past few months that could indicate MS and decide with your doctor if the MRI is appropriate.

Good Luck Susan.

Respectfully,
Dr. J. SHawn Leatherman
www.suncoasthealthcare.net

---------- FOLLOW-UP ----------

QUESTION: I have had no other problems with numbness or tingling or hot/cold feelings in my hands or feet.No visual problems and no dizziness.I am not experiencing any of the other symptoms that you listed for MS either.  The Orthopedic Dr. I saw asked me if I was having any back pain. Actually, I was having bad back pain and shoulder pain right before any of this started. He said he thought this might have something to do with my back. Is it possible that I could have a pinched nerve in my back?

Answer
Dear Susan,

Okay, good that you are not having more of the neurological based symptoms.

A "pinched" nerve in the low back would usually account for localized pain and dysfunction as well as possible symptoms along the course of the nerve down into the leg.  When this occurs, it can manifest as a direct correlation of pain to the nerve root if there is a specific focal insult, but often the pain is diffuse in nature do to the fact that the nerve may be inflamed but without a focal injury.

The fact that your complaints were preceded by a bout of upper and lower back pain is actually a sign of long term issues that may have finally reached their breaking point.  However, this may not be such a bad thing as pain is often the last symptom to appear, and the first to leave with active treatment.  

The fascial numbness and tingling you have described is probably not related to the back at all.  It is possible to get referred pain patterns on the face from myofascial dysfunction in the neck and upper back, but this is usually fairly easy to pinpoint on clinical examination or palpation of the tissue.

I would recommend that you seek out the care of a good local chiropractic physician for an examination.  Active care protocols such as spinal manipulation, stretching techniques, myofascial release, and specific exercise to combat postural issues are very effective at reducing pain transmission while increasing function.  Your orthopedist is likely to do nothing other than offer you injections, pain meds, or possible physical therapy, if your not a surgical case.  A chiropractor will offer a more active care program and thorough musculoskeletal examination, as this is what we excel in.  Find a good local doc and schedule a consult.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net