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Symptom Check

Do you have back pain, shoulder- neck pain, pain in the arm or leg?
Based on the complaints of pain that patients give us every day during office hours, we have put together a small catalog for your symptom check. This will help you classify your symptoms and maybe even clarify some questions. In general, however, a doctor should always be consulted in order to find possible differential diagnoses.

If you cannot find the described symptoms of your exact condition, please use the reference at the end of the page to ask details in our online office hours, or to arrange an appointment with us in practice.

Click on the symptom that describes your discomfort.

Back pain

Back pain

There are many causes of back pain. Here the two main pain generators (pain polluters) are on one hand the small vertebral joints (facets) and the cross-iliac joint (ISG) on the other the vertebral discs. These structures can wear out over the course of life and during exercise. The intervertebral discs lose height and elasticity and the facet joints rub together or become loose. That results in slight instabilities and mechanical overload. This leads to local inflammation in the joints (orthopedic surgery), the spine (osteochondrosis) and muscle attachments (Insertionstendinitis). It is a reflex increase in muscle tension, poor posture and abnormal in turn the pain. Treatment is primarily conservative i.e. pain medication, physiotherapy and possibly local injection to painful muscle attachments and facet joints. With persistence of symptoms despite conservative therapy, more focused treatment is necessary. This requires first of all a more precise cause determination. In the so-called "facet syndrome" (pain originating from the facet joints), is the possibility of a minimally invasive therapy, such as the facet denervation, but also a dynamic stabilization may be useful. In the so-called pain genes disco (disc-related pain), minimally invasive therapies can also be applied as well as an endoscopic or microsurgical discectomy or implanting an artificial disc may alleviate the symptoms. Treatment options are varied and follow a step pattern, beginning with "small" measures and will extend if necessary. A therapy can be tailored to the patient only after a discussion, clinical examination and appropriate diagnosis (Magnetic resonance imaging - MRI, computed tomography - CT, X-ray).

Neck pain

Neck pain

The causes of neck pain with radiation into the shoulders or the occiput are similar to the causes of back pain. Also the degenerative changes in the small vertebral joints (facets) and discs play a role, i.e. wear due to monotonous posture, such as when working at a desk with computer as well as one-sided carrying of loads on the shoulder. Of course, the discs can become worn in the course of life without an increased stress being exposed to them. Genetic factors play a role and determine the severity and the course. However, the effects of wear on the spine cannot be felt as often as in the lumbar spine. The therapy is comparable though. Again, only a detailed analysis of the diagnostic imaging (MRI, CT, X-ray), the conversation with the patient and the clinical examination guarantee the selection of the correct treatment strategy. There must always be a feedback whether the chosen treatment was successful or not, if applicable the therapy must be adjusted appropriately. A step diagram also applies in the cervical spine. It begins with conservative methods including infiltration techniques. At higher levels facet denervation, disc surgery and implantation of an intervertebral disc prosthesis are also possible.

 

Pain in arm or leg

Pain in arm or leg

Pain in arm or leg point to a so-called root compression syndrome i.e. a particular nerve is being squeezed inside the spinal canal. These so-called spinal nerves are made of different nerve fiber types, and have three functions: 1- Pain transmission, 2- Transmission of feeling and 3- Activation of muscles. The various nerve fiber types that fulfill these functions are sensitive differently to pressure. These pain fibers are the most sensitive, i.e. if a particular spinal nerve is being squeezed, the patient first experienced the pain. If the pressure gets stronger, it comes to numbness and ultimately to paralysis. The region of the body that hurts or is numb depends on the affected nerve. There are so called Kennareale(?), that can give accurate information to the doctor. Has the pain affected area been located and can clearly be assigned to a spinal nerve, it is to determine, with help of picture procedures (MRI, CT), what the cause of the root compression syndrome is. The most common cause is a herniated disc, but also a bony capsule tightness or a cyst may occur.
For pure pain syndromes, the therapy is initially conservative and also follows a step diagram. If despite conservative therapy the complaints remain, minimally invasive or surgical measures must be considered to prevent the chronicity of the problem. With an approximate treatment complaints may contemporarily be removed and the resilience to be restored. A close communication between doctor and patient is always necessary, to check whether a chosen therapy is successful or not and the next stage must be climbed. The choice of optimal treatment is in the hands of the doctor who has the knowledge and practical experience with all treatment options.

Schematic illustration on a model of a herniated disc. The herniated disc (red) presses on the yellow nerve. This makes the nerve not fulfill its function anymore and therefore leads to numbness and paralysis.

Numbness in the arm or leg

Numbness in the arm or leg

Numbness in the arm or leg can have several causes. In general it means a nerve, the spinal cord or brain are being affected, i.e. organs associated with the emotional perception and the forwarding of feelings. Nerves may be disturbed in their function by different causes. These may be inflammation (e.g. Borrerliose) or a nerve being pressed i.e. compressed. Classic example is the congestion syndrome, where nerves are constricted in their passage through narrow-body, of ligaments and tendons (e.g. carpal tunnel). Furthermore, an oppression of a nerve in the spinal canal is made possible through a slipped disc. Typically, numbness occurs in the context of pain and eventually of paralysis. Particularly critical is numbness in the buttocks region, indicating a failure of the so-called S1-S4 nerves. These are responsible inter alia for the maintenance of the bladder and bowel functions, so this effect might cause interference. This represents a neurosurgical emergency and requires a quick clarification, with immediate presentation to a doctor and a possible surgery. Numbness along certain nerve may be assigned to a skin area, the so-called dermatome. There are always different qualities of feeling that need to be examined (sharp - dull, hot and cold, joint position). If larger body areas are affected, for example, both legs or an entire side of the body, this points to a disturbance in the spinal cord or brain. Such disturbances must be immediately clarified. Often, the MRI is the method of choice. Emotional disorders can occur suddenly or gradually. Sudden emergence always indicates something acute, such as stroke or acute disc herniation. Slow emergence is an indication of a chronic process (e.g. narrowing of the spinal canal). For numbness in general a doctor should always be consulted early.

Schematic representation of the various skin areas as they are supplied from the corresponding spinal cord or spinal nerves. The letters stand for a spine region (C - cervical, i.e. cervical spine, L - lumbar, i.e. lumbar spine). The number corresponds to the nerve between two vertebrae, e.g. C6-syndrome for the nerves between the 5th and 6th cervical vertebrae.

Paralysis in the arm or leg

Paralysis in the arm or leg

Paralysis of the arms and legs can have various causes just like the numbness. It is important to distinguish whether certain muscles are affected, or one half of the body or both halves of the body. Paralysis affecting one whole side of the body usually has its origin in the brain. Thereby tumors, bleeding and strokes play a crucial role. Important here, is the temporal development of paralysis. Sudden appearance indicates a haemorrhage or a heart attack, commonly known as stroke. Gradual emergence speaks for a tumor. Paralysis of both legs or even arms and legs, the so-called paraplegia indicates a problem in the spinal canal or spinal cord. Here the same causes as in hemiplegia are possible in general, i.e. bleeding, stroke or tumor, but also a so-called pathological fracture, i.e. vertebral fracture without accident. This is most commonly the case with a spinal tumor where metastases of other tumors play an important role.

Paralysis of individual muscles can be assigned to specific nerves. We distinguish the effects of paralysis by pressure on peripheral nerves, the peroneus paresis is classic (paralysis of the dorsiflexors and the big toe-lift) as a result of a Druckläsion(?) at the Fibularköpfchen(?) and paralysis caused by processes in the spinal canal.

Based on the spine, this means that a spinal nerve is damaged by a herniated disc or a bony constriction such that the motor fibers can no longer perform their function. Again, the individual nerves are associated with certain muscles and then the classic symptoms of paralysis show. Rarely, especially located tumors can cause this (such as neurinomas or meningiomas).

C5 syndrome - paralysis of the lateral arm lifting, abduction (deltoid)
C6 syndrome - paralysis of arm flexion (biceps)
C7 syndrome - paralysis of arm extension (triceps)

L4 syndrome - paralysis of knee extension (quadriceps)
L5-syndrome - paralysis of foot and big toe elevation (tibialis anterior and M. ext. Hallucis longus)
S1 syndrome - paralysis of foot lowering (gastrocnemius)

The picture shows a intraforaminal slipped disc. The red arrow indicates the incident, the nerve is not distinguished. The green arrow marks the well-viewable and free neighbouring spinal nerves.

Gait disturbances

Gait disturbances

Many disturbances in gait, fine motor skills but also to uncertainty in the use of knives and forks, weakness in arms and legs, loss of coordination, point to a spinal cord injury. This can have many causes, including circulatory disorders, as well as tumors, inflammation, instability and narrowing of the spinal canal can cause such problems.  The time course also plays a role. There acute changes may be interpreted as vascular, a slow emergence more as wear. A quick clarification of the causes can be done by an MRI.

MRI - Images of the cervical spine showing a narrowing of the spinal canal and compression of the spinal cord. Such images are oftenassociated with gait disturbances and paralysis.

Distance shortening, pain when walking, having to stand still

Distance shortening, pain when walking, having to stand still

A shortening of the distance, or pain when walking may have different causes. Classically it is the so-called intermittent claudication. There the circulatory in the legs forces the affected one to stop. Then it will be fine for a short distance (up to the next window). Another cause is the narrowing of the spinal canal, called spinal stenosis. The narrowing results in nerves being pressed, and thus a reaction with pain. A stopping alone is often not enough and the concerned person has to bend forward to relieve the spinal canal. In order to clarify between the so called neurogenic (spinal) and vascular (intermittent) claudication, a MRI or a CT can be done. In a spinal canal narrowing, it can be widened surgically. This is a very common operation with very good prospects of success.

Your symptom is missing or you have questions?

Share them in our online office hours or make an appointment in our practice.