Comprehensive Evaluation for Persistent Nerve and Muscle Symptoms

May I ask about a single examination?

Hello, Doctor: I am an office worker who spends most of the day sitting in front of a computer and rarely exercises.
I've been experiencing symptoms for about a year, and since I haven't received treatment, my condition has worsened.
For the past five months, I have been seeing doctors frequently, and currently, both of my legs are numb all day.
Sometimes, I feel sharp pains in various areas, and there are painful points on both sides of my lumbar spine.
Occasionally, I experience soreness in my buttocks and thighs, and the muscles around my hip joints feel very tight.
Sitting or lying down is even more uncomfortable.
Recently, I've also been experiencing blurriness and discomfort in my left eye for the past two months, and despite seeing doctors, there has been no improvement.
X-rays and MRIs of my lumbar spine from the orthopedic department have shown normal results.
What specialty should I consult next? I understand that only large hospitals have the necessary equipment for examinations, but each specialty operates independently and requires gradual, localized assessments.
Taking time off work for these appointments is stressful and exhausting, and I feel like I'm not receiving adequate treatment.
Is there a place where I can undergo a comprehensive examination all at once? Thank you.
P.S.
My blood pressure has been quite high recently, averaging 140/95 daily.

Xiao B, 30~39 year old female. Ask Date: 2009/02/08

Dr. Lin Zijing reply Neurology

Normal lumbar spine X-rays and MRIs can differentiate between intervertebral disc and lumbar spine lesions.
Therefore, it is important to consider lower pathologies such as piriformis syndrome, which may arise from piriformis injury, inflammation, overuse, or hemorrhage.
Nearby tumors can also compress the sciatic nerve, leading to symptoms of buttock pain that far exceed lower back pain.
This is because the sciatic nerve exits the buttock and travels down into the leg, passing just beneath the piriformis muscle.
If this muscle is inflamed or swollen, it may compress the sciatic nerve, resulting in numbness or pain in the thigh.
Current treatment primarily involves conservative measures, such as one to two local steroid injections combined with local anesthetics, shortwave or ultrasound deep heat therapy, along with stretching exercises for the piriformis muscle.
It is recommended that you consult a rehabilitation specialist for further evaluation and treatment.

Reply Date: 2009/02/08

More Info

Hello! Thank you for sharing your concerns regarding your persistent nerve and muscle symptoms. Based on your description, it sounds like you have been experiencing a range of troubling symptoms for about a year, including persistent numbness in your legs, occasional sharp pains, tightness in your hip muscles, and discomfort in your lower back. Additionally, you mentioned experiencing visual disturbances in your left eye for the past two months.
Given the complexity of your symptoms and the fact that you have already undergone various imaging studies (like X-rays and MRI) that returned normal results, it is understandable that you feel frustrated and overwhelmed. The interplay of your symptoms suggests that there may be multiple factors at play, including potential nerve compression, muscle tension, or even systemic issues that could be contributing to your discomfort.

Next Steps for Evaluation
1. Neurology Consultation: Since you are experiencing nerve-related symptoms (numbness, tingling, and pain), a consultation with a neurologist would be beneficial. Neurologists specialize in diagnosing and treating conditions related to the nervous system, and they can perform specific tests such as electromyography (EMG) and nerve conduction studies to assess the function of your nerves and muscles.

2. Rheumatology Assessment: If your symptoms suggest an autoimmune or inflammatory component, a rheumatologist can evaluate you for conditions like fibromyalgia, rheumatoid arthritis, or other connective tissue disorders. These conditions can manifest with widespread pain and neurological symptoms.

3. Physical Medicine and Rehabilitation (PM&R): A PM&R specialist, also known as a physiatrist, can provide a comprehensive approach to your symptoms. They can assess your functional abilities, recommend physical therapy, and help manage pain through various modalities.

4. Multidisciplinary Pain Management Clinic: Some hospitals have multidisciplinary pain management clinics where a team of specialists (including neurologists, physiatrists, pain specialists, and psychologists) work together to evaluate and treat chronic pain conditions. This could be an ideal setting for you, as it allows for a more holistic approach to your symptoms.

5. Lifestyle Modifications: Given your sedentary lifestyle as a desk worker, incorporating regular physical activity could significantly benefit your overall health. Simple changes, such as taking short breaks to stretch, walking during lunch, or engaging in light exercises, can improve circulation and reduce muscle tension.

6. Stress Management: Since you mentioned feeling overwhelmed and stressed due to your symptoms and the need for multiple appointments, consider exploring stress management techniques. Mindfulness, yoga, or cognitive-behavioral therapy (CBT) can help you cope with the psychological aspects of chronic pain.

Monitoring Blood Pressure
You also noted that your blood pressure has been elevated (averaging 140/95). It is important to monitor this closely, as chronic high blood pressure can lead to further health complications. Discussing this with your primary care physician is essential, as they may recommend lifestyle changes or medication to help manage your blood pressure.

Conclusion
In summary, I recommend seeking a comprehensive evaluation from a neurologist, and potentially a rheumatologist or a PM&R specialist, to address your symptoms more effectively. A multidisciplinary approach may provide you with the thorough assessment and treatment plan you need. Remember, it’s important to advocate for your health and seek out the care that addresses all aspects of your well-being. Don't hesitate to ask your healthcare providers about the best course of action and any additional tests that may be necessary. Wishing you the best in your journey towards better health!

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