Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1145
Clinical Information 271 CI
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006
"Speaking the Language of the Lawyer & Take a Quiz"
"Case-Numb feet/low back pain and possible Parkinson's"
Dr Studin: So what's going on?
Guest Doctor: I have a 62 year old male who came in with a complaint of mild low back pain with concurrent, spasm and tightness in the right calf and numbness and tingling intermittently in his feet.
Dr Studin: Top of the foot, the bottom of the foot?
Guest Dr: bottom of the foot.
Dr Studin: you know the difference L5S1 Go ahead.
Guest Dr: I did an examination on him, I found that muscle function a mild comb seemed good and dermatomes actually seemed good. I didn't find any numbness or tingling during my examination.
Dr Studin: So Motor and sensory are intact?
Guest Doctor: Yes.
Dr Studin: where's the pain?
Guest Doctor: Pain is low back.
Dr Studin: Is a specific rider or just generalized?
Guest Doctor: lumbosacral, more on left and right.
Dr Studin: What'd he have numbness on the right?
Guest Dr: Numbness bilaterally.
Dr Studin: is he diabetic?
Guest Dr: No. But he does have a pre-Parkinsonian.
Dr Studin: the next step is that Cigna had denied an MRI?
Guest Dr: Yes. So my question is am I jumping too fast to an MRI or should should I go with the x-ray first?
Dr Studin: No, The x ray will not tell you what's wrong with this person, do you do an EMG and do you think that it might be a diabetic issue or if it's Parkinsonian, then you really want to consult with an urologists to try to catch it early. Not that they're going to be able to do much with it. or is it a radicular type issue? But if you have motor and sensory intact, you might have to disparate morbidities one might be a low back, the typical mechanical low back issue, you have ridicular symptoms or signs, but you have on the bottom of both feet numbness, the first thing that came to my mind was the diabetic neuropathy. What can cause lower back problems, But he's got Parkinsonian issues and I don't know if numbness is Parkinsonian, there's no tremors or anything like that, so the first thing I would do is consult with The neurologist. Does he have a history or a Pre-Parkinsonian?
Guest Doctor: Pre-Parkinsonian, he's had a couple of MRIs of brain, he's on leave a Dopa. He's been to the neurologist already.
Dr Studin: You call that neurologist and have a conversation with him. Say this is the clinical presentation. Am I looking at two to morbidities right now? I know he's got mechanical spine issues, which is not a problem, but I've never heard of numbness at the a L5 dermatomes, at the bottom of both feet in Parkinson's. Is that a normal progression? I don't manage Parkinson's patients. So do I need to be concerned that there is a radicular component but motor and sensory intact. I'm not really going there so I want to discuss with you how to best manage this case and I think that that makes the most sense. So go get that information and then call me back and then we'll come up with a treatment plan together.