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Having spinal arthritis and undergone back surgeries. Extreme pain in hands and numbness in fingers. Worried about multiple sclerosis?

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Practicing since : 2005
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Hello Doctor.I am a 59 year old female who has a long history of spinal arthritis with 4 back surgeries with instrumentation.8 months ago I developed extreme pain in both hands and forearms and numbness in my fingers and toes.For many years I have have had vague symptoms of MS and this has been mentioned a few times but never followed up on.I have had 2 episodes in the past 17 years of severe ataxia and vomiting (no specific dx.)I have had scintillating scotomas but no headache.I am being treated for chronic back pain.My hands have become clumsy to use and very painful.I have widespread inflammation,rashes,frequent tendonitis and bursitis over the years.I have severe faigue every afternoon.My balance is off at times and with any exertion I perspire profusely. I cannot tolerate the heat at all.I am becoming very concerned about the possibility of MS as I can barely do what I need to due during the day.Does this sound like MS to you?I have an apt with a neurologist in 1 month.Thank you very much.
Posted Sun, 8 Sep 2013 in Multiple Sclerosis
Answered by Dr. Prasad 3 hours later

Thanks for discussing your concerns here.

symptoms considerably overlap between symptoms of other functional condition, diagnosis multiple sclerosis is always challenging to any physician. Accordingly though you have reported typical symptoms of MS and in all circumstances the symptoms represent it, without neuroimaging and ophthalmoloscopic findings it is too precocious to suggest MS.

I am glad you have planned a neurologist appointment. Discuss with the neurologist and ask for MRI brain (plain and contrast) and ophthalmoscope examination of eyes. If any suspected finding is found, he/she will proceed with further testing (CSF analysis) as well as blood test to confirm MS.

In brief, yes the symptoms seem to be representing MS. However I would bet my money on other conditions than MS right now.

Hope this helps. Let me know if you need clarification.

Above answer was peer-reviewed by
Follow-up: Having spinal arthritis and undergone back surgeries. Extreme pain in hands and numbness in fingers. Worried about multiple sclerosis? 15 hours later
Thank you so much for answering my question.My O.T. and P.T. recommended that I see both a rheumatologist and neurologist as they seem my condition may have a "systemic origin" I have been dx with Dequervain's tendonitis bilaterally,also bilateral carpal tunnel and bilateral radial flexor tendonitis.I have had injections in both hands without much relief but a week of prednisone did give me quite a bit of relief.Could my symptoms be related to an autoimmune disorder or could all of this be related to the history of my back problems?
thank you for your help.
Answered by Dr. Prasad 7 hours later
Brief Answer:
Systemic condition needs to be considered

Detailed Answer:
To explain,

1. As I described earlier, MS is a condition of exclusion and extensive evaluation is in order. Blood test to look at your thyroid hormones, blood sugar, calcium as well as lupus, XXXXXXX and antiphospholipid antibody are part of MS evaluation. I am sure your neurologist will consider these tests. A rheumatology referral at the earliest will be suggested as per the vasculitis work up (lupus, XXXXXXX and antiphospholipid antibody test results).

2. Back problems does cause neuralgic pain and can sometimes be misinterpreted as tendinitis. However if the nature and intensity of pain is almost identical bilaterally then it is less likely to be related to spine arthritis/back surgeries.

3. Further I do not see bilateral tendinitis where the cause is stress and strain induced with identical set of pain. Systemic condition either organic or functional would be my first impression. Local steroid injections have no role in such systemic condition.

In brief, I feel all your symptoms need to be relooked. Discuss about all these when you see the neurologist next month. Let your treatment start afresh.

Hope this helped. I will be glad to discuss further if you have any more concerns.
If all your questions are attended to your satisfaction, please close this discussion.

Good luck!!
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