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Hello, in August, I fell on a wet sidewalk in

DOCTOR OF THE MONTH - Apr 2013
Apr 2013
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General Surgeon
Practicing since : 2008
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Hello, in August, I fell on a wet sidewalk in Switzerland and landed very hard on my butt. I felt a surge go up my spine and into my head, and had a headache after. I flew back to the USA a few days after, still with an aching back/tailbone. At first, it hurt to wipe after I went poop, like pressing up with the toilet paper was hurting my spine or something. That pain is no longer there. I went to an urgent care center a few months ago and was told there was no nerve problems and it was probably just bruised. The pain was at first mostly in the center, but it started to migrate toward the right, in a straight horizontal line from about an inch above my butt crack. At first, it hurt a lot to go over bumps in the road in the car. Still, when I drive, I feel pain on the right side of my lower back when I use my foot on the pedals. Sitting up straight, especially on hard surfaces (like on bus or airplane chairs), is also painful. In October, I was back in Europe, and again fell on my butt, on a hard marble surface; I got a big bruise. I went back to the urgent care when I returned to XXXXXXX and said I was still in pain. I got x-rays, which apparently show nothing alarming. I am constipated, which also showed a lot on the x-ray I got done a few weeks ago. They keep telling me it's probably a deep bruise on my tailbone. I took laxatives but it hasn't helped much. I feel that when I try to do Kegel's it aggravates my lower back/spine pain too. When I was last examined, I felt it less when the PA touched my right leg than when she touched my left. I was prescribed steroids and naproxen after my x-rays, which helped, but now the five days of steroids are over and the pain is still there. I have done acupuncture three times, but the pain did not go away. In the past few days, I have also felt it on the left side. It hasn't really bothered me walking around or swimming. However, after vigorous exercise (e.g. jumping and dancing at Zumba), it would hurt more after. Last night, I was nearly in a car accident. A driver in a red sports car was speeding toward me and I slammed on by breaks; thankfully we did not collide. Since then, my back hurts more. I went to sleep with a heating pad on but woke up in the middle of the night and it still hurt. My pain is moderate, but worse than before. I am also now experiencing tingling in my hands. I am very worried something is seriously wrong. Could I have cauda equina syndrome? Thank you!!!
Posted Sat, 2 Dec 2017 in Lump
 
 
Answered by Dr. Ivan R. Rommstein 1 hour later
Brief Answer:
MRI required

Detailed Answer:
Hi and welcome.

Well, tailbone injuries, even if there is no fracture visible, may be very complex and lead to long recovery. PAin may persist for several months and certain neurologic symptoms may occur. However, in most cases this is self limiting and should improve over the time. Hand numbness should not be related to this injury since proximal spine injuries may affect nerves which innervate arms.

But there is obviously affection of paravertebral and para sacral muscles and nerve roots. I dont think this is cauda equina sy since this would be associated with other symptoms beside pain (sexual dysfunction, bladder dysfunction,sciatgiac and numbness in perianal area). But blunt muscle-neural trauma may lead to prolonged pain in this area especially after exercise. It is possible that hematoma developed around coccigeal bone or sacrum, or less common inside dural sac, but the only way to rule this out is to do MRI scan.

But, even if something is found, there is no some specific treatment except, rest, painkillers and some orthopedic therapy (hydrotherapy, therapeutic ultrasound or acupuncture).
Constipation may sometimes be related to such injuries, but usually occur when there is coccigeal fracture or rectal wall damage. I dont think this is your case, but psychosomatic influence of pain on defecation may be present.

Your repeated injury can definitely worsen symptoms and I suggest to wait for 1.2 weeks more to see if pain will subside and then do MRI scan if possible.

Wish you good health. Regards
Above answer was peer-reviewed by
 
Follow-up: Hello, in August, I fell on a wet sidewalk in 3 days later
Thanks! What does this mean? there is obviously affection of paravertebral and para sacral muscles and nerve roots.
 
 
Answered by Dr. Ivan R. Rommstein 23 hours later
Brief Answer:
follow-up consultation

Detailed Answer:
Hi,

Well, it means that there was a blunt injury to muscles and nerves around the sacral and lumbar spine. In such cases, muscles may swell and press nerve roots. This is a temporary condition and it heals spontaneously over few weeks. Sometimes if ligaments around spine are damaged, this recovery may persist for more months. but in every case, it should not be something serious.

Let me know if I can assist you further.
Regards

Above answer was peer-reviewed by
 
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