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What Causes Unsteady Gait, Temperature Change In Leg And Shoulder?

Posted on Sat, 13 Dec 2014

Question: Hello,

I am curious for your opinion on some issues that I have been experiencing. First, I am a type 1 diabetic for 39 years now. Otherthan hypothyroid disease which I take medication for, I essentially have no other side effects from diabetes; eyes are good, kidney tests all good, bllod pressure, etc., all good. I did experience a hearniated disc 5 years (C6/C7) that resulted in a fusion.

About two years ago I started having a cold burning feeling in my right arm and right calf. I also had an unsteady gait if you will. I guess I lost confidence that my legs were tracking with my brain; although I have never fallen. About a year later, I started having a warm burning feeling in my right calf and left shoulder. During this time my doctor started with normal blood tests, physical therapy, etc., and ultimately sent me to a neurologist who had an MRI done (w/dye) on brain and all of back. It was discovered that the disc between C5/C6 had herniated and was presssing on spine. All other brain visuals for MS were normal. This lead to more physical therapy and ultiamately a fusion with an artificial disc placed. This was about 8 weeks ago. Two xrays since both show a successful surgery.

Today, I still have the same cold burning feelings, random feelings (warm and cold) in right leg and shoulder, and unsteady gait at times. I am worried that the surgery has not produced any relief. Could I be suffering from some other neurological disease?

Answered by Dr. Rakesh Madhyastha (40 minutes later)

Brief Answer:
Give it some time

Detailed Answer:
Hello

Thanks for the query

The history what you have given is very typical of a herniated disc and more over you have undergone treatment for the same.
The nerve compression at c5/c6 must have been a chronic one, patients usually take prolonged time to get better. Sometimes even upto 16 weeks, I recommend that you continue with your physical therapy

With the background of type 1 diabetes mellitus, a very close differential diagnosis would be peripheral neuropathy, if the symptoms do not regress I suggest you to undergo a nerve conduction study to know the effective functioning of the peripheral nerves. But it is less likely as most of the times it starts from the peripheries like feet and hands before progressing to the arms

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (1 hour later)

Thanks. I dont recall the surgeon calling the herniation severe or chronic but it was definitely hitting the chord as the white space around the chord at that veribrae was not showing.

I had instant pain relief from the first fusion C6/C7 but this surgery hasnt made any difference on the cold burning feelings as of yet. Again, this herniation didnt produce pain, just cold burning in my right arm and right leg along with warm (and sometimes cold burning) in my left calf and shoulder. What throws me is the fact it is impacting my calfs which you would think be associated with problems in the lumbar not cervical area.

I have been wondering about things like Raynauds, Lupus, GPS, Hashimotos, Lyme Disease, etc. as they all produce neurological sysmtoms as well.

Answered by Dr. Rakesh Madhyastha (14 hours later)

Brief Answer:
It is related to the cervical

Detailed Answer:
Hello

Thanks for getting back, I am sorry for the short delay in my reply I just got back from the hospital

It is not true that only lesions of the lumbar region causes pain in the calf muscles , lesions anywhere from lumbar and above it including lesions of the brain can cause pain in the muscles below the level of the lesions.
The reason why tingling is still present is because sometimes sensory nerves take longer than the motor nerves to get repaired.
The conditions you have listed do not have this typical one sided affection of the nervous system , they are most often bilateral and acute in condition.

You could ask your doctor to add tab pregabalin at night for symptomatic relief

I am once again sorry for the delay

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (3 hours later)

Thanks.

I did not know that cervical issues could cause lower extremity problems.

The only other point I would make to your reply is that my continued symptoms since the surgery are not one sided, they include cold burning in the right tricep and forearm area, cold burning in the back of my right calf. and, although not as prevalent, I have occasional warm feelings in the back of my left calf and an occasional numbness/warm feeling in the back of my left shoulder. In addition, the un-confident gait. This is why I continue to wonder if there could be something else causing these symtoms.

Thanks again for your reply.

Answered by Dr. Rakesh Madhyastha (9 hours later)

Brief Answer:
Posterior column involvement

Detailed Answer:
Hello

Thanks for getting and also clarifying.

There is a special zone in the spinal cord known as the posterior column, this column is involved in joint position sense, it takes care of positioning of the joint while walking. If this area was compressed then it results in unsteady and difficult gait.

I recommend you to undergo nerve conduction study for the sensory symptoms, if it comes back as normal then it is most likely the cervical issue which has lead to the sensory symptoms as well

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar