Numbness and tingling after a car accident can be a sign of something very serious! Don’t miss the warning signs!
After getting whiplash, individuals often complain of discomfort in the neck followed by stiffness, tenderness, and pain while moving the neck. In most cases, the pain is stronger a few days after the accident. Individuals who suffered more serious injuries, besides the above mentioned symptoms, complain about pain radiating towards the head and shoulders, down the arms, and sometimes even to the fingers. Pain radiation is often combined with tingling and numbness in the same areas, loss of strength in the arms and hands, etc. 1 It indicates that there has been an injury of a nerve root, a nerve itself, or that the surrounding tissues (vertebra, ligaments, spinal disc, etc.) are in direct contact with nerve root or nerve and are irritating it. Spinal nerves originate from the spine and their roots are located near the spine, so any spine injury can cause nerve root injury. The most common causes of radiculopathy symptoms after an accident are disc bulges, disc protrusion, overstretching of the nerve root or nerve, contusion of the spinal cord, etc.
Another commonly injured area in car accidents is the lower back. The mechanism of injury is the same as in a whiplash injury (a combination of sudden flexion and extension), but there are also many individuals who suffer a direct blow to the lower back. In those cases, the most commonly injured structures are the lower back muscles, ligaments, nerves, small spine joints, etc. Car accident victims usually complain about lower back pain, stiffness, and tenderness. In the case of more severe injuries, the person will have pain radiation to the buttocks or down the legs, usually in combination with tingling, numbness, loss of strength, etc.
After the accident, an ambulance usually arrives on the scene within a few minutes, and paramedics provide first aid to the individuals involved in a car accident. If the patient complains about pain radiation down the arms or legs, then the spine should be immobilized. Usually a combination of a cervical collar and a long backboard (LBB) are used for spine immobilization, with the main goal being to reduce spine and neck movements in order to lessen the chance of further damage during the transport to the hospital.
After being transported to the nearest emergency room, the patient is fully evaluated. Many people decline to be transfered to the emergency room because they believe they have sustained only minor injuries, and as a result, are fine. However, they usually return to the hospital after a few days after their pain and symptoms worsen.
In most cases, the examiner will examine the patient in the emergency room to try to find red flags which indicate a possible major nerve injury. A good examiner will look at the patient as a whole and not only focus on the injured areas. One of the best protocols for a suspected spinal cord injury is provided by the American Spinal Injury Association (ASIA), which covers whole body examination guidelines and contains a number of tests to use to determine whether there is a spinal cord injury. The examiner should test sensory function, motor strength, and the level and the extent of injury. 2 The examination usually reveals tenderness at the injured site, painful spasm of the paraspinal muscles, and restricted range of motion. The examiner will conduct a number of tests which can detect a possible major injury. The examination is then usually followed by X-rays, which must be ordered by an ER doctor. X-rays are the most common imaging technique used after car accidents, and they are analyzed by radiologist, who tries to find possible signs of injury (broken bones, misalignment of vertebral bodies, changes of normal spinal curves, dislocation of bone, etc.). In most cases, if the X-ray doesn’t show any injury, the patient is released and allowed to go home.
X-rays are a great diagnostic tool for detecting bone injuries like fractures or dislocations. However, they can’t detect soft tissue injuries. MRIs are a lot more sensitive in detecting soft tissue injuries like sprains, strains, ligament tears, contusions, disc bulges, spinal cord injuries, nerve or nerve root injuries, etc. Any patient presenting with the symptoms of a nerve injury (such as tingling, numbness, pain radiation, loss of strength, etc.) should undergo an MRI to detect possible injury, even if their X-rays are normal. 3
Every hospital should have a protocol in place for trauma patients. Most protocols require pathological findings on an X-ray or CT in order to necessitate a further MRI. But many protocols also require an MRI in case of neurological symptoms. 4
If the person complains of tingling, numbness, pain radiation to the extremities, or loss of strength in the extremities, he/she should be taken seriously as these symptoms occur in radiculopathy, also known as a pinched nerve. Pinched nerves occur in cases where the nerve or nerve roots are compressed following an injury. 5 Any tissue located near the nerve (such as bone, cartilage, muscles, tendons, ligaments, spinal disc, etc.) can cause compression. One of the most common causes of a pinched nerve after an accident is a herniated disc.
Symptoms similar to a pinched nerve can be caused by spinal stenosis, which is a narrowing of the spinal canal located inside the spine. This narrowing is usually caused by bone overgrowth. However, it can also be caused by a disc bulge after an accident. Bulged discs will compress the spinal cord or nerve roots and cause symptoms like tingling, numbness, loss of strength, pain radiation down the extremities, and in severe cases, even paralysis. 6
Stretching during the car accident exerts enough force to cause the nerve roots located in the neck or lower back to stretch, resulting in radiculopathy.
It is very important to determine the extent of injury and to locate the site of injury, as treatment methods depend mostly on the type of injury. If the person has the symptoms of a pinched nerve, he/she should visit their physician and ask for a referral to a physical therapy specialist, orthopedic surgeon, or neurologist.
If the specialist suspects that there is even that slightest chance that the patient has a nerve injury, they will most likely ask for an MRI of the injured area. MRIs are great diagnostic tools for detecting soft tissue injuries, including nerve injuries. They can detect nerve root injuries, spinal disc herniation, ligament or muscle injuries, etc. 7
In the event that you experience numbness, tingling, pain radiation or loss of strength, it can indicate a possible nerve root injury, and you can insist on an MRI.
The MRI findings will have a significant impact on future treatment methods. In the case of no visible nerve injury or minor injury, the patient will undergo an intensive physical therapy treatment. Also, many patients undergo acupuncture or chiropractic treatment after their accidents. These treatments can last for weeks or even months, depending on the severity of injury.
Neurologists often recommend an electromyoneurography (EMNG) study, which can detect even the smallest changes in nerves after the accident. EMNG is also known as a nerve conduction velocity test, and it is used to examine nerve activity. In the event of any nerve problems, there will be changes in the conduction of impulses down the nerve, which are detectable by EMNG.
The timing of treatment plays a very important role in the management of nerve root injuries. Patients who start treatment early have a significantly higher chance of healing than patients who delay in obtaining treatment or who don’t seek or receive any treatment at all. 8
If you don’t treat your nerve injury in time, you will probably have problems related to it (periodic or constant numbness, tingling, etc.) for the rest of your life .
In conclusion, many people suffer major nerve injuries but don’t seek medical attention because they think their symptoms are not that serious. Some of the most common symptoms they may experience are tingling and numbness in their extremities, which occur often after a car accident and can indicate a serious injury. So, if you were involved in a car accident and suffer from numbness or tingling, it is best to visit your doctor for a thorough examination.
References:
1. Ioppolo, F. and Rizzo, R. (2014). Epidemiology of Whiplash-Associated Disorders. Whiplash Injuries, pp.13-16.
2. “Spinal Cord Injuries Clinical Presentation: History And Physical Examination.” Emedicine.medscape.com. N. p., 2018. Web. 6 June 2018.
3. Radiologic Evaluation of Chronic Neck Pain, Richard H. Daffner, Am Fam Physician. 2010 Oct 15;82(8):959-964.)
4. “MRI In Acute Spinal Trauma.” Appliedradiology.com. N. p., 2018. Web. 6 June 2018. So, if you have loss of strength, tingling or numbness you should insist on MRI.
5. Cervical Radiculopathy (Pinched Nerve), Ian Rodway, June 2015, the American Academy of Orthopaedic Surgeons).
6. “Spinal Cord Injuries Clinical Presentation: History And Physical Examination.” Emedicine.medscape.com. N. p., 2018. Web. 6 June 2018.
7. Imaging after trauma to the neck, Bernard Wee, John H Reynolds, and Anthony Bleetman, BMJ. 2008 Jan 19; 336(7636): 154–157.doi: 10.1136/bmj.39433.663715.BE
8. Caridi, John M., Matthias Pumberger, and Alexander P. Hughes. “Cervical Radiculopathy: A Review.” HSS Journal 7.3 (2011): 265-272. Web. 6 June 2018.