[45F] Experiencing a range of neurological and musculoskeletal symptoms

Patient Description

A 45-year-old female presents with a complex of symptoms including internal tremors upon waking, sharp upper middle back pain rated 7/10 that worsens when lying down and is most severe in the morning, and difficulty using arms and hands with reported stiffness in shoulders and occasional slow movement. These upper extremity symptoms are sometimes alleviated by a hot shower. The patient also reports night sweats, primarily on the chest, and has been experiencing blurred vision described as foggy with black floaters for 2-3 months. Additionally, there is a sensation of pins and needles in the feet, sometimes leading to numbness lasting up to an hour. The patient has a history of ulcerative colitis diagnosed 17 years ago and is currently on Entyvio, with no other medications or known drug allergies reported.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, several conditions could be considered:

  • Multiple Sclerosis (MS): This is a chronic disease that affects the central nervous system, especially the brain and spinal cord. It can cause a variety of symptoms, including difficulty with coordination and balance, muscle stiffness, and numbness or weakness in one or more limbs. The tingling sensation in your feet, difficulty using your arms and hands, and blurred vision could be indicative of this condition.

    • Diagnosis typically involves a neurological examination, MRI scans, and sometimes a spinal fluid analysis.
    • Treatment usually involves medications to manage symptoms and slow the progression of the disease.
  • Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Your back pain and the stiffness in your shoulders could be related to this condition.

    • Diagnosis is usually made based on a physical exam and a detailed medical history.
    • Treatment often involves a combination of medications, exercise, stress-management measures, and healthy lifestyle habits.
  • Peripheral Neuropathy: This condition results from damage to the peripheral nerves, often causing weakness, numbness, and pain, usually in your hands and feet. It could explain the tingling sensation in your feet and the difficulty you're having with your hands.

    • Diagnosis usually involves neurological examinations, nerve function tests, and blood tests.
    • Treatment typically focuses on managing the condition causing the neuropathy and relieving symptoms.

Please note that these are potential explanations based on the symptoms you've described, but only a healthcare professional can provide a definitive diagnosis.

What you can do

Given the range and severity of your symptoms, it's important that you seek medical attention as soon as possible. Here are a few steps you can take:

  1. Schedule an appointment with your primary care doctor. They can perform an initial evaluation and refer you to a specialist if necessary.
  2. Write down all your symptoms, even if they seem unrelated. This can help your doctor make a more accurate diagnosis.
  3. Keep track of what makes your symptoms better or worse. This information can be helpful for your doctor.
  4. Stay hydrated and maintain a balanced diet. This can help manage some of your symptoms and improve your overall health.

What you should look out for

Please seek immediate medical attention if you experience any of the following:

  • Sudden worsening of any of your symptoms
  • Difficulty breathing or shortness of breath
  • Severe pain
  • Loss of consciousness or confusion

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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11 mo ago

People Also Ask


What could be causing internal tremors upon waking?

Internal tremors upon waking can be caused by several conditions, including anxiety, stress, or neurological disorders such as Multiple Sclerosis (MS). It's important to discuss this symptom with a healthcare provider for a proper evaluation.


Why might I experience sharp upper middle back pain that worsens when lying down?

Sharp upper middle back pain that worsens when lying down could be related to musculoskeletal issues, such as poor posture or fibromyalgia, or it could be a sign of a more serious condition affecting the spine or nerves. A medical evaluation is necessary to determine the exact cause.


What are possible reasons for blurred vision with black floaters?

Blurred vision with black floaters can be due to various eye conditions, such as vitreous detachment or more serious issues like retinal detachment. It can also be associated with neurological conditions like MS. An eye examination by an ophthalmologist is recommended.


How can night sweats be related to my current symptoms?

Night sweats can be related to hormonal changes, infections, or chronic conditions such as autoimmune disorders. They may also be linked to neurological conditions that affect the body's temperature regulation. Discussing this symptom with a doctor can help identify the underlying cause.


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