Those aches and pains you feel when you think you've strained a muscle might be worthy of your attention.
Schoolteacher Kristen Garrison carried home a bag of heavy text books one day and she says, "I just started to feel a pain, you know, back on my shoulder blade, my right shoulder blade, a pain, you know -- like I maybe pulled a muscle.”
Within months, her right arm was completely numb. When her doctor ordered tests, Kristen was surprised by the findings.
She says, "The first thing he said was that there’s a mass, you know, in your spine.”
Dr. Greg Schucany says, "What she experienced, once we did the MRI, was a spontaneous hemorrhage into the spinal canal.”
Dr. Schucany says the veins in the spinal canal are susceptible to increases in blood pressure.
He says, "What happened was, she picked up this large bag of school books, it increased her blood pressure and these fragile veins ruptured.”
The pool of blood, called a hematoma, was pressing on a nerve that goes to Kristen's arm. Surgery to remove the blood could help prevent permanent damage.
“He said nerves do bruise," Kristen recalls. "And there’s a chance that it might have done a little bit of nerve damage and if that’s the case, you know, the ends of your fingers may always be numb.”
Because these types of hematomas often resolve on their own and Kristen was young and otherwise healthy, doctors decided to wait and do another MRI.
Dr. Schucany says, "We re-imaged this lady three weeks later and it was totally gone.”
As the hematoma dissolved, Kristen gradually regained feeling in her arm.
She says, “Just like opening a jar for the first time, that probably took about two or two-and-a-half months to totally feel like I was back to the way it was before.”
Hematomas like Kristen's are rare but Dr. Schucany says if you experience similar symptoms and you end up with severe pain and muscle weakness, see your doctor for tests.
Fast Facts:A rare cause of back pain is a hematoma, or collection of blood in the spinal space from a ruptured blood vessel. Researchers estimate spontaneous spinal hematomas occur in about one out of every one million people.
In the neck, a hematoma can cause sudden onset of pain that radiates down the arm, and numbness or weakness in the arm. Prompt medical consultation is important because in severe cases, a spinal hematoma can lead to paralysis within minutes to hours.
The spine is the long column of bones that supports the body and head. The area in the lower back is called the lumbar spine. The thoracic spine is the middle area and the cervical spine forms the neck. Bones, called vertebrae, are arranged like rungs on a ladder along the spinal column.
The spinal column encases a network of nerve fibers called the spinal cord. The spinal cord is covered with the dura mater, a fibrous membrane. A pair of spinal nerves runs from the spinal cord into the space between each of the vertebrae. Those nerves transmit sensory and motor information between the spinal cord and the rest of the body.
Spinal Epidural Hematoma and Sudden Neck Pain
A spinal epidural hematoma is a collection of blood that forms in the space between the dura mater and the inside of the spinal column. It occurs when a blood vessel ruptures or is broken, causing blood to leak out. The blood is trapped inside the spinal column and can press against the spinal cord or nerve roots.
Spinal epidural hematomas are most commonly associated with trauma to the spine, spinal surgery, administration of epidural anesthesia and spinal manipulation. Non-traumatic (spontaneous) epidural hematomas can occur, but are relatively rare. Researchers estimate spontaneous spinal epidural hematomas occur in about 1 out of every one million people. Patients who are taking blood thinners, have clotting disorders or blood diseases, like leukemia, appear to be at higher risk for the condition. But in many cases, the cause of the problem is unknown. Greg Schucany, M.D., a Diagnostic Radiologist at Baylor University Medical Center, says the problem can sometimes occur in some people when there is a sudden increase in blood pressure (like when lifting a heavy object) because the higher blood pressure can cause an unusually fragile vein in the spinal canal to rupture.
Signs of a spinal epidural hematoma vary according to the location of the pocket of blood and the area it compresses. Blood pooling in the lower back can cause numbness and weakness in the legs. In the neck, patients may experience a sudden onset of neck pain that radiates down the arm and numbness and/or weakness in the affected arm. In severe cases, the condition can lead to paralysis within minutes to hours. If the blood pools near the top of the spinal column, it can press against the nerves that help control the diaphragm, leading to breathing problems.
Diagnosing and Treating Sudden Neck Pain
Neck pain caused by a spinal epidural hematoma can often be confused with a herniated disc. However, MRI scans show the abnormal collection of blood pooling in the spinal column. Sometimes the blood will naturally be absorbed by the body. But when the symptoms are severe or progressive, or are causing significant weakness, surgery is recommended to remove the clot to prevent permanent damage.
Schucany says spinal hematomas are rare. Patients who experience sudden onset of pain or severe pain and muscle weakness should see a doctor for a medical evaluation.
Web ResourceAmerican Academy of Orthopaedic Surgeons, public Web site
For general information on neck pain: