Is it Fibromyalgia?

Viewing 6 posts - 1 through 6 (of 6 total)

Author

Posts
hrishikesh.ganu
Member

August 3, 2014 at 11:53 pm

Post count: 4
#11247
Hello Dr. Corneman, I’m a 34 year old male from India.
My history:
- Had mild 1/10 pain over c7 spinous process in late 2013 which went away quickly
- Used to feel stiffness in the mid cervical region while working in an awkward position: 2009
- Had left interscapular pain once in 2009 and then in 2010 which went away quickly in 1 day. The orthopaedic surgeon took an x ray and said there’s mild degeneration. No treatment required
- In 2014 Jan I had radiating pain 8/10 goung down to my left hand. A cervical MRI showed left paracentral extrusion of c56 disc and very mild bulge in c67 disc indenting the cal sac. It also showed mild central canal stenosis from c3-c6.( AP diameter in mid saggital plane was11.5mm at c56)
- I was advised conservative treatment and the radicular pain vanished in 15 days from onset. Since then I had mild 4/10 pain around the base of my neck for 6 months. There was no axial pain ( as in over the spine or in the actual neck-pain was around the base of the neck)
- On July 12 I was doing the wall angel kind of exercise on the vertical foam roller. Where you retract the scapula while touching your elbows to the ground while lying vertically on a foam roller. I heard a popping noise like there would be if both scapula sort of settled down on the foam roller. There was no pain at that instant
- I consulted another orthopedic surgeon this time who said that the pain in trapezius was neuropathic. Since 17th July I am on Gabapentin 100 mg per day and on paracetamol as required. I could bear the pain for 5 months without taking any medicine[Dr. had advised me to take medicine if the pain became unbearable]
My questions:
1. I am scared that this could be fibromyalgia. As of now I have tender points only in the mid trapezius bilaterally. Have no tenderness below the waist or near the anterior neck/clavicle
2. I have read that cervical trauma/herniation can more frequently lead to fibromyalgia than other injuries. Also, assuming that central sensitization has just started, can I do something to reverse it-like transcranial Direct Current Stimulation etc? I have heard that aggressive treatment early on helps.
3. I never had this bilateral pain for the first 5 -6 months till I did the exercise so my symptoms were consistent with left sided extrusion. Now I’m scared because the main symptom is bilateral trapezius pain and sometimes pain over c7 spinous process. I think it is related to central sensitization. Has this ever happened in your patients? By the way I have no radicular symptoms at all now
Donald Corenman, MD, DC
Moderator

August 4, 2014 at 10:01 pm

Post count: 8660

#11253

Fibromyalgia is a disorder that is associated with diffuse pain in all four quadrants of the body. There is no specific pain source such as a degenerative disc or a compressed nerve. Yes, Fibromyalgia can be triggered by a spinal disorder but this would be a rare event.

You do not have Fibromyalgia as noted by your history or current complaints. Most likely, you have a new herniated disc or a recurrent larger disc herniation at C5-6. A new MRI would be important to determine what the new source of your pain is. Probably an epidural steroid injection would be helpful both for diagnosis and relief of pain.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

hrishikesh.ganu
Member

August 13, 2014 at 11:24 pm

Post count: 4

#11281

Thank you for your response Dr.Corneman,I will get an MRI done as advised by you.
In the meanwhile my Orthopedic surgeon has given a diagnosis of:

Myofascial Pain Syndrome, Neuropathic Pain
MTrPs and tenderness trapezius, ant scalene, levator scapulae, left pectoralis, EDC

Sometimes I can feel the spasm in the muscle (cervical multifidi?) which seems to be pulling my c7 spinous process downward and then there is severe pain right on top of the c7 spinous process.

If I do any exercise for the back muscles they become stiff and start hurting. Especially the upper trapezius hurts a lot if I do any exercise. I’m pain free for 1/2 days and then again the trapezius and other back muscles start hurting-I can actually feel that they become very stiff when they hurt.
I have restricted ROM during neck rotation-it starts hurting towards end range on both sides

My questions:
1. If this is Myofascial pain, can it be because of my c5-6 herniation or c6-7 mild bulge?
2. What is the general prognosis for these conditions? I mean I don’t have radicular pain going into the arm now( it went away in 15 days) but could it be that the disc has still not healed and is causing this myofascial pain?
3. Will this myofascial/muscle pain go away if the discs are treated?

Donald Corenman, MD, DC
Moderator

August 18, 2014 at 2:30 am

Post count: 8660

#11286

Myofascial pain syndrome is a non-specific diagnosis that is only used when there are no other pain generators found. The disc disorders at C5-6 and C6-7 are most likely the cause of your pain. If so, this would not be called a myofascial syndrome but degenerative disc disease of the lower cervical spine referring pain into your shoulders.

Treatment would consist of a good rehab program, possible epidural injections, medications, chiropractic manipulation and activity restriction.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
hrishikesh.ganu
Member

December 22, 2014 at 6:46 pm

Post count: 4
#11910
Dr. Corenman,
Here are my symptoms now:
1. If I perform resistance training with theraband strapped to my head (movements only through the hip, forward, backwards and to the sides without moving from the neck or lumbar spine) my pain vanishes entirely ( 0/10 apart from some very minor stiffness) for a day
2. I perform these exercises on alternate days and if I miss doing it on some occasion I feel pain ( 2-3 /10) at the base of my neck on the posterior side in a narrow band between the c5 and c7 vertebrae ( I think I can identify c7 by its long spinous process?)
3. If I perform the exercise in #1, the pain again vanishes in like 45 min and does not appear for another day
I have already talked about my MRI report in some earlier posts but these are the canal dimensions:
- On the saggital view from MRI my calsac saggital diameter at c56 ( thsi is where the herniation is) is 7.3 mm
- On the axial view from MRI the max calsac diameter is 9 mm at c56
- Based on the X ray the AP diameter of the canal is 12.3 mm and the AP diamater of c6 vertebral body is 14.6 mm
My questions :
1. I was diagnosed as deficient in Vitamin D ( 25 OH levels of 5 ng/ml) on 11/14 and a bone densitometry showed T-scores of around -2.0 in the spine and femur and -2.5 in the hand.My serum Phosphorus, Calcium etc were all in the normal range. Diagnosis was “Osteomalacia”. After taking oral and injectable Cholecalciferol for a month my 25 OH level is 35ng/ml and Parathyroid Hormone level ( PTH) is also within limits. Could this deficiency be related to the pain?
2. As of now I am fine with performing the resistance training with theraband for my life if that is sufficient for me to be pain free. However wanted to know if there are any other tests that I should do/ Do you sense any other red flags based on the spinal canal dimensions and my initial low Vitamin D levels?
Donald Corenman, MD, DC
Moderator

December 23, 2014 at 6:48 pm

Post count: 8660

#11913

The canal diameter of 7.3mm is something to be concerned about. The cord itself is about 8mm wide. You must add the dura on either side (1mm each) and a rind of CSF (1mm each side) for a minimal diameter of 13mm.

The canal restriction of 7.3mm can lead to a spinal cord injury due to the fact that the canal can narrow even further with a forced extension (bending backwards blow to the head). This is called a central cord syndrome and you can investigate this disorder by finding it on this website.

The osteomalacia (Vit. D deficiency) needs to be addressed as you already have done. Your symptoms otherwise look to be well controlled.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
Author

Posts

Viewing 6 posts - 1 through 6 (of 6 total)

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel