[Donald Corenman, MD, DC]

#6007

Dysfunction is different than damage. The physiological disorders (inflammation) are reversible for the most part. Injury to the root is not.

You are correct as to why the nerve responds so well to steroids. The onset of symptoms is typically a quick compression or a “pinch” of the nerve from an abnormal motion (a flick of your neck in the wrong direction). This causes the root to swell and fit in the foramen even less well than prior to the pinch. Pain can continue until either the nerve naturally reduces the swelling or an epidural injection is used.

“Healing” of the nerve is really a reduction of inflammation. The narrowed nerve hole is still clogged up either with bone spur or with herniation and the pinch can probably occur again.

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.

[exercise453]

#6343

Hi Doc,

At c3-4 the report says left lateral extension with moderate neuroforaminal stenoses. I do believe it is symptomatic and as you said may be the underlying pathology of painful trigger points. I am confused about the c4 nerve root. It seems to be responsible for radiating into the shoulder via its connection to c5. It also is connected to the c1c2c3 complex radiating upwards. You mentioned the c3-4 facet in your explanation about the c2-3 facet.

Can the c4 root cause pain in both directions (up and down)?
Can it mimic c2-3 facet symptoms. When I press the posterior trigger points or turn slightly there is tingling in the ear.
Can facet pain move around (back-side-front)? Can nerve pain?
Can a c3 nerve be symptomatic even as 2 mri’’s say normal (it does look good)?

At c4-5 (ground zero)…mri posterior disc (wipes out most of the canal but does not touch the cord) and left lateral stenoses. A nerve report was +1 fib and +1psw and the neurologist wrote possible root dysfunction. There is no weakness, there are radicular symptoms.

Did I understand you that injured or dysfunctional roots will not recover even if freed?

Someday I’ll tell you the c7-t1 cubital tunnel saga.

As always thanks from a loyal reader and potential visitor.

[Donald Corenman, MD, DC]

#6346

The C4 nerve root can radiate pain to the top of the shoulder, the anterior chest wall and the base of the skull. It is not typically associated with headaches as headaches can be caused by the C2 and C3 nerves.

Compression of the C4 nerve can mimic facet pain at the C3-4 facet. Facet pain as well as nerve pain can radiate to different locations but only to the extent of the limit of those connections. For example, the C5 nerve can radiate as low as the top of the elbow but not further below that point as the elbow is the nerve’s maximum limit.

The C3 nerve can be affected by inflammation of the C2-3 facet.

Injured roots in the cervical spine can recover. In fact I would rather have a six month old motor weakness of the biceps to fix vs. a 6 month old weakness of the gastro-soleis group (calf muscle) to fix as the cervical nerve seems to be much more resilient than the lumbar nerve (due to the length of the nerve determining recovery).

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.

[exercise453]

#6695

Hello admired Dr and Person

I am wondering about your statement “The C3 nerve can be affected by inflammation of the C2-3 facet” which is my case is surely traumatically damaged. The mri looks and says normal. I do believe the nerve is “affected”. Besides pain I feel sensation in the ear when turning or pressing painful, swollen trigger points that seem to deflate and also nerve endings (?). It is a bumpy, atrophied(?) area. Sometimes I think the capsule is busted out (guessing). It is painful to turn in that direction…feeling blocked.

Medial branch blocks worked, but the radiofrequency minimally. I think the anesthetic dripped onto something. I realize now that cortisone and anesthetic was never injected into the facet, the doctor had said not for this condition, and went right to the medial branch, with radiofrequency in mind. The nerve was never considered at the time. I’m thinking that even though the medial branch is deadened successfully the inflammation remains. This inflammation then still affects nerves that affect the ear, ear area, side of face/head etc that do not transmit their symptoms through the medial branch but through the nerve and thus strong symptoms still remain (even with the medial branch muted).

Is that last statement correct?

What do you mean by the nerve affected?

Is it different than compressed and might it clear up if the inflammation is treated?

Should this facet have been treated with the facet being injected vs the medial branch and is this what you would recommend in the soon to be repeated pain management arena?

Thanks for what you are doing.

[exercise453]

#6696

Doc,

Also, on the website it says false positive if the injection is into the facet and there is a tear and it drips on other structures.

What other structures and what is the treatment then?

Thanks again

[Donald Corenman, MD, DC]

#6703

Medial branch blocks “numb” the small sensory nerve that supplys the nerve supply to the facet capsule. The amount of novocaine-like substance used to “numb” the nerve can vary. Another technique to determine if the joint is a pain generator is to inject the numbing agent diretly into the capsule. This is called a capsular block and functions to check if the medial branch blocks are successful (rules out a false positive).

The reason I believe that rhizotomies are not 100% effective is that the medial branch nerve does not always follow a normal anatomic path. Also the burn zone for the needle rhizotomy is not as large as the anesthetic zone from the intial block. A burn that misses the medial branch nerve will obviously not block the pain signal.

Also, a very degenerative facet creates pain from deep set “bone nerves”. If the pain is generated from the bone of the facet and not from the capsule, a rhizotomy will not be very effective.

Finally, if the pain is generated from the disc itself or from compression of the exiting nerve, a rhizotomy will be ineffective.

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.

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