[drtspike]

#7210

Over the past 2 years I started developing “knots” on top of my shoulders (feels to be in the scalenes) and on both sides of my spine where the shoulder blade “meets” the spine. I had regular deep tissue massages but they’d come back then next day. (I can literally hear them “rolling” around when I stretch my arms up). It feels as if my shoulders are constantly being drawn to my neck (also has shortened my neck height). Based on my Googling, I thought it could be TMJ, but finally went to orthopedic surgeon, had X-rays and MRI. The only abnormality was a slight disc herniation between C6/C7. He referred me to a spinal surgeon, but he wasn’t worried at that time since I had 100% strength, so referred me to physical therapy. Coincidentally, I woke up one morning and my left shoulder was literally “stuck” in an elevatated position (imagine it was naturally trying to make contact with my ear). This may have been caused due to my natural twisted-side sleeping position, or the previous day’s workout (was doing heavy shrugs and trap raises). I happened to have an appointment with the physical therapist a couple days after, and he extensively investigated, and said it was textbook C7 nerve pinch since my left tricep strength was virtually gone and had extreme pain on the left side of my neck. I also lost ability to rotate my left arm (could barely open a door) and my thumb, index finger, and middle finger were numb. I got referred back to the spinal surgeon, he referred me to EMG, and the tests showed the same (loss of nerve signal in my left tricep and forearm).

Avoiding surgery, time passed and symptoms remained constant for about a month, then started to get better. I decided to visit a chiropractor, and have been seeing him for about 2 months with 3 adjustments/week for the first 3 weeks, and 2 adjustments/week through today. Now, the pain is gone, the strength is much better, and only my index finger has a faint numbness in the very tip. The chiropractor has measured increased mobility in my neck and increased grip strength. However, the original discomforting “knots” are the same as the beginning, I have tightness/pain that runs from my left tricep down the left side of my abdomen when I do an overhead tricep stretch. I can also feel “fibrous” knots the sides of my shoulder blades under my armpit area. I also have tightness in the front my neck that runs up to my jaws. When I attempt to do very light workouts, it aggravates it and I lose some strength in my left arm again, but it comes back quickly.

It was diagnosed as “acute” but I don’t believe it’s due to a single incident, and that other strength tests by my chiropractor show that neighboring discs are also affected. Things I can think of that are the root cause are: my poor respiratory strength (had bad asthma growing up), poor sleeping position, poor general posture, and/or sitting at the computer. When I sleep on my side, my shoulder blade “juts out” at a single point, and this is exactly the location where the “knot” is symmetrically on both sides, but do not know if this is causing all the problems. Lately I have been very conscious of my posture and sitting positions and have been doing neck stretches, etc, but the discomfort/tightness is still there. I alos noticed what looks like bruises at the shoulder blade “jutting out” locations (equal on both sides), but I’m not sure if that from my bad habit of me massaging/pressing on that area throughout the day with my fingers.

I basically want to get another opinion of what the best path forward is (surgery, chiropractic, PT, etc). Are the “knots” causing the problem, or are they a result of specifically the C6/C7 disc herniation? Could my sleeping position be to blame; if so, if I correct this will the disc heal itself?

Thanks for any help with this.

Dave

[Donald Corenman, MD, DC]

#7214

Your description of a “slight disc hernation” at C6-7 does not fit with the pain and motor weakness that you describe. I assume that there is a substantial herniation or something else is causing these symptoms (Parsonage Turner syndrome or the like).

Shoulder muscle contraction is typically related to disc herniations but there are many other disorders that can cause these contractions. I am concerned that the physical therapist found significant muscle weakness of the trapezius. When you note decreased strength with workouts “I attempt to do very light workouts, it aggravates it and I lose some strength in my left arm again”, this is an indication that the strength in the arm is still significantly poor. A muscle that has lost much of its nerve supply may seem strong initially but will fatigue quickly.

Grip strength involves the C8 nerve which is not involved here. Measuring grip strength will not indicate anything about the health of the C7 nerve. I am unclear about; “other strength tests by my chiropractor show that neighboring discs are also affected” as this would be unlikely.

You need to find a well qualified, meticulous and experienced spine surgeon to give you an opinion. Bring all your studies with you to that visit.

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.

[drtspike]

#7219

Dr. Corenman,

Thanks for the response. The other strength loss I was referring to was the ability to keep my fingers spread out, and keeping my fingers bent 90° pointing downward against resistance. Also, my grip strength was indeed reduced as well.

The spinal surgeon I have been seeing was not advising surgery after the first MRI, but then I suddenly lost strength and he was leaning towards surgery because of my young age (25). After about 1 month my tricep weakness started to get better and the pain/numbness decreased (still faint numbness in my index finger), so he said to wait (follow-up appointment in 1 month). However, the most bothersome symptom is the tightness in the shoulders/neck–sometimes radiating to the throat/jaws.

In your opinion does this sound like a case for disc replacement? I have been sent overseas as an expat for 1 year, so I’d need to start conversations with my employer for time back in the states–I’d imagine it would take quite some time to establish visits hypothetically leading up to the surgery.

Thanks again,

Dave

[Donald Corenman, MD, DC]

#7225

Keeping the fingers spread out are normally the interosseous muscles (C8). Keeping the fingers bent 90 degrees against resistance is also normally C8 (FDP). Weakness in these two motor groups will certainly cause grip strength loss. There are patients who are “wired funny” and have contributions from the C7 root which can cause grip weakness.

If you really want to know if the C7 root compression is causing most of your symptoms, consideration needs to be given to a diagnostic SNRB (selective nerve root block). See the website for description of the block and how to keep a pain diary.

An artificial disc replacement may be indicated as long as the disc space is not severely degenerated. If the insurance company will not approve of an ADR or the disc is too degenerated, a one level ACDF will work very well and you will not notice the difference postoperatively.

It should not take too long to schedule a surgery when you get back to the States. I do think an SNRB would be very helpful to make sure the diagnosis is accurate.

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.

[drtspike]

#8010

Dr. Corenman,

I had posterior microdiscectomy to decompress the left C7 nerve root last week. All went well with the operation (very thankful), and I feel confident in my recovery. The surgeon did a great job, and said it’s now a waiting game (should be improving in the next 3 -4 weeks). Just wanted to get your thoughts on my current state and make sure all is normal and on the way to recovery:

-The acute numbness in my left index finger is the exact same (constant for the past 6 months)
-The knots/spasms (I’ve had for over a year) on both sides of my neck felt like they were on FIRE right after surgery, and now they have “shooting” pains when I turn my head slightly (either direction)
-Wake up a few times with pain in left calf (never felt before)–could this be tied at all?
-When sitting, sometimes get fast/repetitive twitching under the left shoulder blade

Please let me know your thoughts if these are signs of the nerve “coming back.”

Many thanks,

Dave

[Donald Corenman, MD, DC]

#8045

After a decompression, numbness can take some time (up to six months) to recede. The local neck pain is very common after a foraminotomy and can take up to three months to recede.

Left calf pain has to have attention paid to it as the chance of a DVT (deep venous thrombosis) is low but must be ruled out after a surgical experience.

How is your weakness? With a good decompression, the weakness should be much better.

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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