fmfabbriMemberJune 15, 2012 at 8:54 amPost count: 2
Dear Dr Corenman,
Thank you very much for your website. I have learnt a whole bunch from it, and also from your replies in the forum. I was hoping you were kind enough to help me make a good decision based on the results of my MRI.
Here is how it happened: About 6 weeks ago, I woke up with intense pain in my left arm (triceps). As I’ve played all kind of sports all my life (rugby, soccer, tennis, squash, bicycling), the first thought was that I had damage in the triceps. This was strange because I had had lasik surgery and was inactive for the about 2 months, so basically the pain came without physical activity, out of nowhere. The first week I iced it down every other hour for 20 minutes, used tiger balm, hot towels, Tylenol, etc without good results. The 2nd week I tried muscle relaxers, and the not good results got me worried. The pain was not excrutiating but severe (maybe a 7 or 8), exclusively in my upper arm, and the most intense while waking up in the morning. 3rd week I decided to go see a chiropractor, who took an X-ray, and told me the problem wasn’t my arm but it was my neck. He tried I believe ultrasound, and decompression twice that week. As the pain continued, he referred me to a clinic where I got an injection and some pain medication (hydrocone). This did not help much, so he sent me to get an MRI and referred me to a neurologist. I got the MRI done in the 4th week and immediately went to see the neurologist, he performed some tests (can’t remember the name but got quite a good number of electrical shocks), and also tested my strength, and sensitivity to the touch. I think the strength was there, and the sensitivity too, as it felt the same for both arms. After this, the doctor told me he would like to try cervical traction for 4 weeks and see how it goes. He said he could not guarantee it was going to work but he would like to proceed that way. At this time, the pain wasn’t so severe (maybe 3 or 4) but it was not limited to my triceps, I would also feel it in my biceps, and armpit.
Here is what the MRI report says:
There is desiccation of the discs of the cervical spine
At c4-c5, there is minimal bulge of the intervertebral disc effacing the thecal sac
At c5-c6, there is a bulge of the intervertebral disc effacing the thecal sac with mild left neural foraminal narrowing
At c6-c7 there is a bulge of the interverebral disc effacing the thethecal sac with mild left neural foraminal encroachment. There is a tear of the annulus at this level and this the most prominent bulge.
I just finished the 2nd week of cervical traction and pain has been limited to the mornings when waking up, but there is tingling and a little bit of numbness in my arm, armpit, back of the shoulder, wrists, coming on and off during the day. The pain is not as intense as it was but I feel a lot of discomfort and also noticed a little bit of stiffness in my neck, but I could not say that it is painful. It definitely feels odd, maybe like pin and needles, it’s hard for me to make a good description of how I feel it.
Now, I was seeing the non surgical treatment options in your website, and there is no mention to cervical traction, so I got concerned, and I called a friend of mine in Argentina who is an orthopedic surgeon. He told me cervical traction is not performed in Argentina now for a good number of years, and he recommended getting a 2nd opinion. I am not struggling with the physical pain now, as much as I am struggling with the mental and emotional aspects of it. I’d like to think that the quality of my life is proportionally direct to the amount of physical activity I do during the week. For several weeks now, I have not done anything so I’m going crazy. It has even affected my work lately, which I think (I sit in front of a computer for long hours), in conjunction with the nature of the high impact sports I have practiced, has brought me to where I am now.
I would highly appreciate if you can give me your opinion on whether I need surgery or not (I’m a 42 now, never had any physical problems up until now), and let me know what your recommendation is as far as treatment options.
Thank you so much and best regards,
ManuelDonald Corenman, MD, DCModeratorJune 15, 2012 at 10:11 pmPost count: 8459
Your symptoms are consistent with a radiculopathy of the C6 or C7 nerve. You report no motor weakness which is a big plus. Your MRI report is somewhat confusing as it reports foraminal stenosis at C6-7 from a spur but also an associated “tear of the annulus at this level and this the most prominent bulge”. I am not sure if this indicates a herniation or not.
I think cervical traction has its advantages and disadvantages. For foraminal stenosis from a bone spur causing root compression, traction can be effective. For a hernation, it is not as effective. For facet disease, it can flair up the symptoms.
The next step is a consult with a pain management physician that performs diagnostic injections (selective nerve root blocks). An injection should be both diagnostic and therapeutic. This injection might give you long term relief.
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