[dustingfab]

#4956

I was involved in a MVA about 4 1/2 months ago. I would say the first two months my symptoms of pain, numbness, and pins and needles on both my lower and upper extremities were on the moderate to severe scale. With physical therapy and NSAIDs treatments my symptoms of pain, numbness, pins and needles and headaches range now between the mild to moderate range. For the past 2 1/2 months I’ve been holding steady between the mild to moderate range but what concerns me is that new symptoms are surfacing. Such as facial numbing, groin paresthesia, pins and needles vertical of both buttocks. And in the last week and a half, I’ve increased the NSAID dose at the advisement of my MD. The NSAIDs has reduce the frequency of the paresthesia so that’s good. But is this my life. Taking NSAIDs every single day. New symptoms which are not necessarily severe keep surfacing.

In the next several months, if my symptoms are unchanged will this cause irreversible damage to my nerves?

Of course, in the event I experience mild to moderate symptoms of paralysis/weakness or the groin paresthesia gets worse, I would definitely consider surgery. But I don’t think I’m at that point yet and may simply improve. Thank you in advance for your feedback.

[Donald Corenman, MD, DC]

#4970

You note a motor vehicle accident about 4 1/2 months ago but do not note what happened in the accident. What did you injure? You then note numbness, pain and paresthesias bilaterally in your upper and lower extremities. This is about as nonspecific as you can get. I cannot help you with the information you have provided. Did you have a neck fracture? Did you have a disc herniation in your neck and lower back? Are you breathing rapidly causing C02 loss which causes paresthesias? I would be happy to try and help if you can get a diagnosis but with this information, I cannot help you.

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.

[dustingfab]

#4975

Dear Dr. Corenman,

I’m sorry for being so vague. At the accident scene I didn’t feel injured. There was no fracture. I felt really agitated, nervous and scared by what happened. However, about an hour later when I was home and a bit more relaxed I developed a pounding headache and my entire body felt achy.

I am a nurse by trade and the idea of sitting in an ER during the memorial day was unpleasant to me. So I scheduled an appointment to see an orthopedic MD the following week. I was diagnosed with cervical strain, my back was bothering me too at the time but the pain was much more significant in the neck area. He order an x-ray which showed neck straightening. He ordered PT, NSAIDs and a muscle relaxer.

Exactly one month later(July), I was experiencing migraines and pin and needles in my shoulder and down my fingers. I f/u’ed with the ortho doc who ordered a cervical MRI. Here are the results: C3-C4, C5-C6 and C6-C7 disc herniations; mild to moderate C5-C7 stenosis and mild C6-C7 stenosis. Lumbar spine results showed disc space narrowing and desiccation at L5-S1. Posterior disc herniations at L4-L5 and L5-S1 with impingement. Posterior disc protrusion noted at L2-L3. Unfortunately, I don’t have the lumbar MRI in front of me but I what I do remember is L4-L5 and L5-S1 disc herniations and L5-S1 stenosis.

Because the cervical MRI was ordered first, PT was more focused on the neck.

The lumbar MRI EMG and NVC test was not done until August, PT focused on the back was recently started(Sept). I believe I’ve had 3 weeks of therapy for the lower back. The neck PT has been continuous since June.

The EMG and NVC (not sure how to read the NVC, but the neuro and spine docs stated the results were positive for nerve irriation/involvement) was significant and positive for nerve impingement at the cervical and lumbar level and showed decreased velocity.

The EMG showed evidence of right C5-C6 cervical and right L5-S1 lumbosacral radiculopathies. Also, there is evidence of moderate bilateral sensorimotor median nerve neuropathy at the wrist consistent with a diagnosis of carpal tunnel syndrome. So recently, I’ve seen a hand specialist and have been wearing wrist splints on both the right and left hand/wrist. I will follow up with a post note once I have the exact results in front of me.

The spine specialist recommended ESI for the cervical and lumbar spine. After doing research, I’ve declined ESI therapy. The side effects freaks me out too much.

In late August, regular ALLEVE wasn’t providing relief so the neuro MD prescribed relafen. The relafen has helped tremendously. I’ve since increased the relafen which has helped tremendously. The paresthesia symptoms are infrequent. I’ve been on the maximum relafen dose for 2 1/2 weeks now (9/17 was when I increased the dose.) But now I worry about kidney damage. I have a visit to my GP, so I know a CBC and chem 7 are standard tests during an annual. So I am interested in the results.

Did I mention I’ve been experiencing pins and needles in my groin area, no numbness and no bladder or bowel problems. I’ve mentioned this to the spine doc who hasn’t f/u with me as yet but I will also inform my GP.

I think I’ve been naive and in denial about the symptoms that I am experiencing. I’ve fallen in and out of states of sadness and depression. But I think I’ve accepted the fact that this is my life. And I will simply have to deal with it. And simply pretend this is not a big problem and go on with life as such.

Eventually, the no fault insurance will expire and will cease to provide coverage. If my lab results show even the slightest abnormality, I will stop taking the NSAIDs and will not take any opiates and simply hope and pray the stenosed area around my cervical and lumbar spine either decreases or remains unchanged.

Of course in the event, bladder, bowel dysfunction occurs or the lower mild weakness noted by the PT becomes significant then I would consider surgery.

Any thoughts or feedback would be most appreciated. I look forward to hearing from you.

[Donald Corenman, MD, DC]

#4976

You were in a motor vehicle accident and apparently injured your neck and lower back. You do not note any weakness but pain and paresthesias in your upper and lower extremities. Your cervical MRI notes stenosis at C5-7. Is it stenosis of the central canal or the foramen? What was your examination like? Did you have hyper-reflexia, Hoffman’s sign, clonus or a positive Rhomberg’s sign? These are signs of cord compression and are more serious than foraminal compression with paresthesias from radiculopathy.

If you have no weakness and no signs of cord compression, then the current treatment appears to be helping and you should stay the course. Your physician is correct in recommending epidural steroid injections as these can be very effective for your symptoms. Although there is some risk, in the hands of an experienced and competent injectionist, these injections have very little risk. I probably send about 500 patients a year to injections with no real complications.

The EMG/NCV test demonstrated carpel tunnel syndrome but did this test also demonstrate nerve compression from the neck or lower back (radiculopathy)?

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.

[dustingfab]

#4977

Dear Dr. Corenman,

I have mild to moderate central canal stenosis in the C5-C6 and C6-C7.

I’ve update my post with results. Although, my neck range of motion has improved I do have periods of mild neck stiffness. My right shoulder tends to feel weak with increase activity, like in reaching for something or bathing.

The PT noted mild weakness in my lower extremities. But thank you for pointing out the following …Did you have hyper-reflexia, Hoffman’s sign, clonus or a positive Rhomberg’s sign.

The PT, or docs did not reveal if those signs were positive. These are questions I will ask during my next visit.

Although the risks of ESI are relatively small, bc I work full time and the sole provider for my family that very small risk is too big of a risk to take.

Please take a moment to review the results I updated. And that you again Dr. Corenman. I also want to thank you for your quick response and posting very informative You Tube videos.

[Donald Corenman, MD, DC]

#4982

You have mild-moderate stenosis of the cental canal at C5-7. This could cause the beginnings of myelopathy (see website) which could account for your symptoms. Also, simple degenerative disc disease could also yield neck stiffness and shoulder aching. The leg weakness could be from another source including a lumbar spine origin. The physical examination signs I mentioned eariler are associated with myelopathy so if present, could help with that diagnosis.

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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