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  • Mindy1198
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    Post count: 1

    Hello Dr. Corenman,

    I have had pain in my neck primarily on the right side, right shoulder muscle tightness that goes down to the shoulder blade, this radiates to close to my armpit in the shoulder and down the right arm with majority of the shooting/somewhat sharp pain to my elbow. I have pin and needle pain in my hand usually felt in my thumb first then the pointer, and middle finger but tends to increase as it continues to tingle.
    I have headaches that start at the base of my skull and move forward as it intensifies, its a constant headache with no shooting or sharp pain just a constant pain that starts dull and gets more intense throughout the day. The neck pain and headaches are aggravated by anything overhead. I used to participate in Crossfit but have since stopped as it was irritating my symptoms. Now I go to a regular gym and avoid anything overhead but still have intensified pain with upper body exercise.

    Percentage of pain by location 50% neck & headaches 40% shoulder 20%arm.

    Pain intensity varies: Daily 4-6 in the neck. Daily Headache 3-5. Daily Arm pain 2-4. Neck and head pain close to once a week gets to about a 9 with arm getting to about 6.

    Weakness: General over head press weakness but I’m not sure if this is strictly due to avoidance from pain.

    Incoordination and Numbness: None

    Onset and Length of Time Symptoms Have Been Present:
    Pain started about two and a half years ago, was very active in Crossfit, Gymnastics based classes, and Running. Symptoms started with neck pain, shoulder and headache. Arm pain became increasingly noticeable over a month or so while visiting chiropractor.

    No injury.

    Had previous compression fracture of the C5 from a water skiing accident in 2005. Causing extreme headaches and burning down my whole right arm and hand. Completed therapy, steroid injections, and work neck brace for 8 weeks. Problems subsided.

    Activities:
    Lifting heavy at the gym aggravates symptoms sometimes causing an intense headache generally squatting or leg press.
    Biking for 8-10 miles irritates neck and arm pain.
    Laying down on heating pad can curb the neck and shoulder tightness but does little for the arm pain and headache.
    Generally I wake up in pain and the pain intensifies over the course of the day and builds over days.

    Pain Intervals:
    Daily pain that can range from annoying to debilitating.
    2 pain level / annoying pain days are rare but celebrated, and I intentionally will not go to the gym or anything that might cause an increase.

    Activity and Occupational Restrictions:
    Pain has changed my life a great deal, I have went from highly active in different activities to two days a week at the gym with modified lifting.
    I have a management / 80% desk job with no physical demands but walking.
    I have missed work around 1-2 days a month due to pain and headache intensity.

    Previous Consultations or Treatment:
    I have been seeing a Neurologist for about 2 years primarily treated for Migraines – Clear Brain MRI results and normal EMG results. Currently getting monthly Amovig shot and Botox with no improvement.
    2018 was visiting a Chiropractor, some headache improvement but no help with arm and shoulder pain.
    I have had Physical therapy for 12 weeks unsuccessfully causing increased pain.
    Acupuncture down right side of neck, shoulder and arm. No results.

    Neurologist currently seen, indicated my MRI results were normal from the radiologist report.

    MRI completed on 2-21-2020
    Report:
    Indication/History: History of headaches neck pain. History of stiffness radiating down right arm:

    Procedure: MRI cervical spine without contrast

    Comparison Plain film cervical spine performed 5/17/2018

    Findings:
    STIR sequences demonstrate no focal height loss or diffuse marrow edema.

    There is diffuse disc desiccation.
    Cervical cord demonstrates normal signal intensity. Cerebellar tonsils unremarkable.

    C2-3: There is broad based posterior disc bulge. There is mild to moderate bilateral neural formainal encroachment and at least mild central canal stenosis.

    C3-4: There is broad based posterior disc bulge with mild ventral thecal sac deformity. There is mild to moderate bilateral neural foraminal encroachment and at least mild central canal stenosis.

    C4-5: There is broad based posterior disc bulge with mild ventral thecal sac deformity. There is mild to moderate bilateral neural foraminal encroachment and at least mild central canal stenosis.

    C5-6: Posterior paracentral disc protrusion with ventral thecal sac deformity. This does not abut the cord. There is mild to moderate bilateral neural foraminal encroachment and at least mild to moderate central canal stenosis.

    C6-7: Endplate spur visualization, mild ventrical thecal sac deformity and mild bilateral neural foraminal encroachment with mild central canal stenosis.

    C7-T1: No disc protrusion, neural formainal encroachment or central spinal stenosis.

    Impression:
    At least mild to moderate central canal stenosis due to posterior paracentral disc protrusion identified at C5-6 that does not abut the cord.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    You note “pin and needle pain in my hand usually felt in my thumb first then the pointer, and middle finger” and then “pain in my neck primarily on the right side, right shoulder muscle tightness that goes down to the shoulder blade, this radiates to close to my armpit in the shoulder and down the right arm with majority of the shooting/somewhat sharp pain to my elbow”.

    Your symptoms are consistent with a C6 or C7 radiculopathy. The symptoms noted “The neck pain and headaches are aggravated by anything overhead” could be from tilting your head back (extension) which is normally associated with overhead work and associated with cervical radiculopathy (pinched nerve in the neck) but can be associated with thoracic outlet syndrome.

    See: https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/
    https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and
    https://neckandback.com/conditions/thoracic-outlet-syndrome/

    Your MRI notes “mild to moderate bilateral neural foraminal encroachment and at least mild central canal stenosis” at almost every level so this confirms the symptoms could be from nerve root compression but does not specifically identify the level or levels involved.

    I think the next step is a very thorough physical examination to determine if one or two roots can be identified. Most likely the C6 and C7 roots. Then a selective nerve root block with a pain diary would be used to “drill down” to the suspected root(s) involved. Then depending upon your structural anatomy, an ACDF or an ADR can be used to treat this condition surgically. See:

    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
    https://neckandback.com/treatments/diagnostic-therapeutic-neck/
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/
    https://neckandback.com/treatments/anterior-cervical-decompression-and-fusion-acdf/
    https://neckandback.com/treatments/artificial-disc-replacement-adr-for-cervical-spine/

    Dr. Corenman

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