[sestevens]

#28090

Hello,

I am a 35 year old female who has been experiencing neck pain and scapular pain for the past 10 weeks. I also have pain and numbness in my thumb, index and middle fingers bilateral, bilateral wrist pain and upper arm pain and weakness. The finger numbness and upper arm pain has been on and off for a year and a half. The upper arm and wrist/thumb pain causes the most discomfort.

I have seen a chiropractor without success, NSAIDS are not effective, and cold and heat have been temporary as far as relief. My PCP told me to try splints st night for carpal tunnel and offered PT after I asked about it. The PT thinks it’s radiculopathy from my cervical spine. I had some relief from my first session with traction, my finger numbness started to dissipate and I had 3 hrs of arm relief after. The numbness came back shortly after in my fingers. My concern is that I am missing a piece of the puzzle. I’ve had to push my PCP to order prednisone and PT. What else needs to happen? Or am I following the correct path?

Thank you,
Anxious RN

[Donald Corenman, MD, DC]

#28102

You more likely than not have foraminal stenosis. See https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/. You might also have carpel tunnel syndrome along with the above but less likely. https://neckandback.com/conditions/carpel-tunnel-syndrome/

Traction of the neck that relieves the hand symptoms reenforces the foraminal stenosis diagnosis. If you extend your head and lean to the hand side of symptoms with increased numbness. pins and needles and pain in the arm, this confirms foraminal stenosis.

An MRI would be the next step in diagnosis and can lead to selective nerve root blocks.
See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/

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.

[sestevens]

#28106

Thank for your prompt response! I’m hoping that I will get the answers I’m looking for in the near future. This definitely leads me in the right direction.

[Steph810]

#29777

I have several MRI reports. I believe I had sent you one of them a while back.

Penn Medical Hospital did an MRI in 2014.These is the summary of the findings: MRI findings “C4-C5: Small disc bulge with superimposed trace central protrusion type disc herniation and mild facet arthrosis. No central canal or foraminal narrowing. C5-C6: Small disc bulge. No herniation. No central canal or foraminal narrowing. C6-C7: trace central protrusion type disc herniation without central canal or foramina narrowing” indicate typical findings of degenerative disc and facet disease.

Kaiser Cervical MRI from 10/2018: (History: Bilateral UE numbness chronic neck pain, Last MRI 9/11/2014 in Philadelphia: C2-3 Mild facet arthritis bilaterally c4-5 Small disc bulge with superimposed trace central protrusion type disc herniation and mild facet arthrosis. C5-6 Small disc bulge; C6-7Trace central protrusion type disc herniation Neck Pain, Chronic since 1996)

Finding for MRI/C Spine WO/Contrast dated 7/27/2017:
Procedure: noncontrast enhanced, multiplayer, multi sequence images were obtained through the cervical spine.
CONTRAST: No IV contrast administered
Comparison: NONE
Findings:
Normal cord signal. No ligamentous pathology. No aggressive marrow process. No chiari malformation.
Axiial interrogation reveals
C2-3: Mild facet naturopathy without central canal or foramina stenosis
C3-4: Minimal uncovertebral hypertrophy without central canal foramina stenosis.
C4-5: Mild facet hypertrophy without central canal or foramina stenosis.
C5-6: Small left paracentral disk protrusion slightly effacing the left side of the spinal cord with mild uncovertebral hypertrophy resulting in minimal foramina stenosis.
C6-7: Minimal uncovertebral hypertrophy identified without central canal or foramina stenosis.
C7-T1: No central canal or foramina stenosis
IMPRESSION:
No features of nerve root impingement. No central canal or foramina stenosis
Minimal degenerative changes of the cervical spine with a small left paracentral disk protrusion at C5-6.

Now this last one I had on 10/28/2018 (The Nerosurgeon did a full back because I was having horrible pain in the middle of my back and at the tail bone when I would sit.
These are the reports:

MRI Cervical Spine:
Impression:
1. No acute findings are seen.
2. Interval slight progression of degenerative changes at C5-6 noted as before. No clear evidence of nerve impingement is seen.
NARRATIVE:
Exam MRI?C-Spine WO/Contrast
History: Persistent left neck pain and headache CERVICAL RADICULOPATHY
TECHNIQUE: Multiplayer, multi sequence MRI of the cervical spine was performed.
COMPARISON: MRI cervical spine dated July 27, 2017
FINDINGS:
VERTEBRAE AND CORD: Alignment of the cervical spine is within normal limits. Bone marrow signal intensity of the vertebral bodies is within normal limits. Overall mild degenerative disk disease changes appear somewhat more pronounced at C5-6 in sagittal images and overall appear slightly progressed from the prior exam.

The craniocervical junction is in normal position. The visualized spinal cord shows normal signal intensity.

SOFT TISSUES: no acute surrounding soft tissue abnormality is seen.

C1-2: Mild degenerative changes again seen without significant spinal canal narrowing.
C2-3: The posterior disk margin is normal. The spinal canal and neural foramina are widely patent. Mild to moderate degenerative changes of the facets bilaterally again seen.
C3-4: There is an overall minimal disk osteophyte complex with high greater then left uncinate hypertrophy and mild degenerative changes of the facets bilaterally again see. There is no significant spinal canal narrowing. There is mild narrowing of the right neural foramen without evidence of nerve impingement.
C4-5: There is mild disk osteophyte complex and bilateral uncinate hypertrophy with mild to moderate degenerative changes of the facets bilaterally again seen without significant spinal canal or neural foramina narrowing.
C5-6: There is a disk osteophyte complex somewhat asymmetric to the left with left greater then right uncinate hypertrophy and overall moderate degenerative changes of the facets somewhat asymmetric to the left. Findings bay be slightly progressed. there is mild spinal canal narrowing with a maximum AP dimension central canal measuring roughly 9mm per there is no cord compression. There is mild narrowing of the neural foramina asymmetric to the left without definable nerve impingement.
C6-7: There is a minimal disk osteophyte complex with moderate degenerative changes of the facets bilaterally similar to the prior exam without significant spinal canal or neural foramina narrowing.
C7-T1: There is mild right greater then left uncinate hypertrophy with mild to moderate degenerative changes of the facets bilaterally again seen without significant spinal canal narrowing. There is mild narrowing of the right neural foramen again noted without evidence of nerve impingement.

MRI: LUMBAR SPINE
Impression:
No spinal canal stenosis at any level.
L4-5: Small broad based right posterolateral and foramina disk protrusion abutting the traversing right L5 nerve roots. Mild right neural foramina narrowing.
NARRATIVE:
EXAM: MRI/L SPINE WO/CONTRAST
EXAM DATE AND TIME: 10/18/2018 17:18:00
PROCEDURE: Noncontrast enhance, mutliplanar, multi sequence images were obtained through the lumbar spine.
CONTRAST: No IV contrast was administered.
COMPARISION: None available
FINDINGS:
the conus medullar is and caudal equine are normal.
Normal alignment. The vertebral body heights are preserved with no acute fracture and normal marrow signal. Multilevel mild disk desiccation is seen. The paraspinal soft tissues are unremarkable.
Level by Level analysis:
T12-7: No disc herniation or stenosis.
L1-2: No disc herniation or stenosis.
L2-3: No disc herniation or stenosis.
L3-4: No disc herniation or stenosis.
L4-5: Small broad based right posterolateral and foramina disk protrusion abutting the traversing right L5 nerve roots. Minimal facet disease. No spinal canal stenosis. Mild right neural foramina narrowing.
L5-S1: Very small left paracentral disk protrusion with an annular fissure. No associated neural compression. Minimal facet disease. No stenosis.

MRI THORACIC SPINE:
Impression:
1. No acute findings are seen.
2. Mild degenerative changes of the thoracic spine as noted above. There is no evidence for nerve impingement.
NARRATIVE:
EXAM: MRI/T-SHINE WO/CONTRAST
EXAM DATE AND TIME: 10/18/2018 16:44:00
HISTORY: Thoracic pain, history of child abuse Low back pain
TECHNIQUE: Multiplayer, multi sequence MRI of the thoracic spine was performed.

FINDINGS:

VERTEBRAE AND CORD:
Alignment of the thoracic spine is normal. There are minimal endplate changes associated with degenerative disk disease seen throughout. Bone marrow signal intensity of the vertebral bodies otherwise appears unremarkable. There are minimal degenerative disk disease changes seen throughout on sagittal images. There is a small developmental Schmorl”s node deformity versus chronic central endplate deformity involving the superior endplate of T7 noted.
Visualized spinal cord shows normal signal intensity.
Degenerative changes in cervical spine are better profiled on the separate cervical spine exam.
DISK SPACES:
Posterior disk margins overall appear unremarkable throughout the thoracic spine. There is no significant spinal canal or neural foramina narrowing seen to suggest nerve impingement.
There are mild degenerative changes of the facets scattered throughout.
SOFT TISSUES: The visualized paravertebral soft tissues are unremarkable.

MRI SACRUM

STUDY RESULT
IMPRESSION: Asymmetric hypertrophy of the left piriformis muscle with accessory fibers overlying the left S2 nerve and attaching medially. Please correlate with signs and symptoms of left-sided piriformis syndrome.

NARRATIVE:
EXAM: MRI/SACRUM, WO/CONTRAST
EXAM DATE AND TIME: 10/18/2018 17:35:00

HISTORY: Tailbone pain – please include COCCYX – History of pilonidal cyst Spine Fracture
PROCEDURE: Non contrast enhanced, multiplayer, multi sequence images were obtained through the sacroiliac joints/sacrum.

CONTRAST: No IV contrast was administered.
COMPARISON: None Available

FINDINGS:
No acute osseous abnormality. No suspicious osseous lesion.
No cartilage erosions, osteitis or effusion in the sacroiliac joints.
The lower lumbar spine will be dictated separately. There is asymmetric hypertrophy of the left piriformis muscle with accessory fibers overlying the left S2 nerve and attaching medially.
No abnormality identified along the course of lumbosacral plexus bilaterally. Limited evaluation of the posterior pelvis reveals a small amount of pelvic free fluid, most likely physiologic. Metallic artifact is noted in the posterior subcutaneous soft tissues just distal to the coccyx, most likely related to prior surgery to remove a pilonidal cyst.

[Donald Corenman, MD, DC]

#29781

It appears that according to several radiologists, you have no nerve compression in the foramen of the cervical spine to cause your symptoms. Have you had a ENG/NCV test from a neurologist to shed more light on the potential source of symptoms?

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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