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  • Barry_T
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    Post count: 3

    Dr. Corenman, I am a 50 year old man with a history of thoracic and lumbar back pain in the last 10 to 15 years. I have also had 2 to 3 years of problems with my neck following a road traffic accident about 30 years ago. I have some relatives with spinal problems brothers, cousins. The physiotherapist diagnosed multiple symptoms of nerve ‘pins and needles’, with feeling of coldness in my right arm with a measured temperature drop of 1-2 deg C between right and left hand. The physiotherapist sent me for a X-ray suspecting that some of the symptoms were attributed to Thoracic Outlet Syndrome. The X-ray indicated a small ‘Cervical Rib’ protrusion. I was then passed on to a consultant who sent me for a investigative MRI. The results from the MRI indicated a herniated disc between C4 and C5, protrusions of vertebrae into the spinal cord region also. He also mentioned that the white area, are pointing to the C4 cervical vertebrae had a ‘blood blister’ contained within it. I asked about my physical symptoms of temperature difference between right and left hand, and didn’t get a response.

    I repeatedly asked for more information about the ‘whole’ diagnosis but did not get a response other than he was going to ‘quickly’ forward my case to a neurosurgeon.

    I have searched the internet and have found a few references to Thoracic outlet and herniated discs, but I could not find any information on cervical bone blood blisters.

    I am getting worried about the whole situation, can you help me please?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    You have some complaints listed and some conditions listed. Let us first discuss the complaints. Pins and needles in the right arm could be from a compressed nerve in the neck or from thoracic outlet syndrome. Coldness (greater than 1-2 deg C) can be from a condition called RSD or CRPS but that is very rare and most likely, you do not have that.

    You note no complaints of pain in your neck or arm or what makes the symptoms worse and/or better. You note no complaints of weakness or of dexterity.

    Let us work backwards from the stated conditions. Thoracic outlet syndrome is caused by compression of the nerves in the shoulder (brachial plexus) by the first rib, cervical ribs, the muscles in the side of the neck (scaleni) or the tendon of the pectorals minor. These symptoms would include numbness in the pinky side of the hand and worsening numbness with any overhead work. The hand could get cold when raised up but be of normal temperature when at your side.

    The herniated disc at C4-5 would cause pain and numbness into the shoulder but not down the arm below the elbow. The muscle associated with the C5 nerve is the deltoid (lifting the arm up at the shoulder level).

    The “blood blister” in the vertebral body of C4 is a new one for me. I would imagine that this individual means a hemangioma of the body of C4 but I cannot be sure about that. In general, hemangiomas of the vertebra are common and benign.

    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.
    Barry_T
    Member
    Post count: 3

    I visited my general practicioner (GP) today and I have some corrections to the MRI results.

    Radiologist report to GP – MRI Spine Cervical: There is a small haemangioma in C5. There is loss of disc height with both disc and osteophyte at C5/6, I think probably more osteophyte than disc but narrowing the exit foramia certaily on the right and possibly on the left. The spinal cord and vertebrae are otherwise normal.

    In Response:
    My symptoms started after a fall and a ‘partial’ disclocation of the right shoulder December 2010 and Feruary 2011 respectively.

    I have pins and needles regularly and some instances of weakness and sensation in my right hand mainly. The symptoms vary day to day but can be over thumb/index finger or ‘pinky’ and the fingers next to it. I have recently had shaking hand/arm and problems with writing. The sensation of cold was checked by myself with a digital temperature probe (accurate to 0.1 deg C); this measured in a seated position.

    Apologies for getting the vertebrae numbers wrong!

    The symptoms vary day to day and also depending on what I am doing at the time. To start with the symptoms occurred when using a computer mouse and has ‘developed’ into a more irritating problem exacerbated by the ‘coldness’ of my right arm and hand. I aleviate this with heat pads.

    Does this help with diagnosis?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    OK- this makes more sense. The condition of foraminal stenosis of C5-6 (see website for this) would cause compression of the C6 nerve. This radiates pain and paresthesias (pins and needles) down to the thumb side of the hand. Weakness would include biceps (bending the arm at the elbow), wrist extensor (lifting the wrist up opposite side of the palm)- important for grip strength and the thumb muscle.

    Foraminal stenosis would become worse with neck extension (bending the head backwards) making the radiating symptoms worse. Temperature is governed by the sympathetic nervous system that does not originate from the neck so the coldness in the hand is not related to the neck.

    You could also have carpel tunnel syndrome- very common with using a mouse. I do not have a section written on that so you will have to look it up on the internet.

    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.
    Barry_T
    Member
    Post count: 3

    Dr. Corenman, I am awaiting referral to a neuro-surgeon and unsure about delay in the NHS (UK) system it could be many weeks/months.

    Are there any short/long-term effects or damage to the spinal cord with a herniated disc and osteophyte pressing on it; or the symptoms of Thoracic Outlet Syndrome? Should I put pressure the NHS to speed up the referral or go private?

    I am trying to ascertain whether the ‘neural’ conditions could be causing other symptoms in my body, such as:
    1) One-off Seizure (three years ago), 2) Neck and shoulder pain, 3) Neck graunching, 4) Headaches/Migraines, 5) Dizziness, 6) Violent/Panic waking from sleep trying to get my breath, 7) Choking when eating, 8) Stomach upsets, etc

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    With your National Health Service, I understand the referral wait can be months. The good news is that there is no cord compression that you have reported- only nerve root compression. Nerves are more forgiving than the cord and the waiting time to see a surgeon can be longer. There still is some risk with waiting but the risk is much less than with cord compression.

    Seizures would not be associated with nerve compression in the neck. Neck and shoulder pain more likely is related to this nerve compression. Many of the other symptoms are not related to the neck but could be related to anxiety. I am unclear what neck “graunching” is.

    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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