[exercise453]

#6195

Hello again doc…..new topic

I previously asked you about the c2-3 facet. A radiofrequency was done after and separate from c3-8. Results were minimal. I have been asking doctors “what is this thing” referring to a hard, tender, pea shape, mushy nipple type thing with nerve endings at this c2-3 facet for years. Answers have varied. It seems to move around, maybe as I change position and I think there are a few of them. It hurts and it radiates a long way. I press and hole it for a minute or two and sometimes it seems to shrink. It is vicious, sometimes debilitating.

My pain management doc and I parted ways. I commandeered the notes. I was surprised to see on the last page a reference to trigger points around c2-3. The “thing” may be trigger points, not the facet.

Something you said about the skill of the doctor doing the injection makes sense to me now. The c2-3 block, prior to the radiofrequency was 100% successful, but the radiofrequency not so. During the block the “thing” was dead numb. It would seem to make sense that anesthetic got on the “thing” and the “thing” is a trigger point. The radiofrequency deadened the facet nerves but the “thing” lives on. It may never have been the facet even though that area remains murderous.

Do you think the thing is a trigger point(s).
Can they swell and press on nerves and mimic nerve symptoms and referral patterns?
In the neck and specifically c2-3 and c3-4 can they be debilitating?
Can bad ones resist manual manipulation?
Can they be around the front of the neck as well?
In vicious, long standing trigger points what is the best treatments?

As much of this as you can answer is appreciated as is the website and forum

thanks doc

[Donald Corenman, MD, DC]

#6200

Trigger points are painful nodules that defy a normal description of their source. At one time. it was thought that a trigger point is the insertion point of the motor nerve into the muscle belly but prior studies have not held that theory up. As a chiropractor, I had found many trigger points that responded to deep tissue manipulation and as a surgeon, I have injected many with some good results.

I personally think that trigger points are as a result of some pathology (degenerative disc or facet or nerve root compression) but after a period of time, can be self-sustaining foci of pain that need to be dealt with separately. Dry needling or acupuncture can be helpful and if nothing is successful, an injection of a small amount of steroid with lidocaine can be helpful. Be careful with the location in the neck as some less than fully meticulous therapist might put a needle in the wrong area and cause some damage.

Trigger points are not typical pain generators by themselves. You might want another very skilled injectionist to look at the source of your neck pain.

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.

[exercise453]

#7587

Dear Doctor,
This could have been placed on my c2-3 facet thread. To refresh last year I had relief with a c3-4 block, no relief two weeks later with a c3-4 c4-5 block and minimal relief from an eventual c3-8 radiofrequency. Months later there was excellent relief from a c2-3 block and none from a c2-3 radiofrequency.

On this thread I asked about a “thing” right above the c2-3 facet. It is a corn kernel-grain of rice size, hard, irregular, sharp thing that I am forever pressing. After deflating on and all around it, the tender area deflates down to the rocky thing, but the painful thing itself always remains and the area re-inflates.

A new PM doctor (with little to offer) said it was a calcification and there was nothing he could do about it. He does radiofrequencies but not c2-3 and does not do snrb’s so he gave me an interarticular facet joint injection (c2-5). I did not think it could possibly work for a 6 year old condition but the facets had never been injected with steroid so I “took a shot” Two weeks out it certainly has done nothing…(he said it would take a month).

I’ve asked you previously why the blocks worked and the radiofrequencies did not and we’ve discussed that enough, yet I pursue pm because something in that area responded to anesthetic. I now believe it may have been the effect of any anesthetic on the “thing” that quieted it, sometimes for a couple of days. In fact after these recent facet injections I felt better for a couple of days before going back to the usual.

I understand this may be covering a deeper pathology below but maybe not. This exquisitely painful, 6 year old “thing” which has a life of its own seems easily accessible and can be easily injected or dry needled, which makes me wonder why the pm doc said there was nothing he could do. You previously used the word “nodule and dealt with on its own”. I don’t know if that is different than calcification.

If it is a “calcification” should I have it injected or dry needled….what would you recommend???

Is it something that might inevitably be surgically removed, it seems so accessible???

Off topic I would like your opinion on long term, almost daily nsaid use (no pre-existing issues with them and blood tests every 4 months). 1200 mg advil…5 or 6 days a week (in addition to 100mg ultram 2×50 and 800 mg neurontin 2×400 ???

Your performance on this forum is unheard of in the annals of mankind…you have no bigger fan or admirer than I…Thanks

[exercise453]

#7588

One other tidbit…many times as I press and massage the thing and move my head in different positions I feel tingling in and around the ear…one doc said it was a nerve ending

[Donald Corenman, MD, DC]

#7597

This tender discrete spot in your upper neck is a puzzle. Normally these can be trigger points as we discussed earlier and are normally a result of deeper disorders and not a cause of them. Nonetheless, if this spot is not near a dangerous structure (vertebral artery or cord), you could try dry needling. An MRI could also identify it if on a good machine (3.0 Tesla).

Just like how general surgeons identify certain masses by putting a needle into the unknown tissue mass, you could consider that technique to identify the mass but I doubt that you could find a physician who would do that.

NSAIDs can be used by many individuals long term but a liver/kidney lab test needs to be performed every six months to make sure the NSAIDs are not causing problems. If there is GI disturbance, these medications need to be stopped.

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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