KateMemberAugust 1, 2013 at 10:27 amPost count: 1
I have constant neck and shoulder spasm. I get retroorbital headaches many days, jaw and facial ache, and the pain frequently extends down my R arm and sometimes L as a heavy or sharp ache, sometimes with some numbness and tingling in the last two fingers of my R hand. However, the pain doesn’t follow any consistent dermatomal pattern. The spasm pain feels like my neck is on fire and sometimes I ice it. Pain also extends into my occiput and scalp regions. Once recently I woke up with my R arm completely numb though asleep on my L side. The pain in my neck interrupts my sleep regularly and is fatiguing. Also, I have strange spasms eg. occasionally my toes or calves will spasm, or I will get a tic above my eye. I have trouble when my neck is in motion, such as a car on a bumpy road. I get sharp catching with extension and lateral rotation to the L. When I am really in spasm, it is difficult to turn my head L such that my blind spot is impeded while driving, and I have difficulty with extexion almost always. I have crepitus. I do not have a history of whiplash type trauma that I can remember but have a history of high impact sports and heavy lifting in my job as a nurse. (I am not currently lifting patients). The pain has been intermittent for 9 months and nearly constant for 3 months.
I have a history of an SI instability for which I had a pinning 2/2013 after 2 1/2 years of conservative therapy. During that period I would have neck and shoulder spasm when my SI was extremely painful, and I spent a lot of time propped up in bed as it hurt to sit, so I was flexed forward. The muscle spasm associated with this would resolve with muscle relaxants, eg. Skelexin and Flexeril. These no longer work so I take Baclofen for spasm on a limited basis as it makes me groggy and I can’t tolerate that and work productively. I do still have some SI pain post-pinning, and my gait is altered, but I am very functional – I can swim, hike, and ride my bike. Prior to surgery I had days I could hardly walk.
However my neck pain is worsening – the last few months I have noted occasional unprovoked spasm in my legs/feet, and R arm pain has become more frequent and pronounced, the nonresponsiveness to muscle relaxants as opposed to antispasmodics, and I am in pain most of the time. I take ibuprofen every day, Baclofen as often as I can tolerate and still be alert at work, and about once a week I get exasperated and take a pain pill. Typical pain level is 3-4/10 for the last 3 months. I could wear enamel off my teeth with it.
My PCP found me with hyperreflexia x 4 extremities. She thought this could be due to nervous system excitability due to chronic pain. She did only a thyroid lab test which came back normal. After a month of ineffective PT and 3 months of massage I asked my PCP to do imaging and she did an MRI which was normal excepting “straightening of the normal cervical lordosis.” There was mild motion artifact. PCP declined to do flexion-extension imaging unless the PT felt it was indicated and I haven’t asked the PT yet as I am trying a new one – PT up to this point has not been effective.
PT correlates hyperreflexia x 4 except my achilles reflexes are absent. PT to date says I likely have some instability in my neck but doesn’t feel my presentation is concerning as the pain pattern is nondermatomal and I don’t have clonus. She thought maybe I have always had hyperactive reflexes but this is not the case and I confirmed this looking at old medical records. She does find my R subpectoralis muscle extremely tight with scapular winging so we are looking at thoracic outlet syndrome as a possibility given my history of forward flexion in posture. I’ve now had many sessions of massage targeted for this issue with no real relief. The first massage therapist I saw felt that my cervical ligaments were stretched and that I could benefit from traction and strengthening, which is why I sought PT. I thought maybe I could benefit from strengthening for neck and back but the new PT declines strengthening exercises until he can determine what is wrong that my body is pulling into forward flexion. He commented that I am having lot of nerve symptoms and feels my muscles are so tight they are pulling bones out of alignment in my neck. He began working on extensive trigger points, that’s his specialty.
I am in constant, gradually worsening neck and shoulder pain. What is the next step? Should I ask for referral to neurology or physiatry or someone else?
Thank you so much,
KateDonald Corenman, MD, DCModeratorAugust 1, 2013 at 11:22 pmPost count: 8459
Your symptoms and signs (hyperreflexia without clonus) along with no evidence of compression of the spinal cord but with headaches could indicate central nerve irritation (brain origin). You probably also have thoracic outlet syndrome or a peripheral nerve entrapment syndrome (carpel or cubital tunnel syndrome).
You next stop you should consider would be a good neurologist. Make sure you get someone who has experience and won’t stop until there is a good answer.
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