[Donald Corenman, MD, DC]

#10465

Generally, my patients wake up with a slight “sore throat” that disappears in about 12 hours and no problem with swallowing. There are some rare patients that have large boluses of food (not chewed well enough) “get stuck” and have to swallow twice to get this down.

This problem is mitigated by using thick liquids for food (yogurt or kefir) for about two to four days. This difficulty swallowing normally abates quickly.

An incision on the left side is better for the voice box (vocal cords) as the nerve pathway that supplies the cords is consistent on the left but not on the right.

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.

[Maureen Hanson]

#10467

Thank you so kindly for your reply Dr. Corenman. This has put my mind at rest.

Thank you

Maureen Hanson

[venkat]

#11357

Hi Dr Corenman,
I just got my hands on my MRI from 2009, when my symptoms were still going strong – burning hands & arms, and also completely seized up/burning upper trapezius on right side (portion between neck & shoulder) radiating down to the shoulder blade on the right side as well.
My symptoms all started after a horrid motorbike accident in 2008.
My logic suggests that this MRI should tell what the situation was – whether it was due to any disc bulge, facet referred pain, or disc referred pain? I was recently diagnosed by one dr with Neurogenic TOS and I wanted to make sure I didn’t miss anything (cervical issues + TOS).

My MRI
j

So if this suggests no cervical issues, then I guess its TOS alone?

[venkat]

#11359

Please let me know if you can see/access the link above. Its safe and i created an account to show it since i cant type long and didn’t know how to get the MRI details to you (am based out of India). Am stuck between a rock and a hard place here.

[Donald Corenman, MD, DC]

#11360

I am sorry but at this point, I do not download files of images as the possibility of viruses is prevalent. I am working on this but for now, this policy continues.

Check the section “how to describe symptoms” under “conditions” to adequately discuss the symptoms of your disorder.

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.

[venkat]

#11363

Understood doctor. I will type it out. Updated my symptoms below which were in the opening page of this original thread.

My thinking was that my latest MRI in late 2013 was merely a cervical screening (as versus detailed) so not sufficient.

Then i realized that my symptoms were already there when i had my 2009 MRI done a year and a half after my symptoms appeared. If so, what that MRI showed would apply (as my main issues already existed moreorless by that time). This would help me crosscheck the validity of what procedures to continue with and what to skip.

One doctor recently diagnosed me with Thoracic Outlet Syndrome but I have heard that many cervical issues can coexist with TOS & i just wanted to make sure I could address all the possible modalities.

I am wondering whether my upper/middle trapezius problem on the right side is due to any referred pain from a disc or the like (harder to diagnose? versus a “conventional” issue of std nerve compression at the disc.) so it could coexist with TOS.

My guess is that its my scalenes which are the cause of the mess post the injury, but your insight counts for 100x. also with your hands on background as a chiropractor + spinal specialist, you’d know far more about how to resolve a possible TOS issue and the differential dx. i fear many of the specialists i have consulted with don’t really “get” soft tissue entrapment etc and TOS is something associated with extra cervical ribs alone.

Symptoms

Hi Dr Corenman, is there a way to send you my MRI and other reports? An email address? I a male in his mid 30s, and have chronic pain after an accident a few years back. I fell on my face, left side from the back of a motorcycle. Pain is not reducing / body doesnt seem to be healing, and diagnosis of the whole thing remains unclear. I would appreciate any help as I really don’t seem to have a clear understanding of the issue. Based on your forum posts and other content, I seem to have a mild bulge in my C6-C7 (as was originally diagnosed) and also in C4-C5. I am no expert and would appreciate your thoughts if I could send you the MRIs by mail after getting copies from the hospital.

My symptoms as per your FAQ -please excuse any typos as I find it hard to type, my upper back – right side of the trapezius/lower neck seizes up on the right.

What is the quality of the pain?

Hands:I’d put it as 5 on a scale of 1-10…tolerable, but very irritating. Symptoms worsen if i strain my neck, eg on a pillow on the bed, laying on my back, trying to read a book. Or, at a desk, trying to use a computer.

Lower neck/upper/mid back -right side – trapezius extending down to shoulder blades: 7…muscle just seizes up on the right side.

My symptoms become worse i am on te computer or cross my legs when lying down. At night they seem to worsen.

Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles?

mostly burning, aching and pins and needles. occasionally sharp.

in my left and right hands both, all over.
fingers especially.

left foot is always vibrating. after i took a medicine, prescribed by a doctor, its reduced…foot vibration/electrical sensation.. its in the background but tolerable, and spikes when i sit on a chair or in the car etc.

medicine is methylcobalamine, alpa lipoleic acid, biotin, vitam b12 and folic acid.

big issue is shoulder seizes up, id rate it a 7 in pain, complete spasm, basically trapezius muscle, base of neck on right side to near the shoulder …it just seizes up. medicine doesnt reduce it.

Does the quality of pain change with activity?

pain picks up mostly when i am at the computer, or i am lying down on my side or back with a pillow, reduces when there is no pillow and i am flat on my back/neck. sitting has it worse then standing, and standing, my feet hurt or are somewhat sensitive but thats probably because of lack of exercise.

any slight forward head posture triggers my right side – upper middle/trapezius parasthesias and then burning pain followed by spasm.

Is the skin hypersensitive to touch?

Not at all places. But at some spots near my wrist etc, when tapping it, it vibrates/pains and referred signals to my hands.

Are there associated skin changes like thickening, color change or nail changes? This is important in the shoulder, arm and hand.

my nails appear to be more brittle, and color is more blueish and pale, after myofascial therapy (on traps/levator scapula) have become more pinkish with blue tinge.

Percentage of Pain by Location

What is the percentage of pain in the neck vs. shoulder and arm?
This is important as lateral shoulder region can be typically associated with arm pain or nerve pain while posterior shoulder pain can originate from neck or nerve sources. Don’t forget that the shoulder joint itself can cause pain.

Is it 80% neck vs. 20% shoulder and arm pain or the reverse? Is it 70/30, 60/40 or 50/50 (equal in both areas). This percentage number is quite valuable to determine what type of pain the disorder is causing. The pain may be all posterior shoulder (100%) or even only 100% in the hand (or both hands).

the distribution between my neck and shoulder vs my hands is like 50-50% but to be honest the neck hurts when i turn it etc or is stiff, but my hands burn all the time.

i have grown used to pain and work through it, but the neck/shoulder pain are unstoppable. the muscle seizes up. so fingers hurt all the time, and neck/shoulder hurt when i sit down and attempt to use the computer, extending the hand to mouse or keyboard …seizes up on right side, and i am right handed.

its my upper back/middle back pain/spasms which are truly disabling.

Rate each area that you have pain. If the neck has 4-6 VAS, the shoulder has 0-2 VAS, and the arm has 8-10 VAS, make sure that is noted.

i dont know the VAS method but if a rank of 0-10 is employed,
i’d say neck has around 4, shoulder/upperback around 8 and hands around 4-5 too. neck becomes stiff and aches along with feet if i sit for more than 15 mins and lower neck/upperback/right side of trapezius portion just seizes up. hands left and right keep burning 24/7. sometimes both, sometimes one. since my back is seized up (upper) i cant do many exercises. fingers and feet hurt if i walk too fast or attempt to jog.

Is there weakness associated with the pain?

Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is

weak because the signal from the brain is interrupted due to a pinched nerve)?

Is there now an inability to lift the arm due to pain or to weakness?

Are certain activities more problematic like pushing away or throwing (due to weakness and not pain- such as a weak triceps muscle) or lifting due to a weak deltoid or biceps muscle?

i would say i have become weaker in terms of pulling and lifting things.. but it could be due to lack of exercise.. apart from walking my exercise regimen is non existent and even walking is occasional. my arms hurt if i lift them above my head and if i extend my arms at the shoulder and keep them akimbo, my back hurts (muscles)

i cannot raise my arm (right especially) above the shoulder without being fatigued.

both hands become numb and burn if raised above shoulders.

Incoordination and Numbness

Are there now some noticeable problems with coordination and walking?

Do you find yourself unbalanced when you walk?

Do you “misstep” unintentionally much more than you use to do?

Do you have trouble keeping your balance in a pitch black room?

Has your handwriting changed?

Do you now have trouble picking up a dime off a counter, zipping a zipper or buttoning a button?

Do you find lightening type electrical charges down your spine if you tilt your head backwards?

Have your bowel and bladder function substantially changed in association with any of the above symptoms..

Noticed handwriting, i find it hurts if i attempt to write for long periods, then again, it could be that i am fully a computer person now and havent written anything for around 8 years.

but i am definitely weaker in picking up things and more butterfingered.

hands are numb many times, begins with fingers.

i tried the tennis in the sky method a few days back from the mckenzie neck exercises, basically tuck chin in, look towards the roof and move head sideways…when i moved head from side to side, i got severe dizziness and loss of movement control. went away though.

Onset and Length of Time Symptoms Have Been Present

How did the pain start?

Was it a gradual onset over years or was there one specific activity or injury that caused it?

When did that injury occur?

Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually?

How long have the symptoms been present and have they changed in quality or intensity?

For example, did you lift something one year ago that caused neck pain and in the last month you have developed severe

arm pain that radiates down to the hand?

Six years now since the issue became apparent.

Fell down from the back of a motorcycle, face down on the road, injuring the left side of my face, too fast for me to stop,
i was too tired/sleepy to even prevent it, and was trying to catch a bag that was falling off. the bike was going around 30 mph. i had some fractures around my left eye (plastic surgeon said around 5-7 fractures), and deep cuts which required stitches. i then developed a problem sleeping, and that night itself could not sleep due to neck pain. after chronic discomfort for around a year, istarted seeing doctors, and was told the disc bulge at c6-c7 was a probable cause but not a clear answer. after i started making notes and the pain became constant, and i went back to spinal specialists, one diagnosed it as possible whiplash, another said probably due to the minor bulge at c6-c7 in MRI.

as things stand, its become worse since the past 3 years ?(been five years since the accident) as my sedentary lifestyle, thanks to this issue and high stress computer work, probably worsened my posture and also i have been unable to get proper diagnosis on the issue. a doctor told me i have significant anterior postural issue. as i type this, my left hand is burning and right shoulder/upper back are seizing up.

since i hurt my back down a staircase recently, i got another MRI done and CAT scan showed probable hairline fractures to transverse process at L1-L2. so i went back to doctor and on mentioning my issues with burning was prescribed medicines and isometrics.

upon taking the pill, within 1-2 hrs, my left foot’s intense tingling (basically buzzing vibration) reduces to a tolerable level. but my hand burning remains, upper back muscle seizing up remains.

I would appreciate any answers, insights on how to get you my MRI pics, whether they are sufficient and if my above symptoms show any evidence that its actually from nerve root compression at C5-C6 or C6-C7, or it could be any other issue. this issue has badly affected my life and forced me to curtail my activities. not being able to work on the computer or undertake any activities is another serious issue.

2009 MRI

History: Neck pain since 1yr 6 month
Technique: Multiplanar, Multisequence MRI imaging

Findings MRI:

Vertabrae:
Cervical spine shows normal alignment with morphology
Facetal joints: No significant facetal hypetrophic changes noted
CV Junction: Normal. No marrow pathology
Spinal canal:No bony canal stenosis

Intervertebral discs:
C6-C7: Diffuse disc bulge with mild impression on thecal sac. No focal root compressions. No extension into the foramina
Other discs: No significant disc herniations (2013 MRI shows mild bulge at C4-C5)
Cord: Shows normal signal morphology
Pre and para vertabral soft tissues appear normal

Impression:
Diffuse disc bulge at c6-c7 level with mild impression on thecal sac

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