[advrider]

#28937

Dr. Corenman,

Thank you offering this forum and providing information about spine injuries, it’s been a valuable resource as I try to navigate a neck and shoulder injury.

I’m in military special operations and have been struggling with severe neck pain for a year, complicated by a shoulder issue. I injured my right shoulder in Jan. 2016, had an MRI and saw a specialist who thought it was tendinitis and continued to train. I continued to have right shoulder pain, then in the summer of 2017 I began experiencing occasional neck pain, especially on the right side, that felt like generalized aching.

In October 2017 I was carrying a heavy backpack on a long march and my right arm went numb and weak. I had almost complete arm weakness that lasted for 2 weeks, followed by several months of numbness and pins and needles in my right arm any time I put weight on my arm – leaving over a desk or table for example. I had some neck pain at this time, again mostly on the right side.

I saw primary care several times for my neck and arm weakness who blew me off, then in Jan 2018 I was seeing another shoulder specialist who informed me I had a partial tear of my right infraspinatus that couldn’t be surgically repaired because it was intramuscular. However, he was concerned about my neck pain and also detected that my infraspinatus had almost completely atrophied. This was not noticed in a shoulder exam 4 months previously.

He ordered a cervical MRI and EMG in February 2018 to assess right suprascapular neuropathy and right cervical radiculopathy. The EMG came back clear, MRI report below. My neck pain and upper back pain continued to get worse and I was referred to a pain management clinic, I had two interlaminar ESIs, one at C7-T1, another at C6-C7. Neither provided any relief.

I then began to have severe burning type in my upper back behind my shoulder blades and severe pain shooting down my spine when in neck extension, as well as the general aching neck/upper trap pain. I was referred to a spine surgeon who suggested that because I was no longer having arm pain and he assessed me as not having arm weakness that I continue with pain management.

I had an RFA in June 2018 which eliminated the burning pain behind my shoulder blades and pain in neck extension – I can fully extend with zero pain now. However, I continue to have worsening muscle pain in my upper traps and neck, now on both sides, and my neck ROM is more restricted than it has been at any point.

I recently saw another spine surgeon who assessed my right arm as significantly weaker than my left (I have almost no strength in the wrist flexion/extension or bicep test). He believes something is going on, but was unwilling to recommend anything without an additional MRI. He is also concerned that my strength may not return even if he performed a surgical intervention because of the length of time since the original arm weakness (Oct 2017).

I have no right arm pain, but I continue to get faint pins and needles in my right arm and occasionally in my left while walking quickly. I’ve read that tight neck/upper trap muscles can produce those symptoms – it seems strange that I would have them on the left side as well if it was cervical herniation. My neck and upper trap muscular pain is greatly affecting my quality of life at this point, the most recent spine surgeon seemed doubtful that all the muscular issues could be a result of a cervical herniation, but prior to this neck injury I was extremely healthy and had never had a neck or back injury or pain. I’ve tried PT, massage, acupuncture, chiro – basically everything at this point.

Would appreciate any insight you can offer,

Cervical MRI Report:

C2-C3: No focal disc protrusion, central canal or neural foraminal stenosis.
C3-C4: Mild right neural foraminal stenosis. No disc protrusion or central canal stenosis.
C4-C5: Mild right neural foraminal stenosis. No disc protrusion or central canal stenosis.
C5-C6: No focal disc protrusion or central canal stenosis
C6-C7: Right posterior lateral disc protrusion indents the thecal sac with anterior right central canal narrowing and right neural foraminal stenosis.

Shoulder MRI Report:

Rotator Cuff: The supraspinatus, subscapularis, and teres minor are intact. Infraspinatus is unchanged in appearance from prior and remains significantly atrophy. There is no rotator cuff fatty infiltration or atrophy.

No other abnormalities observed.

[Donald Corenman, MD, DC]

#29224

“C6-C7: Right posterior lateral disc protrusion indents the thecal sac with anterior right central canal narrowing and right neural foraminal stenosis”. This indicates that you have (or had) a compression of the C7 nerve root. See if either of these two have the symptoms that you currently have. https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and
https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/.

Your report; “Rotator Cuff: The supraspinatus, subscapularis, and teres minor are intact. Infraspinatus is unchanged in appearance from prior and remains significantly atrophy” indicates involvement of either the C6 nerve root (but there is no evidence of a C6 nerve involvement on your MRI reading) or involvement of the supra scapular nerve where it can get caught in the suprascapular notch.

Your commwnt “I recently saw another spine surgeon who assessed my right arm as significantly weaker than my left (I have almost no strength in the wrist flexion/extension or bicep test)” does not fit as the root compressed is C7 and these muscles you describe as being weak are a C6 nerve involvement. You might have developed Parsonage Turner syndrome (https://neckandback.com/conditions/parsonage-turner-syndrome-neck/) as a possible diagnosis. An EMG/NCV test with a neurologist should be the next step.

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.

[advrider]

#29384

Dr. Corenman,

Thank you for the reply. I took a look at those pages, symptoms didn’t match exactly, my major complaint is unrelenting muscle pain in neck, traps, upper back and right arm weakness. I rarely get pins and needles in my right arm now, much less than several months ago.

I had the second cervical MRI that the spine surgeon ordered. Findings were identical to the first MRI report above, and he recommended not doing surgery.

I had a recent EMG for suprascapular nerve entrapment. It was inconclusive, but they thought it was possible it was entrapped at the spinoglenoid notch.

However, my entire right arm continues to be weak, as well as muscles in my upper back (lat, serratus anterior) on the right side. The suprascapular nerve entrapment wouldn’t explain that weakness according to the doctors I’ve seen so they’re ordering additional tests.

They’ve ordered a CT of the chest and upper right extremity, a CT myelogram of the neck, and a brachial plexus MRI and referred me to a neurologist. They’ve also discussed doing a scalene block after I have the diagnostic exams.

It seems possible it could be TOS based off what I read on your site and others, but it doesn’t seem to be a well understood condition.

[Donald Corenman, MD, DC]

#29390

Thoracic outlet syndrome normally affects the Ulnar nerve more than the Median nerve with which you don’t have symptoms associated. An EMG/NCV should be helpful for diagnosis. A good neurologist consultation should be part of your work-up.

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.

[advrider]

#30676

Dr. Corenman,

I wanted to reach out to you as I’m still dealing with this issue. I had a suprascapular nerve release surgery in January 2019 which significantly relieved some of the pain I had in my right shoulder blade, however I’m still continuing to deal with bilateral neck and trap pain and weakness in my right arm.

I took your advice and saw a neuromusclar neurologist and had an EMG, results below:

“This abnormal study provides electrodiagnostic evidence of
subchronic reinnervation that was most pronounced in the right
extensor digitorum communis muscle with more subtle findings in
the right triceps brachii and pronator teres muscles. No findings
of active or ongoing denervation were observed. The findings
could owe to a subchronic right C7 radiculopathy, though
confirmatory findings were not seen in the mid-cervical
paraspinal muscles. Despite the clinical history raising concern
for an upper trunk plexus lesion, no significant neurogenic
findings were seen in upper brachial plexus muscles. Clinical
correlation is advised.”

The neurologist wrote that “on examination today, he has weakness in predominantly C7 innervated muscles, consistent with the EMG results of today showing chronic reinnervation changes in C7 distributing muscles. We discussed that this is all consistent with a chronic right C7 radiculopathy. Although he still has weakness on examination, there was no evidence of ongoing denervation, which is reassuring. It is possible that the more proximal pain was due to suprascapular nerve entrapment, so we agreed that continuing to monitor for postoperative improvement would be reasonable at this point rather than pursuing the possibility of cervical spine decompression.”

That was 6 months ago and I’m continuing to have neck pain and right arm weakness, I also saw a thoracic outlet specialist who said that I have symptoms that correspond to neurogenic TOS, but that is impossible to differentiate between neurogenic TOS and cervical spine issues in many cases and recommended pursuing a cervical spine operation as c-spine issues are much more common than neurogenic TOS.

I met with a spine surgeon and he seemed ambivalent about whether an ACDF or ADR would help because the majority of my pain is my neck and I only have occasional tingling and triceps spasms in my right arm and the fact that this is now chronic.

FINDINGS: Anatomic alignment of the cervical spine. The vertebral body heights are maintained and the marrow signal is normal. The craniocervical junction is within normal limits. Normal signal and caliber of the spinal cord.

Segmental analysis as follows:

C2-C3: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

C3-C4: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

C4-C5: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

C5-C6: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

C6-C7: Mild broad-based disc bulge with superimposed moderate right paracentral to foraminal disc protrusion. There is mild narrowing of the spinal canal with flattening of the ventral cord. Mild to moderate narrowing in the right neural foramen and mild narrowing of the left neural foramen.

C7-T1: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

IMPRESSION: Moderate degenerative disc disease at C6-C7.

Any thoughts on whether you think this supports a cervical operation and would there be any evidence that predisposes you to an ACDF vs an ADR?

Thank you for any advice.

[Donald Corenman, MD, DC]

#30688

You have weakness and neurological findings of a C7 radiculopathy. I suspect the foraminal compression is greater than the radiologist noted (“Mild to moderate narrowing in the right neural foramen”). If you have failed therapy, you could consider a selective nerve root block at C6-7 short of surgery.

The question of ACDF vs ADR depends upon the amount of degeneration of the C6-7 level and the stability. If the disc has lost greater than 50% of its height or there is shifting of the disc (spondylolisthesis), then you would not be a candidate for an ADR. If the changes are less than noted, an ADR could be considered.

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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