[CShepp1]

#27292

Hello,

I am a 33 yr old female with Ehlers-Danlos syndrome and early onset osteoporosis, particularly bad in the spine and hips. I had x-rays and upright MRI. The results are outlined below. I would like your opinion about the results, and what, if anything, can be done about them. I am having a lot of neck pain that seems disproportionate to the seemingly mild findings. I also have tingling/numbness in arms, particularly numbness in the pinky/ring finger with elbow pain, which a nerve conduction said wasn’t from cubital tunnel. I have brief, stinging electric-shock type sensations in face, neck, shoulders, and upper spine. I have a lot of spine/back pain with sciatica symptoms and particularly bad hip pain, especially if lay on side or press down on it.

However, my main question is about the cyst. What is done about a cyst there, and what causes them?

MRI:
Reduction in the normal cervical lordosis

There is a 1.2 x 0.8
cm cystic-appearing focus arising from the superior aspect of the left sternoclavicular joint
[sagittal T2 image 6].

Between the
flexion/neutral position and the extension views, there is subtle retrolisthesis of C3 over C4 and
C4 over C5 vertebrae [by approximately 0.1-0.2 cm]

C7/T1: Early facet joint
hypertrophy.

x-ray
straightening and minimal reversal of the normal lordosis. Mild grade 1 anterolisthesis of C2 on C3 with flexion measuring 1 mm which is reduced in the neutral view and demonstrates mild grade 1 retrolisthesis with extension measuring 1-2 mm. Additionally, there is mild grade 1 rethrolisthesis of C3 on C4 with extension measuring 1-2 mm, which is reduced in the neutral and flexion views.

X-ray Lumbar spine
degenerative disk disease at L5-S1 with facet arthropathy worst at L4-5 and L5-S1 along with mild rightward curve of mid lumbar spine cobb angle 4

x-ray Thoracic spine
mild leftward curvature of the mid-lower thoracic with cobb angle of 4

shoulder A/C joint arthroplasty

From physical therapist report: decreased range of motion, myofacial neck and upper back pain, protracted neck/scapula, left posterior innominate SI dysfunction, muscle spasms, sciatica, tingling, numbness, electric-shock type sensations in face, neck, spine.

Total bone mineral density (BMD) for lumbar spine in frontal projection for
the range of L1-L4 is 0.884 g/cm2, with T-Score of -2.5 and Z-Score of -2.5.
Total BMD for left hip is 0.699 g/cm2, with T-Score of -2.4 and Z-Score of
-2.3.
Total BMD for right hip is 0.681 g/cm2, with T-Score of -2.6 and Z-Score of
-2.5.
Total BMD for left femoral neck is 0.688 g/cm2, with a T-Score -2.5 and
Z-Score of -2.3.
Total BMD for right femoral neck is 0.647 g/cm2, with a T-Score -2.8 and
Z-Score of -2.6.
Osteoporosis: T-score at or below -2.5 SD

[Donald Corenman, MD, DC]

#27300

First, your T score for bone density is in the osteoporosis range so a consultation with an endocrinologist who has great experience in osteoporosis is highly important. You are in danger of fractures with a simple fall. Severe osteoporosis can cause deep bone pain so treatment might be helpful for some of your chronic pain.

Your cyst is most likely a ganglion cyst (AKA synovial cyst). These commonly occur from a degenerative joint where the synovial membrane forms a cyst filled with synovial fluid. This cyst is generally not dangerous unless the cyst in under this joint and causing compression of the sub-sternal structures. It can be aspirated if it is above the joint and injected with a particulate steroid.

You do have CNS (crappy neck syndrome) due to multiple degenerative changes in your neck that don’t sound to be dangerous based on your description.A good rehabilitation program will be helpful along with strengthening. See
https://neckandback.com/pre-and-post-op/neck-situp-exercises/

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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