Disc Herniation plus other things

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dimalm
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October 9, 2012 at 2:10 am

Post count: 2

#7132

Hello Doctor,

Thank you very much for answering people’s questions.
Will try to be as brief as possible.

Background:
38 year old male, active in sports.
Over last year have been doing pretty extension jiu jitsu and playing soccer at least twice a week.

I injured my knee playing soccer end of august and that kind of opened up a can of worms :(

Up until that point i was ignoring off and on pain in my left shoulder blade and the fact that my left arm would “fall asleep” every night(only the two smallest fingers).

to cut the long story short, pain in left shoulder blade became unberable(i was still trying to do jiu jitsu and boxing with injured knee…) it was fine when i would lie down or sit down or even standing was ok but as soon as i started walking pain in my left shoulder blade would become very intense and i had to stop after about a minute.

i went to chiro, othropaed(who treated my knee), everyone dismissed as simple pinched nerve.

my left arm was getting better but after right arm started feeling tired off and on i became more concerned and went to see a neurologist.

EMG found pinched nerve at left elbow(so that explained that), it is getting better but still sometimes at night it would fall asleep. Anything i can do here?
EMG also found curpal tunnel right wrist(I had this injury off and on so no surprises there).
But otherwise they said everything is great and whatever I feel is not coming from my neck.

Neuro also ordered MRI.

Thoratic is fine
Cervical:
Normal alignment.
The spinal cord demonstrates normal signal intensity. Bone marrow, etc. normal, unremarkable.

C3-4 minimal disc bulge, slightly larger on the left side.

C6-7 There is a moderate-sized right paracentral disc extrusion with slight flattening of the right ventral aspect of the spinal cord and mild narrowing of the right lateral recess.

No cord edema.
Everything is unremarkable, some disc degeneration but was told everyone is like that…

Ok so that maybe explained the tiredness in right arm but if it is extruding to the right why is my left shoulder blade “killing” me :)

I have seen injury doctor who specializes in jiu jitsu, basically saying not a big deal as i can move my neck every which way and it doesn’t bother me and I don’t have any limit to my range of motion anywhere.

Neuro checked me pretty good(her words) and strength is good and everything is great, just the disc.

Was told to stay off the mat for a month and then can return to jiu jitsu but no sparring for another months.

Meanwhile knee is getting better and have been oked to run and play soccer. Every time i play left shoulder blade hurts but not a lot i can play though it.

I can walk about 15-20 minutes and then usually it starts with throbbing on shoulder blade and then will eventually turn into pain(but pain is bearable). Also some activities will make shoulder blade throb(like someone is gently tapping on it) and will turn to pain eventually. If i walk with hands behind my back its much better but will turn to pain eventually.
Right arm getting tired is still there but I think it is less often and maybe less extreme, kind of hard to tell.

Of course, now, I have been paying too much attention to everything that rattles me… can’t say I am happy about it but…

I have been very eager to return to sports, I am confused what can or can’t I do, and what can I do to help myself.
It has been about 1.5 month since my shoulder blade initially hurt and I have about 3 more weeks to go before I was told I can go back to jiu jitsu.

I have been going to physical therapy, for knee initally and now for neck, they have been doing traction and exercises but honestly I don’t think any of this is helping just time.

I know this was long but from reading other threads you want the details so you can have all the info at your disposal.

I also have a sitdown job but try to be active in the evenings.

Thanks,
D.

dimalm
Member

October 9, 2012 at 3:05 am

Post count: 2

#7134

I just re-read my post and I guess I didn’t really formulate any meaningful questions.

I understand that herniated disc can have a variety of symptoms but I am just not at ease with the variety of symptoms I am having. Pain in left shoulder blade, tiredness in right arm and just general feeling of not right, I don’t know hard to explain. I can do everything with right arm, even when its tired but it just doesn’t feel “tight”. Maybe coupling with wrist injury and the fact that I abruptly had to stop sports, I don’t know…

Donald Corenman, MD, DC
Moderator

October 9, 2012 at 4:30 pm

Post count: 8660

#7140

You have three symptoms that might be independent of each other. The numbness of your left two fingers fits with the EMG report of ulnar nerve compression (cubital tunnel syndrome). The nerve is somewhat compressed in your elbow and bending the elbow stretches the nerve, causing numbness of the outside of your hand. For this disorder, you can try a splint that causes your elbow to remain straight when sleeping. There are hand surgeons that can inject a steroid to reduce inflammation and finally, you an have the nerve surgically decompressed.

Pain in the left shoulder blade could be from cervical nerve root compression but the MRI does not confirm this. The EMG test can fail to diagnose this. The EMG depends upon motor nerve compression to diagnose compression. If the motor nerve is functioning well but the sensory and pain nerves are compressed (a common scenario), the EMG will be negative but the pain will still be excruciating. Other disorders that can cause left shoulder pain are rotator cuff problems and instability (common with martial arts).

The right arm weakness could be from the herniation of the C6-7 level. This nerve supplies the triceps muscle, the wrist flexor muscle (it pushes your wrist to the palm side down) and the MCP extensors (I won’t bother you with that description). Normally, the EMG will indicate problems here but the EMG test is operator dependent and subtle findings can occasionally be missed. You can test the triceps muscle with a weight machine. Can you do as many reps with as much weight on the left as you can do on the right?

You need a skilled spine surgeon and a shoulder surgeon to ferret out these complaints.

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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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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