[Longbranch]

#23233

Dr. Corenman, I don’t know if you will ever see this note, this is a follow up to a year old topic that I was asking you questions about. I was asking you what you thought about doing a D-trax surgery on my C6-7 pseudoarthrosis from the year 2003 and you told me that this was not the way to go for my pain and that you told me that I had Crappy Neck Syndrome and I definitely believe you!!!
I still find myself (this being October 19, 2016) I am still no further ahead with my Chronic Pain. I don’t know how much more I can take and still no diagnosis. The reason I am asking you this question is because I am so upset that nobody can find out where my pain is from. I am now going to a new Neuromuscular doctor because my last Neurologist sent me for a Nerve Conduction Test/EMG before he wanted to discuss the possibility of going in with the D-trax facet posterolateral cage fusion in the back of my neck to try and fuse C6-7 as he figures that is where my pain is coming from.He also says I have hypermobility at C4-5 and C1-2 arthrosis in addition to general fibromyalgia. We also discussed a C4-5 arthroplasty down the line if it makes sense.
I have told all of the surgeons that my pain radiates from my neck into my shoulders (trapezius area) down into the front of my arm into my wrist and my hands. I do get numbness and tingly often in both of my hands but mostly my right arm.
They eventually sent me for an MRI of my shoulder with and without contrast. The results were Minimal Articular side undersurface tear of the supraspinatus tendon. No full thickness tear. also Mild hypertrophic degenerative changes of the acromioclavicular joint. The neurosurgeon who sent me for that made absolutely no comment and the other surgeon that was basically going to operate with him all of a sudden said that basically that is where my pain was coming from and cancelled the surgery without even telling me (I believe just to get rid of me). OK so now the other surgeon(The main Surgeon who is a Complex Surgeon who specializes in “Resconstruction Surgery” decides to do the d-trax surgery and I had the date for the surgery and it was cancelled and I was waiting for a new date and I never heard back from him!!! I decided to go to a new Neurosurgeon for another opinion that I know is familiar also with this surgery and before we decide to go through with this as he agrees that this could work but was still skeptical as where the pain is coming from decides to send me for an EMG of my “Upper Extremities” Bilaterally and it comes back with “Myotonic Discharges” in all muscles tested which were Supraspinatus, Infraspinatus, Deltoid, Biceps, Triceps,Brachioradials,PronTeres,FlexCarpRad,ExtCarpiBrev,ExtDigComm, there were a few more but these are the muscles that showed the myotonic discharges. The report says that the EMG was abnormal and that the electrodiagnostic evidence myotonic dystrophy. No electrodiagnostic evidence of a cervical radiculopathy, brachial plexopathy, compressive mononeuropathy or peripheral polyneuropathy. It says also, With the Myotonic dystrophy it is hard to detect any denervation to diagnose a radiculopathy. Now the surgeon sent me for the EMG and it says Cervical disc disorder with radiculopathy. As far as I understand because of the myotonic discharges he could not see a radiculopathy. I am absolutely fed up with everything, so the EMG doctor was basically telling me that I had some sort of genetic disorder like a myotonic muscular dystrophy and I said that I didn’t have anything like that in my genetics. Both of my parents are diseased and grandparents on both sides. He said, well you got it from somewhere. So then I make an appointment with a Neuromuscular Science specialist and she tested all of my muscles and said they are too strong to have Myotonic muscular dystrophy and I told her I think it starts in my neck and she just doesn’t want to talk about the possibility that this could be coming from my neck. I believe she is a specialist in the Dystrophies/Myopathys, Channelopathes etc. department and right now she doesn’t want to look “out of the box”. She wants to concentrate on the myotonic discharges. He put the needle in my muscles and the noice was unbelieve as the call it, sounds like a “dive bomber”, I absolutely heard them!!!

She said it could be a channelopathy disorder and wanted me to do the test over, the EMG with upper lower and back done. Now she wants me to wait. She also did the blood test which I have never had done until last week for the I believe it was CPK protein for my muscles, it could possiblity show muscle disorders or dystrophies and it came back normal.
In 2001 I had an EMG in my left arm, it showed myotonia congenita and I have had 2 EMG’s and an MRI in my back showing, Radiculopathy disc bulging, degenerative discs, disc herniation, but it is my upper extremities and neck I am worried about. I do have pain in my thighs, hips and legs but it is my neck problem that I am trying to deal with. My neck, shoulder and arm right down into my hands is the issue where my pain is the worse. My left side aches but it is my right side mostly that is the problem. I am so so sorry to bother you, but my life is just a mess, always in pain for the last 20 years and no relief. Is there any tie that you can think of from my neck pain to my shoulders with the myotonic discharges. I have probably really overstepped my boundaries in sending this to you Dr. Corenman but sometimes these problems might even help with a case that you might have someday with one of your patients. Thank you so much and I hope to hear from you soon. Lynda Hurrelbrinck

[Donald Corenman, MD, DC]

#23240

First-read the EMG/NCV section on the website to understand what this test can and cannot discern. You will find that pain and numbness will not be detected by this test so the information generally is not helpful in your case. The dive bomber sound is typically associated with myoclonus which is most likely what you have with your muscle disorder. This condition generally does not cause typical neck or shoulder pain.

To determine what is causing pain, diagnostic injections may be the key in your case. Is your shoulder causing more pain than your neck? An injection of lidocaine into the shoulder will give you some relief depending upon how much pain is generated by the shoulder. If you have minimal relief, then it is likely that the shoulder is not causing pain. I will say that neurosurgeons generally do not have the ability to examine the shoulder and determine if there is a shoulder problem. Orthopaedic surgeons are the ones who can determine that disorder.

Diagnostic blocks of nerve roots (SNRB), facets (facet blocks) or even discograms could be used to workup your neck and shoulder pain to determine where the pain is generated.

Again, the D-trax surgery for a pseudoarthrosis is not the best procedure to repair this lack of fusion so I am not sad that this surgery was cancelled.

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.

[Longbranch]

#23268

Dr. Corenman
I did not realize that you had answered me. Thank you so much for your answer which has just confused me more. I have been waiting for the “neuromuscular science team” to reply which was supposed to be early last week and as usual nobody has got back to me yet. They are asking me questions about how long I have been on statin drugs if that could be causing my muscle pain and as I mentioned to you they said my muscles are still very strong even though I feel very weak and fatigued all of the time!!!
I am beginning to feel that there is no “light at the end of the tunnel for me” and I just don’t understand why not? So you are actually saying that this Nerve conduction study and EMG test might tell me what is going on in my muscles but it is not going to help for my neck pain. I have been thinking all along that it was connected maybe?

The pain seems to come from my neck and run down into my shoulders (particularly my right one more than my left) which is where I have the small tear that I mentioned in my last note and goes down my arm, my elbow, into my wrist and into my hand. My hand in fact both my hands have been going numb off and on for years, my ring and my pinky fingers. My shoulders have ached badly for years (all of the muscles ache badly, do my shoulders hurt worse than my neck…I don’t think anything hurts worse than the chronic pain in my neck!!!
I have had all of those shots that you suggested years ago, nerve ablations, you name it I have had it and didn’t get much relief at the time!! I never did have a discogram, I will do anything to get a proper diagnosis and yes you are correct I don’t know if the last few neurosurgeons have given me the correct diagnosis either if you say that the D-trax is not going to work. I did go to an Orthopedic surgeon who was going to do the surgery but the problem for years is nobody seems to be 100% sure if I am actually fused at C6-7 or not. I seem to be passed around from one doctor to another. He said he thought I was fused and the next time I came back to him he didn’t even seem to know why I was there. I told him he sent me for another scan and then when he went to study the new scan he came out of his office and said “oh you are not fused”, I didn’t feel very confident even though he is very well known in the state that I live which is Michigan. He gave me the paperwork on a fusion to be done this time going in through the back (his paperwork says …indication for a surgical intervention in the form of a posterior cervical decompression and fusion to treat her nonunion of fusion. He did tell me to go to an orthopedic surgeon for my shoulder pain!!!! I just remembered that!!!! He is an orthopedic doctor!!! (I give up), this has been going on for so long, things come up all of the time, no wonder I am confused!!!
I took that new scan (because it just seemed so “matter of fact” that one minute he remembers the next minute, oh yes you are not fused” to another well known “neurosurgeon” who wasn’t exactly positive either and he is the one who wanted me to get the neurosurgeon who is the one who wanted to do the D-trax surgery and we know that that got all screwed up. He made me sign a paper that said this would be the first D-trax surgery that he would be doing!!!
The pain management specialist that did the EMG test didn’t seem to know if the myotonic discharges were related to my neck but says it is related to my shoulder because there were myotonic discharges in my shoulders and most doctors even my GP seem to think it is myotonic dystrophy or myotonia congenita. Either way it is certainly not the life I want to live with the neck pain being maybe a separate problem!!!
I am so confused and am sick of being in so much pain for 16 years. I am 65 years old now and have such a wonderful life and beautiful children and grandchildren and an amazing husband and feel like I am facing a disability of everything. I am waiting for the specialist to call me back!! I have an appointment for another EMG of my arms, legs and back again because the other test was done at an outside institute. It is in a few weeks!!I will certainly try an orthopedic surgeon or orthopedic doctor as you suggested and thank you so much for taking the time out of your busy day to answer me. She is saying maybe she doesn’t want me to have that done now because in the year 2001 they saw myotonic discharges in my left arm and at that time they called it myotonia congenita.

Again Dr. Corenman thank you so much for reading this and for answering me. I do appreciate your advice and I will go back to another Orthopedic doctor as you suggested and hopefully some day I will get some answers as to what is going on. My chiropractors also have taken some good x-rays of my neck that they say I am not fused and I keep on going to get adjustments weekly but the pain never goes away.
Take care, thank you Lyn Hurrelbrinck

[Donald Corenman, MD, DC]

#23366

EMGs will delineate motor messages that are impeded but these tests are not sensitive for pain as pain nerve are too small to be picked up from these tests.

Pseudoarthroses can be painful but about 50% are not painful. The only way to discover if they are or are not painful is with a block (similar to a discogram) but the fluid injected is numbing medication and not X-ray dye. This test is however not 100% predictive of pain generation. That is, you could have a negative block (a block that does not relieve pain) but the disc in real life does cause your pain. This is called a false negative test.

You could have the non-fusion fixed surgically to see if you get relief and if no relief, then further go on to test other levels (with discograms).

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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