[drjaffe]

#21958

Hi Dr. Corenman,

I injured myself about 7 weeks ago performing shoulder presses in the gym. I felt a burning sensationbetween my shoulder blades that lingered for about a week or so. Then, I developed marked weakness in my right triceps as well as some right pectoral weakness. I also developed neck pain with radiating pain (burning sometimes throbbing) that goes through my posterior deltoid down the medial aspect of my upper right arm and into the triceps. The pain also sometimes travels into my wrist extensors with tingling traveling to my hand, especially if I retract my neck or look to the right or fall asleep on my right side.

I had an MRI performed and this was what the radiology report said:

There is mild type I Modic endplate degenerative signal change present at
C3-C4 and C6-C7. There is no loss of vertebral body height and there is
no spondylolisthesis.

The spinal cord shows normal signal intensity and caliber throughout.

At the skull base and at C1-C2, the spinal canal is patent.

At C2-C3, no focal disc abnormalities are observed and there is no spinal
canal or neural foraminal narrowing.

At C3-C4, mild loss of disc height is present and there is a small disc
osteophyte complex. Eccentric focal increased endplate osteophytes are
appreciated within the right inner foraminal location. There is no
overall spinal canal narrowing, but eccentric narrowing at the right
aspect of the thecal sac is noted and there is mild narrowing of the
right neuroforamen. The left neuroforamen is patent.

At C4-C5, minimal early endplate osteophytes are appreciated, without
spinal canal or neural foraminal narrowing.

At C5-C6, a small to moderate-sized disc osteophyte complex is
appreciated, eccentric to the left. There is no spinal canal narrowing.
There is no right neural foraminal narrowing. There is mild narrowing of
the left neuroforamen.

At C6-C7, a small disc osteophyte complex is appreciated. Eccentric
increase osteophyte formation is appreciated within the left foraminal
location. Additionally, increased soft tissue is noted extending from the
disc margin in the right foraminal location, consistent with a
moderate-sized disc protrusion. Moderate to severe right neural foraminal
narrowing is present. There is moderate left neural foraminal narrowing.
There is no spinal canal narrowing.

At C7-T1, no focal disc abnormalities are observed and there is no spinal
canal or neural foraminal narrowing.

Assessment of soft tissues reveals no significant findings.

IMPRESSION: Right-sided disc protrusion at C6-C7 with right neural
foraminal narrowing.

I have seen 2 orthopedic spine specialists in the Boston, MA area who both said the MRI imaging was of poor quality and that the radiologist who read the MRI over estimated the damage at C6-C7. One surgeon recommended no treatment at all and thought that I had a 90% chance of getting better within 3 months. The other surgeon recommended conservative treatment at first with PT with traction, epidural shots, etc and then consider surgery if that fails. He felt that the problematic disc was really C5-C6 and that based on my MRI images I did not have enough compression at C6-C7 to cause triceps weakness. He mentioned that it could be possible C5-C6 could actually be the underlying cause of all of my symptoms including my triceps wekaness, and that if he were to consider a single level fusion it would most likely be at C5-C6 rather than C6-C7? He wanted me to come back in a month for a repeat MRI and possibly an EMG. The first surgeon did not seem to think on these lines at all.

Also, I am concerned about the abnormal findings noted on the MRI report at C3-C4. Is this likely to progress to the point of causing myelopathy?

I just wanted to ask you what your opinion is on how I should proceed going forward. I have had 5+ weeks of constant symptoms with little improvement in pain and no improvement in getting triceps strength back. I appreciate any advice you have.

~ David

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