Left hand pins, needles and weakness

Viewing 4 posts - 1 through 4 (of 4 total)

Author

Posts
slboudreau
Participant

May 15, 2018 at 10:21 am

Post count: 2

#28275

I am a 43 year old female with a 14 year military career from which I received a medical release due to “exercise intolerance” and a variety of other symptoms a will list below. A few weeks ago in the evening my hand felt like it “fell asleep” (wasn’t holding it in an awkward position or leaning on it) and I had extreme difficulty navigating my buttons when trying to get ready for bed. When I woke in the morning and it was the same (pins, needles and very weak). I went to outpatients and they performed an MRI of my brain and cervical spine to rule out stroke or other central nervous system disorders. Because I don’t have a family doctor, the results were being sent to an Internal Medicine specialist. When I phoned the specialist for follow up I was advised by the receptionist that “the doctor would not be calling me unless she sees something major on my MRI”. I still haven’t heard anything back so I requested a copy of my MRI results. Here is what was noted:
Straightening of the cervical spine. Multilevel degenerative disc disease and spondylisis at C4-C5, C5-C6 and C6-C7 with disc space narrowing, endplate bone spurring and degenerative changes of the Luschka joints. No marrow signal abnormalities. Normal position of the cerebellar tonsils.

No abnormality at C2-C3 or C3-C4.

At C4-C5 there is diffuse disc osteophyte complex which is causing flattening of the anterior aspect of the thecal sac and displacing CSF indicative of grade one cervical spinal stenosis. Minimal impingement of anterior cord. Bilateral neural foraminal narrowing, more severe on the right.

At C5-C6 there is diffuse disc osteophyte complex impinging the anterior aspect of the thecal sac and displacing CSF in keeping with grade one cervical spinal stenosis. Mild bilateral neural foraminal narrowing more significant on the right.

At C6-C7 there is just a mild diffuse disc osteophyte complex causing flattening of the anterior aspect of the thecal sac. No significant central canal stenosis. Neural foramina are patent.

No high signal in cervical cord indicate demyelination.

Impression: No evidence of cervical cord demyelination. Multilevel degenerative disc disease and spondylisis at C4-C5, C5-C6 and C6-C7. Grade one cervical canal stenosis at C4-C5 and C5-C6. Bilateral neural foraminal narrowing at C4-C5 and to a lesser extent C5-C6, worse on the right.

History of symptoms prior to my left hand tingling and weakness include neck pain, stiffness and decreased ROM for several years (thought it was normal aging and wear and tear from my military career), random muscle twitches in my leg and arm muscles, twitching of my left thumb and baby finger, arm weakness when performing tasks overhead, leg weakness when climbing stairs and walking long distance,daily headaches, and most recently, pain and and decreased ROM of my right upper arm that was thought to be rotator cuff related for which physio was prescribed with no improvement, and a burning pain in the back right side of my head.

CT of brain was normal other than “A couple of nonspecific high signal intensity foci in subcortical white matter of right frontal love, not likely of any clinical significance.”

My questions are:

Could the MRI results explain my symptoms?

Do I need to seek follow up for my MRI results?

Thank you for your time and consideration.

Donald Corenman, MD, DC
Moderator

May 16, 2018 at 7:45 pm

Post count: 8660

#28284

Paresthesias in the hand can be generated by nerve compression in the arm (see https://neckandback.com/conditions/carpel-tunnel-syndrome/, https://neckandback.com/conditions/cubital-tunnel-syndrome/ and https://neckandback.com/conditions/thoracic-outlet-syndrome/ but this is commonly caused by nerve compression.

The C5 nerve (C4-5 level) is compressed (“Bilateral neural foraminal narrowing, more severe on the right”) but this nerve does not descend into the hand so we can rule that one out.

C5-6 is read as “Mild bilateral neural foraminal narrowing more significant on the right” so if we can trust the accuracy of this reading then we can rule out the C6 nerve (but trusting that report could be a mistake).

C6-7 is also found to be OK (“Neural foramina are patent” meaning there is no compression).

There is no mention of the C7-T1 level (C8 nerve) but this nerve (along with the T1-2 level-again-no mention) also descends into the hand.

A good physical examination will differentiate these conditions and maybe having a spine surgeon do the exam and read these films would be your best bet.

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.

slboudreau
Participant

May 16, 2018 at 8:29 pm

Post count: 2

#28285

Thank you for your reply Dr. Corenman. I will return to outpatients to see if I can get a referral to a spine surgeon. Do you think the MRI results could explain the persistent pain in my right upper arm (constant nagging outer arm pain with sharp pain upon certain movements like reaching back for a seatbelt, throwing or sudden movements like reaching for a falling object)?

Sherri

Donald Corenman, MD, DC
Moderator

May 17, 2018 at 2:40 am

Post count: 8660

#28289

Pain from arm motion can be generated by the shoulder too (see https://neckandback.com/conditions/rotator-cuff-syndrome-shoulder-impingement-syndrome/). Right upper arm pain can originate from the C5 nerve which is compressed as noted by your MRI. See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

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.
Author

Posts

Viewing 4 posts - 1 through 4 (of 4 total)

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

81 reviews

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel