MRI Cervical Neck Findings

Tagged: Stretch cervical nerve and brachial plexus injury

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Mpneagle
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July 22, 2017 at 1:45 pm

Post count: 11

#25618

Dr. Corenman

Thanks you for the reply and the time you have taken to look at my problem.

The accident that caused the trauma was a dirt bike wreck. Unfortanly I do not recall a lot of the details. I would guess the speed around 40mph.

Regarding the shoulder, I did have an MRI completed of my shoulder here are the results:

FINDINGS:
Osseous acromion outlet: The acromion is type 2. Coronal images demonstrate
mild lateral downsloping. The AC joint is unremarkable.
Rotator Cuff: There is insertional strain of the supraspinatus tendon with
minimal interstitial delamination partial tearing seen on coronal image #7. No
discrete or through-and-through tear. There is edema and mild fatty atrophic
change within the infraspinatus muscle belly seen on coronal image number 11
and axial image number 10 within the supraspinatus and deltoid muscle bellies
seen on coronal image #4. Findings could be a strain or denervation. Given
that the findings affect to different nerve distributions, if denervation then
the findings likely represent Parsonage Turner syndrome.
Labral and capsular structures: There is no evidence for Bankart lesion or
posterior labral tear. No evidence for capsulitis.
Biceps tendon and anchor: No evidence for biceps anchor tear. No evidence for
biceps dislocation or subluxation.
Osseous structures: There is bone marrow edema within the greater tuberosity
consistent with a bone trabecular injury. No cortical fractures seen.
Other findings:The suprascapular and spinoglenoid notch appear normal. No mass
identified.
IMPRESSION:
1. Insertional strain of the supraspinatus tendon without discrete or
through-and-through tear.

2. Strain of the infraspinatus, supraspinatus and deltoid muscle bellies
versus denervation change. If denervation, consider person’s turner syndrome
given more than a single nerve distribution.

The shoulder specialist had me perform some basic elevations with my arm and he is the one who noted the atrophy as mentioned above. He was glad I had some gains.

In regard to the EMG I guess I was vague as I didn’t have the report electronically but I will recreate it here:

IMPRESSION:

Severe left c5/6 radiculopathy. The involvement of the rhomboids makes this more likely to be nerve root related than upper trunk plexopathy although both could be injured. There are motor units present suggesting that the nerve stretch did not damage all nerve fibers. Prognosis for functional recovery remains guarded but given proximal localization and presence of motor units, one would expect improvement.

Followup in 4 to 6 months may be helpful.

Typically when I went for visits they would check for strength such as “don’t let me pull your arms, don’t let me push your arms, etc”. These test all noted the left side as being weaker.

It seems each doctor I see (neurologist, orthopedist, neurosurgeon) all say things should come back in time. Hence my comment of the wait and see approach.

I would like to provide you with an MRI image that may help but I am unsure which one I should post.

Thank you again

Donald Corenman, MD, DC
Moderator

July 22, 2017 at 4:16 pm

Post count: 8660

#25624

It appears you had a stretch injury of the nerve roots and brachial plexus. This is common if you take a fall at speed and impact your shoulder. The EMG report notes “severe left c5/6 radiculopathy. The involvement of the rhomboids makes this more likely to be nerve root related than upper trunk plexopathy although both could be injured. There are motor units present suggesting that the nerve stretch did not damage all nerve fibers”. This report alludes to stretch which makes the injury non-surgically repairable. Stretch injuries take time and sometimes, only partial functional recovery occurs. See “https://neckandback.com/conditions/how-muscles-recover-from-nerve-injuries-neck/” and “https://neckandback.com/conditions/stingers-and-burners/”.

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.

Mpneagle
Participant

July 22, 2017 at 4:45 pm

Post count: 11

#25627

Dr.Corenmen

Thank you again for your educational reply.

What are your thoughts on a follow-up EMG study would this be worth while? My previous EMG was completed on 6/21. From reading the linked articles. I am hoping that the myelin sheath is still intact and will repair on its own over time. I hope this is the case since the EMG showed nerves to be intact and only have partial denervation. This regrowth will take some time as the article states. I guess its fortunate that the muscles that are in question are close so regrowth of the path may not take too long.

In the case of the nerve budding scenario since some nerve input is occurring this could also be the cure assuming there is enough inputs to “pickup” the lost ones.

It seems this all takes a considerable amount of time. My question now is how long should I wait to seek some kind of surgical fix assuming there is one? Is there a length of time that is just too long that would yield no chance at recovery? Is going to physical therapy (neck stretches, range of motion exercises, etc) worthwhile to prevent muscles from atrophying further and even recovering from the atrophy? Also, can a TENS or EMS aid in the recovery process?

Thank you again!

Donald Corenman, MD, DC
Moderator

July 23, 2017 at 7:27 am

Post count: 8660

#25638

If your injury is strictly a stretch injury of the cervical nerves and brachial plexus, there really is nothing more you can do than wait for healing to occur. If there is a specific nerve compression (and according to your MRI reading, there is not), then surgery could be considered.

Interestingly, electrical stimulation can possibly delay healing as the muscles put out a chemotactic factor (a protein that calls the intact nerves around the injured muscle cells to sprout) that can be delayed if electrical activity is induced artificially in the muscle.

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.

Mpneagle
Participant

July 23, 2017 at 7:48 am

Post count: 11

#25639

I have learned that there can be imaging done of the brachial plexus network. From looking at what I have found it should be able to see the stretch and it’s improvement over time. Maybe heading to a good neurologist with experience in this type of imaging is warranted. Them maybe subsequent follow up visits to check the changes.

The MRIs that I have already had done don’t focus on this so possibly it could provide more information and some guidence.

Dr. Thanks again for your time and effort here. Its comforting to have an expert that responds.

Donald Corenman, MD, DC
Moderator

July 23, 2017 at 8:24 am

Post count: 8660

#25642

A brachial plexus scan is a specific scan with a specific protocol. The imaging technician with the radiologist is important, not the ordering physician. Since you have innervation (EMG) findings of some connection to your muscles, it is unlikely that you have a nerve avulsion which is the only surgically fixable problem.

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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Donald Corenman, MD, DC

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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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