[Tom]

#32348

Hi Dr. Corenman,

I’m a male in my early 30’s and was in a rear end accident over two years ago — 60mph impact.  I’ve had intermittent dull aches in my right thoracic spine as well as frontal left shoulder aches (which had a grade 1 AC separation) and clicks/pops all the time.  

My initial cervical & thoracic MRIs taken 3 weeks after the accident showed the following — cervical rather normal, thoracic a bit more problematic.
Cervical: C3-C4 C4-C5 C5-C6 Broad Based 1mm posterior disc protrusion.  AP diameter 12mm.  All other levels normal.
Thoracic:  T3-T4 Broad Based 1mm protrusion, T5-T6 Right paracentral/lateral 3mm protrusion mildly indenting the ventral surface of the spinal cord (no cord edema present to suggest acute compression).  Mild right lateral recess narrowing.  T7-T8 Left lateral 2mm disc protrusion, 12mm canal

In August 2019 my thoracic spine started clicking when breathing and got me all concerned, so I visited a chiro to see if an adjustment would help. While it was my 8th or 9th chiro visit within the last 2 years, when he was adjusting my neck I somehow flinched and resisted the HLVA technique. No audible pops, just muscle tension.  No pain at the time, but quite unsettling.  

Coincidentally, I had an EMG scheduled prior to this incident in order to discover if there was any nerve disfunction affecting my left shoulder, which took place 3 weeks after the chiro accident.  Between the chiro visit and EMG study, I began experiencing electric-like shock symptoms on the left side of my neck — sometimes localized to the nape of my neck, sometimes radiating across my trap.  The EMG study revealed Moderate Chronic C8 radiculopathy on the left.  In reviewing this study with my Ortho, he ordered an CTA Chest with contrast and an MRI Brachial plexus to rule out any plexopathy related to my thoracic outlet syndrome.  Both studies were negative.

I went through over 12 weeks of physical therapy, and continue to do so to this day but things still haven’t resolved.  I visited a pain doc last month who ordered another MRI.  That report showed:
C3-C4 posterior 2mm bulge, Mild uncovertebral hypertrophy.  
C4-5 Minimal posterior bulge.
C5-6 Minimal bulge with mild uncovertabral hypertrophy.  C6-7 no significant bulge.  
C7-T1 Left paracentral shalloow disc protrusion measuring approximately 1.6mm AP.  This measures approximately 5.2mm transversely.  This mildly effaces the ventral thecal sac.  This may contact the ventral nerve rootlet on the left.  No significant spinal canal stenosis.  No significant facet joint arthropathy or foraminal narrowing.
At the T1-T2 level, there is a ventral disc osteophyte complex.

I’m curious what the “5.2mm transversely” means.  Here is an image of my C7-T1 if you can offer an opinion:

Epidural Steroid Injections were scheduled for 3/13, but I cancelled due to concerns of side effects and didn’t want to dampen my immune system during this pandemic.  I’m not opposed to ESIs if necessary, but reading about their inability to correct the core problem leaves me with little hope that I could benefit from them.  I’ve looked into alternative procedures like Regenexx’s PL-Disc Platelet Lysate epidural as well and am leaning more that way if anything.

In the early stages of this shocking symptom (7 months ago), I didn’t monitor my activity heavily to avoid this shocking pain — I was more busy trying to see what my limits were and what made it happen so I could tell doctors.  Working under my car with awkward arm and neck positions, etc.  Heck, just 2 weeks ago I tried to go indoor rock climbing thinking I could manage and re-aggravated it all over again.  The pain isn’t in any way constant, it comes and goes.  Doesn’t happen when I sleep.  No paresthesia.  Symptoms are not aggravated by spurling/compression test.  Perhaps the most consistent motion that exacerbates it is when I try to nerve glide (both arms out, right hand down, turn my head to the right and ZING!)

While we’re on lock-down, I am really focusing on improving non-operatively — at-home traction, natural anti-inflammatories, better diet, PT exercises that DON’T aggravate, and I even have a posture-pump in attempt to restore my neck curve and release tension.

Would love your opinion on the chiro incident and if I should be on the lookout for anything else that it may have caused.  Its my opinion that the rotational torsion of my neck (with me resisting) is what caused the disc bulge, given the difference in MRI findings and timing of the onset of symptoms.

In your opinion, do I have any hope of spontaneous regression or lessening of the pressure on my ventral C8 nerve root through conservative treatment?  Is surgery a likely outcome in my case?  

Sorry this was so long — just lots on my mind. I really appreciate any insight & help you’re able to provide.

Sincerely,
Tom

[Tom]

#32359

One other symptom I’m having — when massaging the musculature of my left trap with my index finger, starting from the base of my skull moving downwards, there’s a point where I get instant electric shock with pins & needles that travels to my index finger. If this is instigated by palpation, is there an indication of what structure could be the culprit? Could it also be my C7-T1 junction or perhaps facets? Thank you doctor Corenman.

[Donald Corenman, MD, DC]

#32366

The C7-T1 level is less subject to motion so a spurling’s compression test might not be too positive. Do you have motor weakness of your hand (grip strength loss)?

Chiropractic manipulation can on occasion enlarge a disc herniation and create pain in a nerve root.

Your self-manipulation of your shoulder creating “zinging” into your arm is probably stimulating the C8 root which will be sensitive.

As long as you have no motor weakness of your hand, you should be OK waiting to allow the root to calm down. You can ask your treating doc for an oral steroid which can be helpful with symptoms.

“I’m curious what the “5.2mm transversely” means”. That is the measurement of the disc herniation in the “shoulder to shoulder” plane.

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.

[Tom]

#32369

Thank you Dr. Corenman. Thankfully I do not have grip weakness or any numbness, just electric shocks/zings that stay local to the trap & neck. I do feel like there has been some some loss in muscle strength in my left lower trap/shoulder, leading to an upper left trap which over-compensates for everything. It could also simply be the nerve irritation tightening up the upper trap to extremes; I’m not sure which. Could C8, or really any cervical radiculopathy cause a tight upper trap?

Although its been 7 months since onset of initial symptoms, would it be wise to take my most recent flare up from 2 weeks ago as day 1 of recovery? I know nerves need time to heal… I’m just getting so discouraged that I’ll continue to experience resets with any activity I used to love, especially If the core issue of the disc bulge can’t resolve without surgery (unless that magic stem cell/platelet lysate stuff really has any hope). From the looks of it, my disc is in “bulge” state vs. extrusion which I’ve read has much less probability of regressing.

Regarding Chiro — With opposing forces during a high velocity neck manipulation, are there any other side effects besides disc herniation that you’re aware of? Perhaps ligament tears causing instability? I don’t believe there were any issues with this junction before my brain screwed me over and resisted the chiro adjustment given I had no neck pain, but I’ll just have to accept that as it is… ahhh such is life.

I haven’t yet tried oral steroids; would it be wise to try those first versus ESI targeting C8?

I really appreciate your forums and willing to give advice, especially during these times when its becoming hard to get non-essential treatment.

Tom

[Tom]

#32403

Dr. Corenman — I haven’t yet improved, but recently booked an appointment with a local highly rated Gonstead chiropractor. Based on my MRI findings, would this type of care be contraindicated? Any opinion on Gonstead? Thank you sir.

[Donald Corenman, MD, DC]

#32408

It is almost always helpful to use oral steroids for a radiculopathy. Now, an injectable steroid targeting the HNP is always more effective but of course requires an invasive procedure. Be careful with manipulation of the neck. On rare occasion, manipulation can increase radicular symptoms.

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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