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  • montegut
    Member
    Post count: 4

    Dr. Corenman,

    Thank you for your generosity in providing advice in this forum. If I lived closer to CO, I’d certainly make an appointment with your office.

    I’m a 50-year-old active male suffering from chronic neck pain and numbness in my right arm, ring and pinky finger. I recently had an MRI; my appt. with the physician isn’t for another 3 weeks, but I did get a copy of the MRI report. I would love to understand better the severity of my condition while I wait. The report impression reads as follows:

    “Multilevel degenerative spondylosis extending from C3-4 through C6-7, but most prominently at C6-7 where there is a prominent broad-based posterior disc osteophyte complex and hypertrophic changes resulting in moderate central canal stenosis and bilateral neural foraminal stenosis but without abnormal signal within the spinal cord. Disc osteophyte complexes at C3-4 through C5-6 result in only minor impression upon the ventral thecal sac but no cord impingement. Neural foraminal stenosis is moderately severe on the right at C4-5, severe on the left at C3-4, and moderate on the left at C5-6.”

    Based on this impression, how serious is my condition, and would fusion surgery be indicated?

    Kind regards,
    John

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    You have neck pain and right arm numbness into the ring and pinky fingers. It would be helpful to describe your symptoms more thoroughly. Please see the section on website under “Conditions”; “how to describe symptoms” for a better understanding of how to convey a history.

    Nonetheless, I can give you some outline regarding your MRI. You report no myelopathy symptoms (see myelopathy section for description) so the central stenosis noted at C6-7 is not symptomatic.

    The distribution of numbness into the ulnar two fingers (ring and pinky) can be from the C7 nerve, more likely the C8 nerve or from two conditions called thoracic outlet syndrome where the nerves of the shoulder become entrapped or cubital tunnel syndrome where the ulnar nerve becomes entrapped at the elbow (funny bone). You do have foraminal stenosis at C6-7 (see website) which involves the C7 root. This could cause your right arm numbness.

    Local neck pain is typically generated from degenerative cervical discs or from degenerative facets (see website for description).

    A workup would be required to determine the cause of your pain which includes a thorough history, physical examination, evaluation of the images and possible diagnostic blocks.

    The only concern I have regarding your MRI is the stenosis (narrowing of the spinal canal). See website under myelopathy and central cord syndrome to understand the concern.

    Dr. Corenman

    montegut
    Member
    Post count: 4

    Thanks for your prompt reply! I’ll review the website.
    Regards,
    John

    montegut
    Member
    Post count: 4

    Hi again, Dr. Corenman,

    Pain history: gradual onset, but most prominent over the last 3 years. Constant headaches, the best description would be the sensation of a hot knife, sometimes dull and throbbing, sometimes sharp and steady, at the base of my neck radiating upwards into the base of my skull. Trapezius muscles are usually rock-hard, limited mobility. Crackling or popping sound when I turn my head or lower my chin to my chest. No skin changes or hypersensitivity. Pain is 95% neck, 5% arm (which is more of a numbness, not pain). Neck pain intensity usually 6-8 range. Moderate weakness in right arm is most problematic upon waking. No problems with gait or coordination. Pain is usually mild to moderate upon waking, increasing in intensity throughout the workday; evenings are usually the worst. It wasn’t until I recently took my first hydrocodon that I experienced what it feels like to *not* be in pain.

    Activity/occupational restrictions: sitting through a movie is challenging, had to give up swimming laps (rotating head side to side is a problem), used to run 4 miles per week but running seems to aggravate the pain. Part of my job requires lifting/pushing very heavy objects or vehicles, but I have been excused from that lately
    I have been a graphic designer/illustrator for the past 28 years, sometimes spending many hours at a drafting table or computer, so my condition is not surprising.

    Consultations/treatment:
    Chiropractor for three months: not effective
    Orthopedist: during a visit for lower back pain 3 years ago, I asked the doctor to also check my neck. He stated that I did indeed have a partially “blown” lumbar disc, but that my neck was “far worse.” Prescription: PT, anti-inflammatories, pain medication. PT was mildy effective but temporary. Second doctor, last month: x-ray revealed “collapsed” disc at C6-7, prescribed Celebrex and ordered MRI (impression listed above). MRI also indicates numerous osteophytes but most significant at C6-7. Moderately severe disc desiccation at C6-7, minor desiccation at C4-5 and C5-6. Minor facet arthrosis C2 through C7, moderate at C4-5.

    And that brings me to today, waiting for my consultation with the orthopedist to discuss this recent MRI.

    Again, thank you for your generosity.

    Regards,
    John

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    You have three sets of symptoms that are probably from three separate diagnoses. First- your headaches at the base of your skull. There are of course many differential diagnoses but a common origin of these symptoms are inflammation of the facets at C2-3 and C3-4. If you could reliably cause onset of these headaches and then obtain a set of facet blocks (see website) of these facets, significant temporary headache relief most likely would indicate these facets are the origin (see pain diary). If relief is noted, rhizotomies would be the next step.

    Your neck pain is really your predominant symptom (95% of your complaint). I assume that this is central neck pain and the headache is not a significant part of this percentage. Central neck pain origin is normally from degenerative facet or disc disease. A “collapsed disc” at C6-7 is most likely isolated disc resorption where the disc has dissolved away and the two segments are bone on bone. This can be quite painful and become worse with loading (prolonged flexion, impact, jumping or bumpy car rides). There could be a surgical fix (see “When to have neck surgery”) if you are a candidate for surgery.

    The arm pain which is “more of a numbness” and worse when awakening could be thoracic outlet syndrome. I have not yet written a thread on that disorder but stay tuned. This is common if you sleep with the affected arm “over the head”. The brachial plexus becomes stretched and numbness into the small fingers results. Treatment is typically physical therapy.

    You do not have to give up swimming, even with this condition. Use a specially designed snorkel that allows you to keep your head straight and relatively unextended. This will reduce pressure on your neck.

    Dr. Corenman

    montegut
    Member
    Post count: 4

    Thank you, Dr. Corenman, this has been very helpful.

    Regards,
    John

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