[aftrshok99]

#24981

Hi Dr. Corenman,

I’m a 46 year old male, 5′-10″, 204 lbs. I lift, golf, play guitar, swim, bike and lots of other outside activities. About 14 weeks ago I had what felt like a pulled muscle in my shoulder blade, it didn’t go away and about 6 weeks late I woke up with extreme pain down my right arm from neck to my finger tips. The pain, muscle weakness in my tricep and grip along with my index and middle finger being numb have been going on for about 5-6 weeks now. I’ve lost about an 1″ when I flex and measure my right upper arm and compare it to my left. My left has always been 1/4″-1/2″ smaller than my right.My index and middle finger have been numb ever since and I’ve lost all of my strength in my chest and tricep. If I put my right hand out and lean against a wall I can hold myself but if I start bending my elbow at all I’ll fall into the wall because I can’t hold myself. I can’t do an overhead tricep extension with a milk jug either.

With all that said, I’ve had an MRI, been to a Neurosurgeon which put me on PT for 4 weeks (2x a week) and want to talk after that is finished. I have two weeks left of PT but I don’t seem to be getting any better. I don’t have much in the way of pain anymore but I’m not active other than doing my desk job. If I do any yardwork or pick up something heavy I will have some pain. What I’m worried about is the weakness and atrophy. Does that still mean the nerve is still compressed and I possibly will need surgery to fix that?

I just want to be able to do the things I once did without worrying about causing more damage.

MRI Results:

Findings: There is minor cervical dextroscoliosis centered at C5-6 and straightening of the usual cervical lordosis. The cervical vertebra are generally normal in height and intrinsic bone marrow signal There is mildly increased T1 and T2 signal in the odontoid that may be artifactual due to inhomogeneity in the field. Benigh intraosseous hemangiomas are present at C2, T1 and T2. There are no paravertebral masses, Visualized lung apices are clear.

C2-3: The intervertebral disc is normal.

C3-4: There is a minor dorsal spondylotic ridge that is asymmetric to the left and minor left uncovertebral hypertrophy. There is no central canal stenosis or foraminal stenosis.

C4-5 There is a minor dorsal spondyloctic ridge that is asymmetric to the left and a small central disc protrusion that contacts the cervical cord. Minor right and mild left uncovertebral hypertrophy is present. There is mild spinal stenosis. AP diameter of the thecal sac is 8.5 mm

C5-6: There is a mild disc bulge and a moderate central disc extrusion that is slightly asymmetric to the right which extends above the disc level. This mildly indents the cervical cord and causes mild to moderate spinal stenosis. AP diameter of the thecal sac is 7 mm.

C6-7: There is a mild disc bulge with marginal osteophytes and a small central and right posterolateral disc extrusion that may extend into the medial right neural foramen. This is poorly visualized due to decreased signal-to-noise. This mildly indents the right ventral cervical cord and effaces the right later recess where it may adversely contract the right C7 nerve roots. Bilateral uncovertebral hypertrophy is present, greater on the right and there is mild spinal stenosis, right lateral recess stenosis and probable mild to moderate left and possibly moderate right neural foraminal stenosis. The nerual foramina are not well seen AP diamter of the thecal sac is 8.4 mm

C7=T1: There is minor disc bulge and bilateral uncovertebral hypertrophy. There is probably mild to moderate bilateral foraminal stenosis.

Impression:
1. Mild cervical degenerative spondylosis with mild C4-5 and C6-7 and mild to moderate C5-6 spinal stenosis.
2. Moderate central disc extrusion C5-6 that mildly indents the cervical cord without edema.
3. Small central and right posterolateral disc extrusion C6-7 that may extend into the medial right neural foramen and probably encroaches on the right C7 nerve roots.

So what do you think? I know that having pain or no pain isn’t the issue but the Atrophy and Weakness concern me.

To Recap:
My symptoms as of now, Pain comes and goes but isn’t all that bad (uncomfortable at times), atrophy and weakness in tricep and chest, numb index and middle finger, pins and needles in my pinky.

Thanks,
Brian

[Donald Corenman, MD, DC]

#24982

You have a typical C7 radiculopathy with initial pain, paresthesias (pins and needles), probable sensory loss and especially motor strength loss. The C7 nerve is compressed by both bone spurs (uncovertebral joint spurs-see https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ and https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/) and by a small disc herniation that was the “straw that broke the camels back).

Normally, I would treat your initial symptoms the same way with therapy (and an injection) but I would carefully monitor you for motor strength recovery. If there was atrophy or a lack of some partial recovery of motor strength in the initial 2-3 weeks, I would consider surgery-either an ACDF (fusion) or an ADR (artificial disc replacement) depending upon the appearance of the disc space. This nerve root (C7) can tolerate some compression for a period of time but with dense weakness (as it sounds with your case) and no real recovery of strength (pain relief is important to you but does not help with motor recovery), I would recommend surgery to decompress and fix this level.

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.

[aftrshok99]

#24985

Thanks for replying Dr. Corenman.

My motor strength after 6 sessions (3 weeks) of PT and doing things at home hasn’t improved at all and in fact seems to be getting worse. I’ve always been strong but I just can’t make my chest, tricep and apparently some muscles between my shoulder blade and arm pit work no matter now hard I try.

Again for the most part I am pain free expect for this restless leg syndrome in my arm (that’s what I call it) and the slight numbness I described in my initial post.

Here is an update from my PT session this past Friday:
Ok PT update, did all the usual stuff but they added a new thing in which revealed something. She had me lie on my stomach with my arms at my side, shoulders flat on table and try to touch my shoulder blades together. I thought I was doing it and she said nope, your right one isn’t moving. She got to feeling both sides and had two other PT’s look at it just to double check. Without touching me they both could see it, one put her hands back there and had me try it again. Nope didn’t work…They said you can see the indention between my shoulder blade and arm pit, the muscle right there has severely atrophied and isn’t working at all. They seem to think that there is nothing left they can do sense I don’t seem to be gaining any strength back. If i hold my arm straight out and try to flex my tricep, it barely flexes and is mushy feeling to the touch.

[Donald Corenman, MD, DC]

#25136

If you feel like you are worse and have developed greater muscle weakness, you should consider surgery to decompress the nerve root. The rhomboid major and minor and trapezius muscles are the muscles that are not firing. These muscles are connected to the brain by cranial nerves (trapezius) and the C5 nerve (rhomboid major and minor) so involvement of C7 should not cause this weakness.

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.

[aftrshok99]

#25137

Donald Corenman, MD, DC wrote:

If you feel like you are worse and have developed greater muscle weakness, you should consider surgery to decompress the nerve root. The rhomboid major and minor and trapezius muscles are the muscles that are not firing. These muscles are connected to the brain by cranial nerves (trapezius) and the C5 nerve (rhomboid major and minor) so involvement of C7 should not cause this weakness.

Dr. Corenman

My PT and I talked about my weakness Friday and she said I’m not getting any stronger and am getting weaker as the weeks go on.

Between Resistant band and light dumbbell exercises I did 300 reps (10 exercises, 30 reps each) I wasn’t the least bit sore or where my muscles tired. I should be sore because it wasn’t easy doing those exercises and I had to work hard on my chest and tricep ones. I also still don’t have any pain to speak of, this concerns me but maybe that is normal for some people?

With the major and minor rhomboid muscles atrophying could that be caused a disk bulge slightly touching my spinal cord? Would I not have any other symptoms if it was touching it? Would I not have any pain if that was the case?

Sorry for the questions, this is all just a little scary for me.

Thanks again,
Brian

[Donald Corenman, MD, DC]

#25178

“With the major and minor rhomboid muscles atrophying could that be caused a disk bulge slightly touching my spinal cord? Would I not have any other symptoms if it was touching it? Would I not have any pain if that was the case”.

Major and minor rhomboid muscles generally are not solely affected by a nerve compression at C4-5 as the deltoid muscle is the major muscle affected by a C5 nerve compression. Your compression is also lower than that level. Symptoms generally would include pain, paresthesias (pins and needles) and numbness along with weakness which you do not have.

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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