Neck Pain with Numbness/Tingling of right arm and hand

Tagged: osteophyte foraminal stenosis degenerative disk thecal sac lordosis

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TMoyer42
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February 5, 2022 at 3:37 pm

Post count: 2

#34815

I Have Ankylosing Spondylitis. I am on daily NSAIDs and have been taking an infusion medication (anti-TNF I think). Since my late teens through early 20s, I have dealt with pain starting in my lower spine and SI Joints that has slowly worked it’s way up to my neck. I have been through so many physical therapists, oral steroids and injections, nerve blocks, nerve ablations, and trial for spinal cord stimulator. None of it ever gives me any long term relief (more than 3 weeks and symptoms return).

About two months ago, I started to have severe pain in my right shoulder/arm pit area if I tried to tilt my head to the right (ear to shoulder stretching). About a week later, I began having tingling in my lower right arm (below the elbow) and hand (thumb, index and middle fingers only). This has continued to worsen for the past several weeks and now my neck (right side) is in pain most of the time. If I move my head in certain stretches (tilt up/down, tilt right ear to shoulder) the pain in right shoulder/arm pit area increases and the tingling in my right arm and hand/fingers increase until I return my head to a neutral position. When I lay down on my bed on my left side, my entire lower right arm below the elbow tingles until I move positions.

My most recent MRI of my cervical spine was dated 07/28/20. These are the written notes:

MRI CERVICAL SPINE WO CONTRAST

IMPRESSION:

1. Mild multilevel degenerative changes. This is only mildly progressed compared with prior study from January 11, 2006.

END OF IMPRESSION:

INDICATION: Cervicalgia. ICD 10 code M 54.2. Patient reports neck pain with bilateral upper extremity radiculopathy

TECHNIQUE: Multiplanar multisequence imaging cervical spine, without contrast, standard protocol

CONTRAST: None.

FIELD STRENGTH: 1.5 Tesla magnet

COMPARISON: MRI thoracic spine April 25, 2019, June 19, 2013. MRI cervical spine January 11, 2006

FINDINGS:

There is mild straightening of the normal cervical lordosis, without significant prevertebral soft tissue swelling. The cervical junction is maintained.

There is no acute fracture or traumatic subluxation. On fluid sensitive sequencing, there is no abnormal bone marrow edema or soft tissue edema. There is no ligamentous injury.

Right-sided rounded foci of increased T1 and T2 signal involving the T1, and T2 vertebral body levels. This is best seen on sagittal image 8. This is consistent benign focal fat or benign hemangioma. Multilevel bony spurring is seen. This is most pronounced from C4, through C7. Otherwise, vertebral bodies of the cervical spine are normal in height and signal intensity.

Cervical spinal cord signal appears to be normal. There is no evidence of underlying cord compression or cord contusion.

Limited images to the posterior fossa demonstrates no suspicious abnormalities. Assessment of the regional soft tissues demonstrates no definite discrete suspicious soft tissue abnormality.

At C2/3, no significant stenosis.

At C3/4, central disc protrusion. Right-sided uncovertebral hypertrophy. No significant stenosis.

At C4/5 broad-based degenerative disc osteophyte complex. This mildly effaces ventral thecal sac. No stenosis.

At C5/6 broad-based degenerative disc osteophyte complex. This effaces the ventral thecal sac and just abuts the ventral spinal cord. Question minimal central spinal stenosis. No significant neural foraminal stenosis.

At C6/7, broad-based degenerative disc osteophyte complex extends to both lateral recesses. In conjunction with bilateral uncovertebral surgery is minimal central spinal stenosis and perhaps mild bilateral neural foraminal stenosis.

At C7/T1 no significant abnormalities are seen.

With my current symptoms, my doctor tried to schedule a new MRI but insurance is denying the claim. I have been scheduled to see a Neurosurgeon in a couple weeks. Will the Neurosurgeon be able to help without current MRI? What exactly is the risk involved with not addressing the numbness/tingling while waiting to get approval from insurance for a new MRI, which could take several months of appeals? Having these symptoms progress to this state in two months has me concerned that damage may occur before I get any meaningful treatment. What should I be asking my doctors, especially the Neurosurgeon and Rheumatologist? I am a 44 year old male caucasian, history of Rheumatological illness throughout family, including RA, and other autoimmune diseases in immediate family (Father had MS).

Donald Corenman, MD, DC
Moderator

February 6, 2022 at 11:13 am

Post count: 8660

#34816

Shoulder pain can be a result of cervical radiculopathy (nerve generated pain) or shoulder generated pain (rotator cuff syndrome or other). Cervical radiculopathy commonly is triggered by neck and not shoulder motion. The act of lateral bending or extension to the side of the pain increasing the pain in a good indicator of foraminal stenosis where the neck motion narrows the nerve hole and pinches the nerve.

If you keep the neck still and move your shoulder (especially elevate or “up”) causing pain, this generally means a shoulder problem. A careful physical examination can help to identify and differentiate these disorders.

Your MRI is about 1 1/2 years old so a new one is warranted. The radiologist did not distinguish between foraminal stenosis and central stenosis (“C3/4, central disc protrusion. Right-sided uncovertebral hypertrophy. No significant stenosis”). I assume this means no central stenosis but probable foraminal stenosis on the right present.

You are probably not in danger currently. In these days, a spine surgeon might be required to order a new MRI. You need to get an examination and a new MRI.

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.

TMoyer42
Participant

February 8, 2022 at 3:37 pm

Post count: 2

#34822

Thank you for your reply. I am scheduled to see a Neurosurgeon next week and will be asking about getting a new MRI. I always struggle with my insurance to get any tests that are beyond an x-ray or blood test. I definitely have more issues moving my neck than my shoulder. The pain in my shoulder goes from my armpit to my shoulder blade and feels like it’s coming from my neck. The past few days the pain has radiated from my neck to my shoulder blade, then from my armpit to my bicep. The tingling in my arm and hand has reduced a little, but is still very noticeable with movement of my neck.

Thank you for taking the time to answer my post. I’m really just trying to regain some of my range of motion in my neck but the pain/tingling is stopping me from progressing. I’m tired of being in pain every day, losing out on all the things I used to be able to do, and feeling like I’m being brushed off by my doctors. It really makes me think they are just doing the bare minimum and not being proactive in my treatments. I’m having a hard time coping with the reality of living with these issues for the remainder of my life as they get worse over time.
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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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