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  • TMoyer42
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    Post count: 2

    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
    Post count: 8468

    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

    TMoyer42
    Participant
    Post count: 2

    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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