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  • talkingtoclouds
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    Post count: 3

    I’m 25, female, relatively healthy, but not very active. Almost three weeks ago I started a new internship for grad school, and so far I like it a lot. I was getting over a severe sinus infection, but there wasn’t too much stress involved, other than a lot of sitting and writing, which I’m used to from my previous jobs/internships. However, before the end of the first week, I was sitting at my desk and within minutes, out of nowhere the left side of my neck started hurting, excruciatingly painful, for absolutely no logical reason. Within the hour, I could barely move my head or neck at all, and every time I did turn it, there would be a loud popping/cracking/clicking sound that started about halfway down my neck and reverberated into the back of my head.

    I went to urgent care and the doctor did an X-ray, but he said everything looked normal and that he thought I had a cervical muscle sprain or pinched a nerve in my neck. The X-ray did not show anything out of alignment and supposedly the spaces between my vertebrae looked normal. I have since seen my PCP and she says relatively the same thing, though she thinks it’s only muscle sprain and so prescribed me Prednisone, muscle relaxers, and a prescription painkiller, and recommended that I see a physical therapist. She does not think it’s a pinched nerve or herniated disc based on the results of the X-ray, where she also said everything looked normal.

    Right now, the pain has not subsided at all, and it’s still extremely difficult to hold my head erect. The pain comes from more the center of the back of my neck now at the base of my skull, and my head cracks/clicks and pops loudly every single time I turn it to the left. It is especially loud when I look down and turn my head in either direction or when I’m fixing my hair in the morning. Oddly, though, it doesn’t do anything if I’m looking straight up or down, but standing up or lying down can make it pop, and they are these really quick and loud single clicks/pops. It feels like something is hitting something else inside my neck, or something is rubbing up against something else.

    So far, I have tried the following without any success:
    [ul]
    [li]Ice packs[/li]
    [li]Heat packs[/li]
    [li]OTC and prescription painkillers[/li]
    [li]Prednisone[/li]
    [li]Muscle relaxers[/li]
    [li]Epsom salt baths[/li]
    [li]Neck collar[/li]
    [/ul]
    I went for a massage yesterday with a LMT, who said he did not feel any significant muscle tension and that my range of motion in my neck was much better than average for someone with a supposed neck sprain. He said that normally people he sees with muscle spasms or strains in their neck have difficulty moving their necks entirely, but mine hurts the worst when it pops and it hurts to hold my head up. I can’t stop myself from turning my head to the left all the time, and when I do, I’m quickly reminded when that jab of pain goes into my head because of the popping.

    Dr. Corenman, do you have any idea what might be causing my pain?

    EDIT: I saw my physical therapist today for some “strength training” in my neck, at the recommendation of my PCP. Physical therapist does not believe muscle spasm is the cause of my pain.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Muscle spasm is normally the result of a neck disorder and not the cause. The popping sound you hear is more likely from the facets as these actually “rub” on each other with motion. You could have a small cartilaginous tear or flap or even infolding of the synovial membrane which “catches” with certain motions.

    “Normal” X-rays do not rule out disc herniations or “pinched nerves”. In fact, I see “reportedly normal” X-rays every day that have some subtle unrecognized pathology but I look at these films every day. The family docs have so many other responsibilities and therefore can’t know all the subtle findings found on X-rays.

    You might try gentile chiropractic care for this disorder.

    Dr. Corenman

    talkingtoclouds
    Member
    Post count: 3

    Dr. Corenman,

    What you said sounds eerily similar to what my physical therapist said. She sees patients with a host of orthopedic problems all the time and I am more inclined to trust her over my regular doctor because she actually listens and takes my pain seriously. I am currently in the market for a new PCP for that reason alone.

    I am seeing a sports medicine doctor at my city’s Bone and Joint Center today, because my PCP refuses to refer me to an actual spine surgeon at the hospital’s spine and neurological institute (though I did manage to get a referral for July from a doctor at my university’s health clinic). If what you say is true (and I am inclined to believe you are right on the money about what’s going on with me because I do feel a rubbing sensation) and it is actually a cartilaginous tear or infolding of the synovial membrane, what other things would you be able to recommend besides chiropractic? Is physical therapy even worth it, and if so, what kind is necessary? Strengthening exercises? Muscle relaxing stretches? Should I invest in an MRI for a definitive diagnosis? Extension and flexion x-rays? Are the kinds of problems you described likely to resolve themselves or only with treatment?

    I would be lying if I said I wasn’t at least a little skeptical of chiropracters, but I’m willing to try anything at least once.

    I apologize for all these questions. Thanks so much for taking time out of your busy schedule to respond to me! Your expertise is so appreciated and it’s nice to know that I’m not crazy.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Physical therapy can be effective in your situation but you must find the right physical therapist. Just as with chiropractors, there are varying degrees of skill and expertise that therapists exhibit and a great therapist is highly valued. Unfortunately, there are also therapists and chiropractors that are not as skilled. How to find the best individual is something I cannot at this point tell you.

    Therapy by a PT or a chiropractor should involve manipulation, stretching, exercises, ergonomics and activity modification.

    MRIs may or may not be valuable in your situation. An MRI can only resolve down to about 2mm and some of these flaps and wear areas may be smaller than that.

    Dr. Corenman

    talkingtoclouds
    Member
    Post count: 3

    Dr. Corenman,

    The findings of my flexion extension x-ray are as follows:

    1. The cervical vertebral bodies are normal in height and alignment on neutral positioning.
    2. There is 2 mm of anterolisthesis at C3-4 and C4-5 on flexion views reduces back to neutral on views most consistent with physiologic motion.
    3. No prevertebral collections identified.

    I won’t be able to see my specialist again for another two or three weeks. Can you tell me what this reading means?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    The findings can be consistent with minor wearing of the C3-4 and C4-5 facets or with normal finding found on some patients (normally adolescent but not always). Again, facets disorders are not easily seen on MRI and a diagnosis with examination and injection findings are the most reliable sources of diagnosis.

    Dr. Corenman

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