[alievans77]

#10288

Here was my original post that has all of the information. Thanks for looking over my stuff and any help you can offer.

alievans77 post=5956 wrote: Hi. I found your site and am praying you can help me better understand what is happening to my body and if/how I can get better or even completely back to my previous self.
I read how to describe my injuries on your post so I will do my best and apologize in advance if I miss something or give information you don’t actually need.

I had a horseback riding at work on 10/05/2013. I work on a cattle feedlot and we were out at the pasture checking on cows and fences. I was riding up a ravine going slowly and about halfway up my saddle strap broke from my saddle. I fell from the side of the horse with the saddle. I do not know anything about how I landed, what I hit or details. I was knocked unconscious for about a minute and my boss who was riding with me was in front and did not see how it happened he found me on the ground.

Neck/Arm/Hand:

Quality of pain is variable. Most of the time I have aching dull pain midline on back of neck. The pain deepens on the base of my skull on the right side. It feels like immense pressure. This can come or go and I have not deciphered anything in particular that precedes the changes in pain or intensity. I usually have some degree of headache everyday. 1-6 VAS. The pain extends down my right shoulder and upper arm. The pain there feels sharp, and stabbing, in the shoulder socket area. I get numbness with tingling down right arm. This I noticed is mostly onset by position such as driving. Changing positions and lowering my arm to my side usually helps to relieve the tingling and numbness feeling. Then the sharp pains will subside. At one point my first finger and thumb on my left hand were less sensitive to touch and feeling. I noticed this for about a week and it has since subsided and not returned. This was about a month ago. I have not noted any skin changes. My neck is sensitive to massage type touch. The percent of pain in neck vs shoulder/arm also varies. When I am not experiencing the pains down my arm it is 90/10. When the pain radiates down my shoulder and arm it is 50/50. The intensity of pain in neck usually is in the 2-6 range. But with driving, lifting things more than about 15 pounds, pushing, pulling, sweeping and action as such the pain will increase to 3-7. Usually ending up on the later end of the scale after doing such activities. I have not noticed significant weakness in any limbs but my PT did not decreased strength in my left grip of 20%. My handwriting has changed noticibly. It is much more sloppy and not as fluid. The pain was almost immediate after my accident and has progressively gotten worse over the last few months. Sitting increases my pain if I am reading and holding my head at an angle other than completely straight forward and my posture very erect. Standing does not seem to change pain. Laying down on my side is most comfortable and relieves the pressure feeling in my neck but usually increases arm pain radiation. So I find myself changing from side to side often to decrease pain. I can sit for about 20-30 minutes before it gets so uncomfortable that I have to get up and move. I have also noticed that lifting both arms directly over my head relieves the pressure and associated pain in the midline area of my neck and base of skull. The pain has completely changed my quality of life. I was a very active person who worked an extremely physical job daily. I also enjoyed many outdoor activities prior to my injury that I cannot do not due to my pain. Now just doing menial household chores causes my pain to increase and I find myself dreading seemingly simple tasks. My job is extremely physical and is different everyday. I have been off of work since my accident and work comp is handling my treatment.

Lower back/Legs:

The pain in my lower back is equal to and sometimes worse than my neck areas. It is low on my back and is persistent. It feels dull at times, sharp with movements that are sudden, sitting for longer than 20 minutes, pushing, pulling, driving, lifting, sweeping, etc. At times, mostly random it seems, I get sharp extremely painful shooting pains down my buttocks and back of my legs. This happens on both sides but more on my right side when I am driving for longer than 30 mins or so. I try moving around in my seat to ease the pai but it usually will not let up until I am able to get up and walk around. The pain intensity in my lower back varies as well. If I stay fairly inactive it is about 1-4 but with driving or increased activity and sometimes for no reason at all that I can pinpoint it changes to 4-7. The percent of pain from back to legs is usually 80/20. I have not noticed weakness in my limbs, however the Dr I am seeing noticed a decrease in strength of my left big toe about a month ago which he said has now resolved. I do frequently get numbness/tingling down both legs when sitting with feet touching the floor. This happens within 5-10 minutes of sitting in that position and is resolved by walking.

Other symptoms:

Vision blurry and double vision with night time driving
Left side of mouth slightly droopy after accident until about 10 days post accident
Extensive deep bruising on almost every part of body post accident

Previous Tx:

Physical therapy for 4 wks one month post injury-would feel slight improvement in some areas for a few hours after visit. Went 3x week

Chiropractor 2 visits greatly increased pain

Physical therapy again for the last month 2x week- usually makes things worse the night of and day after

Ultrasound to neck and low back at PT

E Stim to neck, shoulder and low back at PT

At home stretches and exercises which also increase pain in low back and neck after doing them

Heat and Ice do relieve flare ups occasionally but only for a short period of time and more for muscle pain not radiation down arms or legs.

Physiatrist doing manual treatments on neck and back with so far have made my pain extremely unbearable following the treatment.

I have tried a slew of medications for headaches, muscle pain, nerve pain, inflammation, etc. None have helped much. They make me sleepy but don’t do much to relieve pain.

Physical medicine and rehab Dr who is treating and managing my care lists the following Dx on my recent clinical summaries:

Neck pain
Cervical spine stenosis
Myofascial pain syndrome
Herniated lumbar disc
Lumbar disc degeneration
Hypermobility syndrome
Concussion grade 3/post concussion syndrome
Cervical spine pain
Parascapular pain
Cervicalgia
Nonallopathic lesions
Lumbago
Migraine headaches
Visual disturbances

Medications I am taking or have tried recently:

Nortriptyline HCI 25mg 1qd at bedtime
Aspirin 81 mg (I have factor v leiden)
Calcium
Nabumetone 500mg 2 tabs 2x daily as needed for pain
Vit D3
Disipramine HCI 10mg 3 tabs daily at bedtime (DC’d)
Meloxicam 7.5mg 2 tabs daily (DC’d)
Gabapentin 100mg 3 tabs daily at bedtime (DC’d)
Vicodin (DC’d)
Flexiril (DC’d)

I had several x-rays taken after injury of neck and all were negative.

MRI done of cevical spine and lumbar spine on 11/29/13

Both were non contrast closed MRI

Final Results:

CERVICAL:

Craniocervical junction is unremarkable. No cerebellar tonsillar ectopia is seen. No abnormal cord signal is identified. There is congenital narrowing of the osseous central canal from C3-C7 level. Osseous central canal measures 9 mm in AP dimension.

C2-C3
C3-C4
C4-C5
level shows no significant osseous central canal or foraminal stenosis

C5-C6 level shows a posterior disc osteophyte complex which impresses on the anterior thecal sac and mildly deforms the cord. There is moderate narrowing of the bilateral intervertebral foramina.

C6-C7 level shows no significant osseous central canal or foraminal stenosis. Mild posterior disc is identified.

C7-T1 level is unremarkable

Impression:

Moderate posterior disc at C5-C6 produces moderate narrowing of the osseous central canal. There is moderate narrowung of bilateral intervertebral foramina at this level. Patient has background congenital narrowing of the osseous central canal from C3-C6.

Lumbar Spine:

There is straightening of the normal lordotic curvature. Conus terminates at the T12-L1 level. No abnormal signal is identified within the conus. Sagittal evaluation of the T11-T12 and T12-L1 discs show no significant disc pathology. Osseous central canal and bilateral intervertebral foramina are patent.

L1-L2
L2-L3
L3-L4
Level shows appropriate disc signal. Osseous central canal and bilateral intervertebral foramina are patent. Nerve roots are evenly distributed throughout the thecal sac.

L5-S1 shows a posterior disc protrusion. No significant osseous central canal or intervertebral foraminal stenosis is identified. The traversing S1 nerve roots are interposed between disc material and ligamentum flavum without evidence of impingement. Sagittal sequence shows a posterior annular tear. No marrow edema is identified within the vertebral bodies or the pedicles.

Impression:

Posterior disc at L5-S1 with a posterior annular tear. No evidence of nerve root impingement is seen.

Again, I appologize for the extremely long post. I just figured if I give you all the information I can think of now maybe you would have all you need to help if you can.

Oh yeah, almost forgot…work comp sent me to a neurosurgeon and he said he can’t help me that he believes I do have significant pain but that it is muscular and not something he can fix. He also said that he doesn’t see any cord compression or that anything is even touching my soinal cord and that my MRI results are comparable to any person over 12 yrs old in America if you were to take a random screening of MRI’s.
He said I need pain management and made a referral for me to see them. The work comp nurse is supposed to be getting them to see me but it is going to be a month before they can get me in.

I truly appreciated any help you can offer!!!

[Donald Corenman, MD, DC]

#10296

Let us start with an inventory of your symptoms after your fall from the horse.

You have headaches constantly but increase with intensity from a 1 to 6 VAS (visual analog scale).

You have pain down your right shoulder and arm associated with numbness and paresthesias (tingling). Driving normally aggravates your pain and lowering your arm to your side normally relieves these symptoms. Your thumb side of your hand developed symptoms for a short period of time that vanished for no reason.

Neck pain vs arm pain varies from 90/10 to 50/50 with a 2-6 VAS. Your handwriting has suffered. Flexion seems to aggregate your neck pain. Elevation of your arms seems to relieve your neck pain temporarily but you do not mention what this action does to your arm symptoms.

You have lower back pain. Mechanical activities aggravate this pain (1-7 VAS). You also have sharp pains that radiate down your legs. This occurs with prolonged sitting. Still low back to leg pain ratio is 80/20.

You have been off work since your accident and you have significant impairment (difficulty with typical life duties).

Your cervical MRI notes; “There is congenital narrowing of the osseous central canal from C3-C7 level. Osseous central canal measures 9 mm in AP dimension.C5-C6 level shows a posterior disc osteophyte complex which impresses on the anterior thecal sac and mildly deforms the cord. There is moderate narrowing of the bilateral intervertebral foramina”.

Your MRI of your lumbar spine reads; “L5-S1 shows a posterior disc protrusion. No significant osseous central canal or intervertebral foraminal stenosis is identified. The traversing S1 nerve roots are interposed between disc material and ligamentum flavum without evidence of impingement. Sagittal sequence shows a posterior annular tear. No marrow edema is identified within the vertebral bodies or the pedicles”.

There is a lot of information here. i’ll give you my best estimation. You really need a thorough physical examination to compare to your symptoms.

Arm symptoms seem to be from thoracic outlet syndrome (see website). Arm pain originating from nerve compression normally occurs from bending the neck backwards. Thoracic outlet syndrome normally occurs from elevating the arm.

Neck injury might be causing two separate symptoms, headaches and neck pain. Headaches can originate from the top of the neck. Occasionally, these cervicogenic headaches can develop from C1-2 or even occiput/C1 but mainly will originate from C2-3 and C3-4. The way to determine this is to aggravate the headache and then have facet blocks at these levels (see pain diary). If good relief, you might be a candidate for rhizotomy (again-see website).

Neck pain could originate from annular tears or aggravation of preexisting degenerative disc disease. Epidural injections might help this. If pain continues, a disc pain workup would be in order. This might be in the form of discograms or other workups. This is a pre surgical test so you have to understand this route of care.

The same path could be used to determine if lower back pain is discogenic in nature or there is something else (facets or pars fractures) that could be causing your pain.

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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