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  • CaliFornia
    Participant
    Post count: 12

    Dr. Corenman:

    I am a 38 year old male.

    On Feb 17, 2018 (Day 1), I woke up to a sharp pain behind my right shoulder-akin to a muscle sprain. The pain radiated throughout my shoulder area and underside of my right bicep. My right hand grip felt and numb-especially the ring and pinky fingers. I did not feel pain on my neck or near my spine.

    The sharp pain subsided on Day 2. But for the next few days, my shoulder continued to ache as if I had sprained it. I also felt discomfort in the underside of my biceps, especially at nights.

    On Day 5 (Friday), my doctor took an X-Ray. He thought the C4-C5 and/or C5-C6 disc spaces looked slightly narrow. He ordered an MRI for tomorrow, Day 8. He did an informal hand grip and arm strength tests, and thought there was not noticeable difference between my two arms. He also attempted to rule out trapezius sprain by aggressively massaging the trapezius and asking if there was excruciating pain (there was not). Lastly, he prescribed gabapentin.

    Now, on Day 7:

    pinky, ring finger, and top of my hand (mostly near the pinky and ring finger) is still numb;
    right hand grip is still weak but improved;
    right flexor feel weak when I lift things;
    right shoulder feels tender and aches if I move it aggressively but otherwise feels fine if I’m at rest;
    general stiffness in my right shoulder and neck area;
    have not taken Advil since Day 4 (Thursday); and
    did not take the prescribed gabapentin.

    Questions:

    1. My symptoms point to compression of the Ulnar nerve, which is near C7-T1 not the C4-C6. My readings says disc bulge or herniation in the C7-T1 region is uncommon.

    Do you agree disc bulge/ herniation in C7-T1 region is uncommon? And is it likely my symptoms are caused by Thoracic Outlet Syndrome, sprained trapezius or some other compression in the shoulder area?

    2. Since the sharp pain has subsided, is it possible the Ulnar nerve is no longer compressed? And is it common for strength/numbness to recover more slowly once Ulnar compression is removed? If so, how long will such recovery take?

    3. If there’s a bulge/herniation in C7-T1 region, are the non-surgical treatments promising? And are minimally invasive procedures-like posterior foraminotomy- available for C7-T1 bulge/herniation?

    4. Finally, more generally, what’s the prognosis for regaining strength in my right hand grip and flexor and restoring sensation to my pinky and ring finger?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    It sounds like you might have developed Parsonage Turner Syndrome (https://neckandback.com/conditions/parsonage-turner-syndrome-neck/). Thoracic outlet syndrome is possible but has specific mechanical symptoms that you have not noted (https://neckandback.com/conditions/thoracic-outlet-syndrome/).

    Yes, a C7-T1 HNP is unusual. The ulnar nerve is not compressed in the neck. It’s origin (roots from C8 and T1) can be affected in the neck. Posterior surgeries can be effective.

    What’s your prognosis? That depends upon what is causing your symptoms,

    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.
    CaliFornia
    Participant
    Post count: 12

    Thank you for the reply. These are my MRI results. Do you believe the “abutment” in C5-C6 can cause the symptoms I described in my earlier post?

    FINDINGS: There is normal alignment of the cervical spine. The vertebral bodies are of normal height. There is no compression fracture identified.

    C2-C3: Disc desiccation. There is no disc protrusion.

    C3-C4: Disc desiccation. There is a 1-mm midline disc bulge resulting in effacement of the anterior thecal sac with no central canal narrowing.

    C4-C5: Disc desiccation. Endplate degenerative changes are noted. There is mild biforaminal uncovertebral bony hy pert rophy .

    C5-C6: Disc desiccation. Endplate degenerative changes are noted. There is a 2-mm midline disc protrusion resulting in flattening of the thecal sac with a mild degree of central canal narrowing. There is a 3-mm right foraminal disc osteophyte complex resulting in abutment of the exiting right cervical nerve root with moderate narrowing of the right neural foramina. There is also left-sided uncovertebral bony hypertrophy with abutment of the exiting left cervical nerve root.

    C6-C7: Disc desiccation. Endplate degenerative changes are noted. There is a 2-mm midline disc protrusion resulting in flattening of the thecal sac with a mild degree of central canal narrowing.

    C7-T1: Disc desiccation. Endplate degenerative changes are noted. There is a 2-mm midline and right paracentral disc protrusion resulting in some flattening of the thecal sac with mild narrowing of the right lateral recess.

    There is no cord compression.

    IMPRESSION:

    1. At C5-C6 and C6-C7, there are 2-mm midline disc protrusions with mild degree of central canal narrowing.

    2. At C5-C6, there is a 3-mm right foraminal disc osteophyte complex resulting in abutment of the exiting right cervical nerve root with narrowing of the right neural foramina. There is also left-sided uncovertebral bony hypertrophy with abutment of the exiting left cervical nerve root.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    You have some foraminal narrowing that would affect the C6 nerve (“resulting in abutment of the exiting right cervical nerve root with moderate narrowing of the right neural foramina. There is also left-sided uncovertebral bony hypertrophy with abutment of the exiting left cervical nerve root”) but no modifier for the left compression.

    See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to see if a C6 nerve fits with your symptoms.

    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.
    CaliFornia
    Participant
    Post count: 12

    Thank you.

    Big picture, is my cervical spine in good, average or poor shape for a 38-year old male? In particular, is the “mild degree of central canal narrowing” in the C5-C7 region concerning?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Not concerning to my eyes unless you are a WWF fighter.

    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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