[Verojay]

#20963

Hello!

I had acdf surgery (C5-C7) last January. I had suffered from neck pain, migraines, etc. for at least 15 years. I had carpal tunnel surgery in 2013 on both hands. . My right hand came out perfect but the left was still not normal. I could feel the nerve if I touched my palm or wrist. Use of my thumb was not good. I went to many months of therapy. They did another MRI and saw that my neck was worst-Degenerative Disc Disease through the whole neck, but C5-C7 was very bad-on the verge of collapse. Surgery was rough-4+ hours and post op pain was way worst than I had imagined. After a few months-my arm was still hurting (it hurt really bad when I woke up) and I couldn’t straighten it, nor lift it in front all the way or to the side-it shook, hurt, and I had no control. The surgeon said it would likely just take time.

I started therapy in March and the therapist said the same as the surgeon-be patient. By June, Dr. and PT were surprised it was still so bad. He said the nerve was just compressed too long and probably needed more time. He ordered another nerve conduction. Nerve conduction showed no permanent damage (although first nerve conduction didn’t even show my neck was that bad) but that I was in the early stages of nerve recovery. Back to therapy. By August, the therapist didn’t think it was helping much and then my insurance denied coverage for it (only get so many sessions per calendar year). I have continued to pay out of pocket for therapy 1-2 times a week, but I would say the arm is maybe only 10% better…maybe.

Neck is still in pain every day (maybe only 25% reduction from pre op), still can’t straighten arm t elbow (it almost feels stuck and frozen. It can be straightened if you force it), wrist is very weak, can’t lift over my head or to the side, shakes because of lack of control, it hurts badly some days, etc. It seems to hurt more often than not at this point. I exercise, take vitamins, eat well, Therapist said I plateaued a long time ago a few weeks ago and I stopped therapy.

I had an MRI today and the surgeon said all looks ok. I have some herniations (C3 and C4) but nothing compressing the nerve badly. He is stumped on what is going on with me. He ordered a CT scan, but said on xray fusion looks ok. He now thinks the original EMG doctor didn’t do a good job (based on other patients) and he doesn’t use him anymore. So he referred me to a new EMG doctor.

I have lost my job due to how long I was out and my arm still isn’t working. Is it possible the last EMG had false negatives? The report stated I had abnormal peak latency differences in my left arm. This is the arm with all the trouble. He didn’t say much else except that he thought I was in early stages of recovery, even at six months post op. I am almost at a year post-op and my arm isn’t much better. Any thoughts?

I am so frustrated! Thanks:-)

[Donald Corenman, MD, DC]

#20969

I am concerned about your immediate results after surgery. Did you have increased pain after surgery? If so, was it neck pain (expected) or shoulder/arm pain (unexpected). Did you have weakness of the shoulder prior to surgery or only after surgery?

It was not clear if you had surgery at C5-7 or C4-6. The inability to lift up the shoulder is typically a C5 nerve root (the C4-5 level). If this level was not addressed surgically, weakness could be from some unusual stretch of the nerve or a rotator cuff problem (shoulder problem).

See the section on EMG here on this website to understand the test. It would be surprising if the EMG was negative (shoes no problem) if you have motor weakness from nerve compression. There are other problems that could occur not nerve related (Parsonage Turner Syndrome, thoracic outlet syndrome, rotator cuff impingement, CRPS-see website) that can cause your symptoms.

A new set of eyes on your problems could be helpful.

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.

[Verojay]

#20986

Hello! Thank you for your response. The pain the arm was right after surgery. My neck pain was bad, but more in line with what is post op (more than I expected though). When I completely woke up from anesthesia, is when I noticed how much my left arm hurt. It was weaker to begin with because of how bad my neck was, but I could straighten it pre-ACDF.

My surgery was fusion from C5-C7. My C4 does have a herniation but the Doctor said it isn’t very severe and he said on MRI it isn’t impinging the spinal cord. He didn’t work on that level at all. The weakness is through the whole arm-even my wrist is weak. My arm hurts off and on, some days worse than others. Left side of neck still hurts a lot.

Years ago I had a clean up surgery on that shoulder-but I haven’t had any problems since that-none before surgery at all-shoulder was fine. My left hand was weaker than my right hand due to the carpal tunnel surgery, before my acdf. The nerve sensation in that left hand never went away. If you brush your fingers on my palm, I can feel tingling and my thumb doesn’t work normally and hurts.

My arm isn’t completely useless-I can use it, but it won’t do certain things. I have read that sometimes a nerve that affects the shoulder could be stretched or affected in surgery, depending on how your neck/head was positioned. Not sure if that is accurate.

The first EMG didn’t show any issues in the neck, just severe carpal tunnel. When I had my EMG in June (Post ACDF), the Dr. at the time said before the test, he would bet it was permanent based on how the arm was looking. But he said the EMG tests didn’t show that. I will see what the next EMG says.

I sure hoped my neck pain would be greatly diminished. I can’t take NSAIDS due to severe allergy, so pain management is tricky and frustrating.

I am starting to worry it is something more serious. I have severe facial pain off and on (especially at night)-feels very nerve related. And I still get the migraines at least 1-2 times a week.

I have two young boys, so I am very active. No sitting around here. You would think my neck would have loosened up by now. It feels lock a rock and 7 months of therapy barely helped.

Thank you!

[Donald Corenman, MD, DC]

#21030

Your symptoms worry me that you had increased pain and weakness after surgery. Your prior carpel tunnel surgery seems not to be effective as the EMG noted “severe carpal tunnel” syndrome. This should not be present with an adequate previous decompression and I think you need to see a senior experienced hand surgeon to determine if this is part of your current problem.

The level at C4-5 does not have to compress the spinal cord to cause problems. How “open” is your foramen at that level? Do you develop pain and paresthesias down into your shoulder with head extension and leaning to that side (the Spurling’s test)?

If you note muscle weakness when you use your arm and there is no pain inhibition (pain when you try to tighten the muscle), I worry how accurate the EMG test is. These tests are very temperamental and an experienced physician needs to perform the testing.

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.

[Verojay]

#21049

Hello! So I had the new nerve conduction. Results were the following: (ignore typos:-)

1. Left ulnar sensory study showed mildly prolonged distal latency. However, with temperature correction, this was within normal limits.
2. Left media sensory study showed prolonged distal latency with stimulation at the writs.
3. Left media and left ulnar F waves showed normal Latencies.
4. EMG of left extensor digitorum communis showed chronic denervation changes. Motor unit recruitment was preserved.
5. EMG of left pronator teres showed chronic denervation changes. Motor unit recruitment was preserved.
6. Chronic left cervical radiculitis involving C6 and C7 nerve roots. No acute denervation changes noted.
7. Moderate residual carpal tunnel syndrome in left hand.

MRi stated: persistent disc and bony degenerative changes leading to mild impingement of the thecal sac without significant central stenosis.
There is foraminal stenosis bilaterally at multiple levels most promintently on the left at C4-C5 and on the right at C5-C6.

The surgeon said, it shows permanent nerve damage to arm (chronic and preop damage). It probably explains my issues. He thinks I can keep working at increasing mobility and strength, but it will probably never be normal. he thinks the pain is from an ongoing irritated nerve and obviously issues in the arm.

He is sending me to a second opinion and to rule out any diseases or other issues that may cause my muscle loss. I am frustrated it took this long to give me answers on my arm not working. My pain is increased in my arm and I would love to put it in a sling on some days. But of course I won’t. The surgeon said moving it is the best thing, to prevent claw hands. Hard week!

[Donald Corenman, MD, DC]

#21074

The pain certainly could be from chronic injury to the cervical nerve root but the symptoms increasing after an ACDF might mean that there could be continuing compression to the root. A new MRI has revealed continued compression of the roots (“There is foraminal stenosis bilaterally at multiple levels”).

The second opinion (in my opinion) should be with a spine surgeon and not with another neurologist (“rule out any diseases or other issues”).

What is your physical examination like? Where do you have reduced sensation, reduced muscle strength and what is the grading of your reflexes? These physical examination findings are the most sensitive of all the tests that can be performed.

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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