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#19530

Hi Dr. Corenman:

I was rear ended 5 years ago, and have had constant pain/muscle spasm where the neck meets the T-1 area, accompanied by muscle spasm, shoulder pain and weakness in left arm. I also have a slap tear.

The MRI below is from sometime ago. The MRI has been reviewed by many good Dr.s in my area that tell me the there is nothing wrong with my neck. I have had one steriod injection at c5-c6 that did not help. 4 rounds of botox, little relief. Chiropractic has given some relief. Trigger point massage therapy gives the most relief for 1-2 days. I don’t know if there is scar tissue built up from the whiplash or if there is something more going on.

My pain is a dull nagging pain; I feel like I have to play tug of war with my neck all day long until the neck pops and gives me some relief. Flerxil does help, but I feel very nausea from taking it.

Please see below, I am trying to figure out where to go from here ! THANK YOU !

FINDINGS: Partial straightening of cervical lordosis may be related to muscle spasm. Minimal 1 mm, retrolisthesis is demonstrated in neutral position at the C5-6 level, and this alignment does not change appreciably with active flexion or extension maneuvers. In fact there is relative\y little range of motion exhibited by these active maneuvers, further supporting spasm. No compression deformity or suspicious marrow signal lesion is uncovered. The craniocervical junction structures are normal. Normal signal is maintained through the cervical and upper thoracic cord.

At C2-3, there is stable disc desiccation with a left posterolateral disc protrusion that flattens the left ventral thecal sac contour and mildly encroaches upon the left lateral recess. Uncinate spur mildly narrows the left C3 foramen. stable in retrospect.

At C3-4 there is mild disc desiccation and minimal annular bulge. The canal caliber remains adequate. The C4 foramina are patent.

At C4-5, there is mild disc desiccation and minimal annular bulge. An adequate canal caliber is maintained. The C5 foramina are patent.

At C5-6, disc bulge eccentric toward the left flattens the ventral thecal sac and results in a borderline central canal caliber. Uncinate spur modestly encroaches image upon the C6 foramina, especially the left, perhaps slightly progressed from the prior study,

The C6-7 through T2-3 levels are normal.

[Donald Corenman, MD, DC]

#19539

The base of neck pain (“constant pain/muscle spasm where the neck meets the T-1 area”) can originate from the disc, the facet or the nerve root. There also is a subset of patients who have shoulder disorders that can mimic this pain.

You have a SLAP lesion. Of which shoulder? If you have left arm weakness, shoulder pain on the left and a SLAP lesion on the left, this could be the source of all these symptoms.

The C5-6 level is moderately degenerative (“disc bulge eccentric toward the left flattens the ventral thecal sac and results in a borderline central canal caliber. Uncinate spur modestly encroaches image upon the C6 foramina, especially the left”). This could be causing your neck pain.

You would need to see a skilled and meticulous spine surgeon to get a better picture of the pain generators. There is most likely a source for your pain and the docs you have already seen do not have the understanding of these potential pain generators.

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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#19551

Thank you Dr. Corneman.

Yes, I have a labral tear on the same side, left side, where the disc bulge is. I am told that the disc/neck might have torn my labrum over time. Is this possible ?

The problem is that I don’t know if shoulder is causing the pain, disc bulge or both causing pain.

The only thing that works on the neck pain is 800 mgs of ibuprofen.

1.) Can the disc bulge I have at c5-c6 even be operated on with a microdiscetomy ? I do not believe there is an annular tear or a major herniation, just a small bulge from the image on MRI.

My shoulder does need surgery, but I believe the pain right near the spine at c5-c6 might not go away.

2.) Would you suggest facet injections at this point in neck, or steriod injection in shoulder or surgery for both !?

3.) what about a discogram ? Could this mimic the pain at c5-c6 ?

In my opinion, I feel like both the shoulder and the neck are the cause of pain and both need surgery.

You are a very kind Dr. that puts the patient first.

Most surgeons are not very helpful these days like yourself !

Thank you kindly !

[Donald Corenman, MD, DC]

#19562

A disc problem in the neck will not cause mechanical shoulder problems like a labral tear.

You need to have the source of pain defined (pain generator). This can easily be done for the shoulder by an intraarticular injection. This can be done in the office. If you gain 2-3 hours of relief of shoulder pain, you have the answer. If the neck pain is also relieved with this shoulder injection, it is a good bet that the neck pain is shoulder driven.

If you do not get neck pain relief with a shoulder injection, you would then be a candidate for a neck pain work-up. This might include facet blocks, nerve blocks or discograms depending upon your findings on history and examination.

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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#19569

Thank you

I have had bad reactions to steroid injections in the past. My primary says I have an allergy to steriods.

1.) Is there an alternative to steroid injections to diagnose pain, such as lidocaine or other anti-inlfammatory injection? I understand that steriod injections are not systemic, however I have had bad reactions to them in the past.

2.) I have read that disc bulge at c5-c6 can adversely effect heart and lung function. How so ?

Thank you again for your common sense approach. I read your website and posts all the time !

[Donald Corenman, MD, DC]

#19570

For diagnostic blocks, there is no need for steroids. Steroids can give long term relief but are useless for diagnosis as they take at least 12 hours to work and do become systemic (which can lead to an allergic reaction). I do believe that you are not allergic to steroids as these medications are used to treat allergic reactions. The allergy is probably to the carrier in the medication.

Diagnostic blocks are commonly performed with only lidocaine or marcaine.

There is no significant relationship between the C5-6 level and heart/lung function. You probably have looked at some chiropractic diagrams that represent this to be true but these charts are inaccurate.

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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