Donald Corenman, MD, DC
Moderator
Post count: 8436

By your description, you have herniations at C5-6 and C6-7 on the left with C6-7 being a larger herniation. These herniations would compress the C6 nerve (C5-6 herniation) and the C7 nerve (C6-7 herniation). Symptoms of a C7 herniation would be shoulder pain that radiates into the middle of the hand, weakness of the triceps, MCP extensors (straightening of bent fingers) and wrist flexion (bending the wrist down). C6 compression symptoms would be shoulder pain radiating into the thumb side of the hand, weakness of the biceps and wrist extension (bending the wrist up and important for grip strength). Neck may or may not be present- it depends upon the tear of the disc itself.

You have already had a very good conservative treatment program with chiropractic, physical therapy, traction and epidural injections.

There are new complaints of paresthesias (pins and needles) down the arm which concern you. Paresthesias are generated from the proprioception portion of the nervous system. This is the system that tells your subconscious brain where your body parts are in space.

Symptoms of paresthesias generally are an indication of nerve root compression and new onset symptoms are slightly concerning. The most concerning symptoms to me however are the generalized weaknesses of the muscles of the arm. This requires some explanation.

There are four nervous system functions carried by one nerve root. These are sensory (compression would cause numbness), noceceptive (compression causes pain), proprioception (compression causes paresthesias) and motor (compression causes weakness). All except the motor are pure sensation type transmitters. The sensory roots can cause these symptoms with only mild compression but the motor portion of the nerve root is much tougher and more compression is required to make it dysfunction.

When weakness develops from motor nerve compression, this means the compression is significant. The motor nerve root does not recover easily after compression and some patients even after decompressive surgery may not recover full motor strength. The nerves that are the most to least sensitive are T1, C8, C5, C7 then C6.

There are four indications for neck surgery, significant motor weakness, spinal cord compression, instability of the vertebra and intolerable pain. You have at least one of the indications.

In my experience, PRP will do nothing for symptoms of nerve compression. Epidural steroid injections are the single most effective treatment for pain but will do nothing for motor weakness. PT is very important for function but will not help motor weakness.

My opinion is that surgery for motor weakness is the best option. In the face of a disc herniation without neck pain, surgical options include ACDF or artificial disc (see website for discussions). Motor weakness with neck pain most likely requires ACDF only. There are no studies regarding how quickly the surgery needs to be performed but in my opinion, the quicker the nerve is decompressed, the better the chance of recovery.

Hope this helps.

Dr. Corenman