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Over the past 2 years I started developing “knots” on top of my shoulders (feels to be in the scalenes) and on both sides of my spine where the shoulder blade “meets” the spine. I had regular deep tissue massages but they’d come back then next day. (I can literally hear them “rolling” around when I stretch my arms up). It feels as if my shoulders are constantly being drawn to my neck (also has shortened my neck height). Based on my Googling, I thought it could be TMJ, but finally went to orthopedic surgeon, had X-rays and MRI. The only abnormality was a slight disc herniation between C6/C7. He referred me to a spinal surgeon, but he wasn’t worried at that time since I had 100% strength, so referred me to physical therapy. Coincidentally, I woke up one morning and my left shoulder was literally “stuck” in an elevatated position (imagine it was naturally trying to make contact with my ear). This may have been caused due to my natural twisted-side sleeping position, or the previous day’s workout (was doing heavy shrugs and trap raises). I happened to have an appointment with the physical therapist a couple days after, and he extensively investigated, and said it was textbook C7 nerve pinch since my left tricep strength was virtually gone and had extreme pain on the left side of my neck. I also lost ability to rotate my left arm (could barely open a door) and my thumb, index finger, and middle finger were numb. I got referred back to the spinal surgeon, he referred me to EMG, and the tests showed the same (loss of nerve signal in my left tricep and forearm).

Avoiding surgery, time passed and symptoms remained constant for about a month, then started to get better. I decided to visit a chiropractor, and have been seeing him for about 2 months with 3 adjustments/week for the first 3 weeks, and 2 adjustments/week through today. Now, the pain is gone, the strength is much better, and only my index finger has a faint numbness in the very tip. The chiropractor has measured increased mobility in my neck and increased grip strength. However, the original discomforting “knots” are the same as the beginning, I have tightness/pain that runs from my left tricep down the left side of my abdomen when I do an overhead tricep stretch. I can also feel “fibrous” knots the sides of my shoulder blades under my armpit area. I also have tightness in the front my neck that runs up to my jaws. When I attempt to do very light workouts, it aggravates it and I lose some strength in my left arm again, but it comes back quickly.

It was diagnosed as “acute” but I don’t believe it’s due to a single incident, and that other strength tests by my chiropractor show that neighboring discs are also affected. Things I can think of that are the root cause are: my poor respiratory strength (had bad asthma growing up), poor sleeping position, poor general posture, and/or sitting at the computer. When I sleep on my side, my shoulder blade “juts out” at a single point, and this is exactly the location where the “knot” is symmetrically on both sides, but do not know if this is causing all the problems. Lately I have been very conscious of my posture and sitting positions and have been doing neck stretches, etc, but the discomfort/tightness is still there. I alos noticed what looks like bruises at the shoulder blade “jutting out” locations (equal on both sides), but I’m not sure if that from my bad habit of me massaging/pressing on that area throughout the day with my fingers.

I basically want to get another opinion of what the best path forward is (surgery, chiropractic, PT, etc). Are the “knots” causing the problem, or are they a result of specifically the C6/C7 disc herniation? Could my sleeping position be to blame; if so, if I correct this will the disc heal itself?

Thanks for any help with this.

Dave

Hi Dr.

Thank you for reading in advance.

I had my 2nd lumbar discectomy on L4/L5 last February 2011. The first one was 10 years earlier. I needed a 2nd operation due to L4/5 herniation in 2 directions. Majorily towards the left and a bulge posteriorly.I had acute left foot drop and surgery within 2 days. The surgeon took care of the left sided extrusion causing foot drop but left the remaining disc alone. Therefore i still now have a remaining broad based posterior disc bulge. The surgeon did not think it necessary to adress the posterior bulge during my operation.

My followup MRI from 16/5/11 is below;.
L4/l5 there is a broad based postereocentral disc bulge 14 mm in width and 5 mm AP. No migration of sub-ligamentous extension. There is mild narrowing of lateral recesses. No definite neural impingement. Bilateral foraminal narrowing with contact without compression of L4 nerves. Severe facet arthrosis at this level and L5/S1. The cauda equine nerve roots are non blunt and non thickened. No features to suggest arachnoiditis.

A 2nd MRI done 2/11/2011 of last year says;

L4/l5 broad based disc protrusion mildly abutting thecal sac. Superimposed upon this there is focal signal abnormality within left lateral recess that diffuse lay enhances and is round like in appearance at 9mm. The left L5 nerve root is thickened at this point. Appearance is focal abnormal scar like tissue causing compression.

I have no weakness and bowel and bladder are normal. Although I never regained full power of my left foot. I do not need orthotics. I am very fit and exercise regularly including ore and back exercises. Normal height and weight, 40 year old female.

My problem is off and on deep sacral pain/ fullness with a feeling of tenderness. My lower Back easily stresses now and sometimes even a wrong movement or wearing the wrong shoes for 10 minutes may cause sacral pain and tenderness. Also I have migratory numb spots and tingling on thighs and buttocks ( not in perenium)which was the reason for my 2nd MRI only 4 months after the one in May of last year. Final symptom is when my lower back sacrum is acting up I get wind/gas and a feeling of a fullness back there. i am not sure if there is a connection?? What do you think my treatment course should be? What can I do?? How is the gas/ wind thing related to my back pain?

Thank you very much.

Hello,

I had a fusion at L5-S1 over 20 years ago for spondylolisthesis. The surgeon used bone chips from my hip and casted me for 3 months. After intense physio, I spent 20 pain free years enjoying sports, rock climbing, biking, nursing career.

Now, I am having severe lower leg pain, numbness, weakness and back pain. Traction and squatting help. My back is very warm to touch and I use ice frequently. Exercise worsens symptoms.
On flexion-extension xray I have a 12mm movement. A CT scan is this week.

My questions are: what grade is 12mm, what is the likelihood of avoiding surgery and what is the success rate of re-fusion?Thank you very much.
Leslie from Vancouver, BC

Hello Dr. C.,
I am reposting because I am really unsure what I should do or what my options might be. Can you assist me? 11 years ago I was involved in a near fatal MVA. Since my ACDF, I have had progressive pain (mostly in the last couple of years) in my neck and increasing numbness to my right inner arm and 4th and fifth fingers including palm. I have had some numbness and tingling to my left as well but not as much. Weakness accompanies the above symptoms and also coldness. I have also noticed numbness in my abdomen (weird I know). I have tried everything over the years mostly on my own. Initially I tried TENS, PT, hot/cold packs, Steroids, injections, NSAIDS, Muscle relaxers( highly allergic to those though). Wish not to take narcotics due to their limited help and also I have young children. I am a healthy 42 year old female that is active in youth sports. I am not over weight or engage in any risky behavior or habits. My doctor finally talked me into the MRI although I have been reluctant because I am quite sure I need another surgery. I have come to terms with the need to be more aggressive in treatment but I was wondering what you think so that I can be more aware of options. Thank you in advance!!
MRI Findings:
alignment of spine normal. There is anterior cervical discectomy and fusion c4-5. mild bone marrow edema is present at superior endplate of c7. there is a cord signal abnormality at c7 level consistent with degeneration. Otherwise the cord demonstrates normal signal without mass or syrinx.
There is multilevel degenerative disc disease as detailed below:
c1-2: normal
c2-3: posterior ligamentous hypertrophy with mild canal stenosis.
c3-4: annular disc bulging and posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate neural foramina narrowing.
c4-5: discectomy with fusion. no canal stenosis or neural foramina narrowing.
c5-6: annular disc bulging posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate to severeneural foramina narrowing.
c6-7: right paracentral disc protrusion resulting in right neural foramina narrowing. posterior ligament and hypertrophy.
c7-t1: normal.
Impression: c4-c5 ACDF. multilevel degenerative disc disease as described above worst at c3-c4 and c5-c6 with canal stenosis and mass effect on the cord.