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OMGoodness rpowell01, I swear you have been living in my body for the past several years. What you have written describes me to a “T”.

For starters, 27 years ago I was shot completely through the head and was left with headaches and pain above the clavicle region. In addition, I would experience “ice pick” headaches for days and at times, weeks on end. About 10 years I began having severe fasciculations and muscle spasms in my body. The spasms were so severe that you could see the muscles ( many different individuals including multiple doctors) witnessed this happening. Every test known to man was run through blood work and MRIs of the brain. Finally I was told it was Benign Muscle Fasciculation?Spasm Syndrome and that basically nothing could be done for it.

3 years ago I developed left shoulder pain and went to an orthopedist. He ordered X-rays then after viewing them sent me immediately for and MRI of the Cervical Spine. which stated the following: c3/c4 4 mm posterior protrusion centrally, c4/c5, anterior disc protrusion, c5/c6 4 mm left disc protrusion posteriorly with moderate left neural formanal narroing, narrowing of the spinal canal centrally. c6/c7 4 mm left disc porturstion, severe left neural formainal stenosis and impingement of the left exiting roots, There is rotation of the left thecal sac and cord. I was immediately placed in an Aspen collar for at least 12 hours a day, traction twice a day and severely limited on what I could do with my arms.

Within the year I began having constant pain in my chest, as if someone was tearing out my pecs, and yes, like you, specific areas of pain which later I was told were trigger points in my body. Soon my arms joined in the debacle and I was sent off to have EMGs and NCSs on both arms since my pain was bilateral. Reports came back with median and ulner nerve damage in both arms. I am highly allergic to most medications and one by one we went through the list of pain management medications and slowly eliminated them. I have been in and out of ER with chest pain that mimics a heart attack yet all tests show that my heart is fine even though it feels on a daily basis that a spear is piercing my chest wall.

Woke up one morning last winter to find the area on the right side of my chest were TOS would be located swollen to at least triple its size and I was unable to move my arm from shoulder to elbow. Elbow to hand was fine. The pain was horrific and but all I could use was Advil and ice. all other methods had previously been ruled out. Mind you, I was still working a full work day in the Aspen brace. Slowly over the past 6 months the occasional pain in my arms, from arm pit to finger tips, has grown in intensity from burning nerve pain, to feeling like someone is stabbing me with a knife. 2 months ago my right bicep swelled up as large as a grapefruit and the arm turned a pale bluish white. Back to the ortho, immediately sent in for MRI which indicated fluid and swelling in the cubital tunnel. Back to the ortho who physically tested for TOS and he discovered he could not find a pulse in my left arm, the normal one. Now off to a Vascular Surgeon who stated in his report,” I am not sure of what she has, but something is definitely abnormal.”

Next stop is a Rheumatolgist who diagnosed me with aggressive and controlled Fibromyalia above and beyond the physical findings of the surgeon and orthopedist. Now back to the Neuron-surgeon who put me through the pin prick to the fingers test to having me fail on the right hand; never flinched when he was poking the fingers, but on the left hand, the side with the impingement, I could feel pain, but less than before.

Technically my pain should NOT be bi-lateral but it is, and is proven by observation, physical tests, diagnostic imaging and just about anything you can think of. I have had to leave my job because I could no longer perform my duties. My regular MD just shakes his head and tells me he has never in 30 years of practicing medicine, seen anything like this, but here I am. After the latest series of testing by the Rheu to see if there is another issue, I will return to the Neurosurgeon for another MRI and probably the scheduling of surgery. Do not give up, do not be dismissed and believe in yourself. 10 years ago I was told it was anxiety and look where I am today. In a neck brace and arm braces and sorry, I have never seen a shrink instruct a patient to wear those!

Your pain is classic for lateral recess or foraminal stenosis. The pain is generated by the congenitally narrowed region that the nerve root passes through. When you stand from a sitting position, the nerve moves and translates not unlike a brake cable on a bicycle. This transitional movement of the nerve can cause it to “catch’ in a narrowed zone. Also, the act of standing causes the lower back to change from a flexed position to an extended position.

This change to extension narrows the two transitional zones (lateral recess and foramen- see website for more details). If these zones are congenitally or developmentally narrowed (you were either born with this narrowing or degenerative changes have narrowed it), the nerve will become pinched and pain in the buttocks and thigh will occur.

Your MRI notes this narrowing (” ANTERIOR EPIDURAL FAT, MILD THECAL SAC COMPRESSION & MODERATE NARROWING OF BILATERAL LATERAL RECESS AND NEURAL FORAMEN”.

If this is the case (a good physical examination and careful evaluation of the images will reveal this), epidural injections can be very helpful. Also, a flat back therapy program will be effective in reducing the lumbar lordosis and therefore reducing the pressure on the nerve root.

Dr. Corenman

First, a coccygectomy is a very rare procedure. I perform these with the help of a general surgeon and have removed fully two in my career out of tens of thousands of patients I have seen. Both patients had a protruding coccyx that was painful to sit on due to the tenting of the skin. Other than those instances, the coccyx removal is not a procedure that I recommend.

Now I have performed probably ten coccyx injections and most of them have been helpful. There is not insignificant risk for the injection. The area has very thin skin and is full of bacteria. An injection complication can be devastating and these complications do occur occasionally.

Dr. Corenman

You have three symptoms that might be independent of each other. The numbness of your left two fingers fits with the EMG report of ulnar nerve compression (cubital tunnel syndrome). The nerve is somewhat compressed in your elbow and bending the elbow stretches the nerve, causing numbness of the outside of your hand. For this disorder, you can try a splint that causes your elbow to remain straight when sleeping. There are hand surgeons that can inject a steroid to reduce inflammation and finally, you an have the nerve surgically decompressed.

Pain in the left shoulder blade could be from cervical nerve root compression but the MRI does not confirm this. The EMG test can fail to diagnose this. The EMG depends upon motor nerve compression to diagnose compression. If the motor nerve is functioning well but the sensory and pain nerves are compressed (a common scenario), the EMG will be negative but the pain will still be excruciating. Other disorders that can cause left shoulder pain are rotator cuff problems and instability (common with martial arts).

The right arm weakness could be from the herniation of the C6-7 level. This nerve supplies the triceps muscle, the wrist flexor muscle (it pushes your wrist to the palm side down) and the MCP extensors (I won’t bother you with that description). Normally, the EMG will indicate problems here but the EMG test is operator dependent and subtle findings can occasionally be missed. You can test the triceps muscle with a weight machine. Can you do as many reps with as much weight on the left as you can do on the right?

You need a skilled spine surgeon and a shoulder surgeon to ferret out these complaints.

Dr. Corenman