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#7009 In reply to: MRI results |
Wow Dr. Corenman, that was a super fast reply. Thank you.
I originally injured my right shoulder from exercise. and then I keep on exercise my lower body and left hand. I only weight 135lb and I did 40-50lb bicep curl. I did very heavy bicep curl with left hand. I think that is when I injured my neck. I felt pain in the back of the neck before. but now I mainly feel tight(3-4) on both side of the neck. also, I feel some pain(2-3) on my shoulder blade.
so it could be my right shoulder injuries that cause my neck pain?
so base on the MRI, something else is causing the pain?Can these traction device help degenerative disc disease?
if yes, which would be better for degenerative disc disease?Can a TENS unit help?
can a Ultrasound Massager help?I hope the external links are okay with you. if not, I can remove it. Your website has lots of great information to learn.
Thank you so much for spending your valuable time to help me.
Have a great week.Sam,
Failed back surgery syndrome (FBSS) is a syndrome of many different disorders. The disorders can be separated into failure of fusion (pseudoarthrosis), failure of decompression of the neural elements, instability of a segment or segments, surgery for the wrong diagnosis and finally chronic nerve injury which includes chronic radiculopathy (injury to one nerve root) and arachnoiditis (see website for explanation).
Sacroiliac disorders do exist and do have more association with a prior lumbar fusion (normally of more than three motion segments or four vertebra). However pain in the region of the sacroiliac joint is typically not associated with sacroiliac syndrome. This area is the most common referral location for radiculopathy (nerve root disorders) and L4-S1 disc disorders.
A typical work-up for FBSS starts with an MRI with gadolinium, a CT scan, X-rays including flexion and extension and a thorough physical examination. After that, a differential diagnosis is formulated. Provocative tests (discograms) or anesthetic tests are then performed (SNRB, epidural steroid injections, facet blocks, SI blocks). An EMG might be required if there is thought of nerve injury or peripheral neuropathy is suspected.
All the results are correlated and a diagnosis is formulated. The problem is surgically fixed if this disorder is a decompression problem or a failure of fusion. A spinal cord or peripheral nerve stimulator is used if there is arachnoiditis or chronic neuropathy.
By the way, I like that you still have your sense of humor. Believe it or not, that is a very good sign for the chances of recovery.
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.Dr. Corenman,
I really appreciate your time with this. I think we’re focusing on the SI Joint as the etiology because my spine has been “scanned to death”… While my last MRI did yield probable stenosis at L3/4, there seemed to be this circus of indecision as to whether, A) it was actually there in the image at all, and B) if it were there, a 6th lumbar surgery would likely result in a 3rd fusion extension to T/11, rendering me as about as flexible as a telephone pole. I’m mentally spent from surgeons looking at me with this blank stare, saying, “You’ve had a lot done to your back, so there’s no wonder it hurts. It’s nerve damage… It’s muscle damage… It’s failed this… It’s failed that.” While a small percentage of surgeons sleep well at night having earlier dismissed or blown off a patient in pain, they leave a line of patients in their wake who only needed one surgeon to think outside the box for an answer. It’s absolutely frustrating to the point of controlled anger. I’m sure you’ve treated patients who are at the ends of their proverbial ropes, just like me.
Another reason for perhaps investigating the SI Joint is that my symptoms, according to orthopedic clinical studies and research, are classic. Even down to variables such as the inability to roll over in the morning, to uneven leg length (my right leg is 1/2 inch shorter than my right), being stopped in mid-stride by a severe “catch” in the region of the joint, to the pattern of pain distribution. Per your advice, I recently had my PM anesthesiologist order AP/LAT films with extension and flexion views. Not to sound arrogant, but the radiologist’s reading and impression seemed woefully inadequate. Although the sacral region was ordered for the films, he mentioned nothing in terms of even looking at them, or acknowledging whether the area appeared normal or not. All his reading said, roughly, was “There is evidence of extensive prior surgeries. I see bolts and screws and a wristwatch and a Cracker Jack prize. Disk spaces are narrowed at all levels. I’m going golfing now. The end.” His impression said nothing about instability, pseudoarthrosis, or osteophytes, or the Chupacabra.
The neurosurgeon to whom I sent my records and MRI films should be calling this week with his ideas and theories as to the SI Joint Dysfunction. Obviously, he wanted to see a concise list of my symptoms prior to initiating any treatment or diagnostics. Money is also a factor for me… Although I’m a college professor, I don’t live in the Hollywood Hills (although our students think otherwise)… One advanced diagnostic scan of my SI Joint is more cost-effective for me than three more tests on my lumbar spine. Right now, I’m being “$100’d to death” with out of pocket charges for lumbar MRIs, X-rays, and pre-implant screening procedures for the neurostimulator.
QUESTION: Are neurostimulators indicated for patients with SIJD, should this be my ultimate diagnosis? I’m scheduled for implant within the next three weeks for lumbar-related pain, but am recommending my implant procedure be delayed only until the SIJD is ruled in or out. Is this a good decision?
Just being offered a definitive diagnosis at this point would do a world of good for me. I’m exhausted mentally from being labeled “beyond help”, or as having this nebulous, vague condition of Failed Back Syndrome, when my back may not be the culprit at all… Sometimes patients begin to think that surgeons and doctors are forgetting about being good investigators and seekers of the causes of symptoms. So, thank you for what you do, and again, your reply to my question is appreciated.
S.W., NC
Dear Dr. Corenman,
Given the less-than-ethical treatment I received by a new orthopedic surgeon last month (regarding presumed severe bilateral foraminal stenosis in my previously fused lumbar spine), I elected to contact my prior neurosurgeon to get his opinion and assessment of other potential causes for my severe low lumbar pain, groin-to-extremity pain which stops at the anterolateral knee / calf, and other specific symptoms. He listened carefully and intently, then afterward, stated, “I am over 90% sure, just from your detailed description of symptoms, distribution and intensity of pain, and your issues with neurogenic claudication, that I know what this may be.” His working theory is based upon several reliable and valid orthopedic clinical studies whose samples consisted of patients with symptoms consistent with Sacroiliac Joint Degeneration & Dysfunction. In one study, 75% of patients whose histories included one or more lumbar fusions developed symptoms identical to mine; nearly all were definitively diagnosed after the implementation of two diagnostic tests. The first was the SI Joint Injection to assess either significant pain relief, or the complete eradication of pain within 10-15 minutes of the injection.
The second diagnostic tool is the subject of my question to you. Recent medical journals and other similar sources have mentioned a rather new form of diagnostic imaging known as SPECT / CT Imaging. Traditional X-rays, MRI imaging, and CT scanning typically have not been effective in identifying degeneration, arthrosis, or abnormalities in the SI Joint — articles suggest that patients would present with very specific symptoms (identical to mine), yet their imaging results from traditional modalities yielded no discernible disease of that joint, and patients just like me were sent out the door with catch-all, vague diagnoses such as Failed Back Surgery Syndrome. Thus, intra-articular injections, until recently, have been the only somewhat reliable method for diagnosing SIJD.
First, can you tell me as to whether most major medical facilities now have SPECT / CT, and how “new” this imaging option is?
Second, what differentiates traditional Computerized Tomography machines from SPECT / CT? Are the machine designs basically similar, or are there differences?
Third, what is imaging like using SPECT / CT? Does it yield images in 3-D, or are the images clearer?
Finally, why is SPECT / CT imaging capable of detecting SI Joint Dysfunction as opposed to standard MRI, CT, and X-rays, whose images rarely reveal anomalies in the SI Joint?
As I mentioned above, my neurosurgeon is cautiously optimistic that my symptoms are correlated with Sacroiliac Joint Dysfunction — if he calls this week and indicates that the SI Joint is the likely instigator, I’ll request imaging via SPECT / CT, along with the injection that I’m sure he’ll order. My next step will obviously be to locate a facility with this type of machine.
Thanks, as always, for your time.
S.W., NC
#6985 In reply to: neck pain radiating to shoulder and arm |I am always suspicious of MRI reports read by someone other than myself. “Mild, moderate and severe” terms are value judgements that are simply interpretations.
A thorough physical examination can differentiate the pain generation between the neck and shoulder pathology. Some simple examples are that shoulder pain generated from the neck is associated with neck extension and the “spurlings maneuver”. Shoulder pain generated by the shoulder itself is associated with elevation of the arm without neck extension.
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.#6980 In reply to: degenerative disc bulge L5/S1 |Location And Quality of Pain:
Pain started from the coxes lower end of the back and radiate in leg and lower back. Quality of pain is like injury or swelling.Quality of Pain changes (increases) with activity and no skin color changes when touched.Percentage of Pain by Location:
Pain originates from lower back and radiates in left leg and back and pressed the nerve root. 80% back and 20% leg. Severe pain in posterior and in coxes.Intensity of Pain:
6-10-VAS- for 2 years. Lower back 5-6 and leg 2-4. Very severe pain like injury.Weakness:
Yes, muscles are weak due to pain and always cramp occur in muscles.
Onset and length of Time symptoms have been present:
Pain started 7 years ago and gradually increased. I cannot sit and cannot stand even for 2 minutes. I feel most pain while sitting and standing.
Activities:
Activity causes severe pain in lower back and hurts me sitting and standing and bending towards. I cannot walk more than 20 minutes. Not mild pain rather severe pain in activity.Pain intervals:
I never free from the pain in the day. Only feel relief lying in the bed straight. And I felt little bit better after physiotherapy only for one to two months but after that it came back to its original intensity.Activity and Occupational Restriction:
Pain has changed my life. Every activity has been ended. I am on bed for the last 6 months and I am bearing this pain for the last 7 years.Diagnose:
MRI Recent report 7 days ago is:
Degenerative Disc Bulge L5/S1 in the small posterior.
Liability:
No Liability of any corporation. A forceful impact occurred during plane landing. And after 3 years I joined gym. Then I got into this severe pain.Previous Consultation or Treatment:
Within 7 years I’ve had many treatments but all were useless. Recently, Dr. advised me physiotherapy and some simple painkillers. And suggests me that you need no surgery but even after all these experiences I couldn’t get rid of this severe pain at all. I am very much disappointed. So, I am sending you my full history.
Kindly, Dr.Corenman help me getting rid of this pain.
NOTE: My pain is like needles are hurting/knocking inside me.
My nickname is Anila.
My real name is Attiya.
Previous Profession: Flight Attendant. -
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