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#32133 In reply to: Parsonage Turner Syndrome |
It is possible that you developed Parsonage Turner Syndrome (PST) but you do need to be ruled out for a radiculopathy. Does moving your neck back (extension) but keeping your arm still cause increased symptoms?
I generally order a cervical MRI to look for foraminal stenosis when a question of PST is raised. Also, an EMG 3 weeks after symptom onset can help to rule PST in or out.
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.#32132Topic: Parsonage Turner Syndrome in forum GENERAL |Dr. Coleman-
I was recently told that I may possibly have Parsonage Turner Syndrome. I began having left shoulder pain that radiates down my arm and causes heaviness and numbness, especially into my index and middle finger. With certain positions, the numbness can go into the ring and pinky fingers as well. I do not have pain in the posterior shoulder, only anterior, and currently no thumb pain or numbness.The pain began two weeks after being diagnosed with an infection in the left parotid gland which was treated with an oral steroid. The sports medicine physician I saw for my shoulder believes the infection migrated into the shoulder and caused the PST.
I did test to have weakness in the rotator cuff muscles, deltoid, and grip, but my bicep/tricep and wrist extensor/flexor muscles were fine. He did not order scans yet as he wanted to see if any changes occurred over an additional two week period (I saw the MD two weeks after the shoulder issue began, and four weeks following the jaw pain.)
Does this sound like typical PST? I am a massage therapist and it is difficult to work currently with this issue. The shoulder problem came on quite suddenly, but there was no specific injury. I work with OT’s who have done some taping of the shoulder, but would love to know if there are other treatment options if this is indeed PST.
I appreciate your opinion on if this fits PST diagnosis, as well as options for treatment.
-Mindy#32122Topic: Non-fusion of cervical spine in forum NECK PAIN |Dr Corenman,
I am hoping that you will help me to understand my neck problems.
Last August, a neurosurgeon shocked us by stating that he thought I was going to need another surgery on my neck because he didn’t think it was fused. He sent me for flexion / extension x-rays and a CT scan. He also requested a new 3T MRI scan to see my cervical and thoracic cord.I had an ACDF of C3/4 and C4/5 done 7 and a half years ago. At the time the two levels below this were also not good, but the neurosurgeon said he would only fuse the two upper levels where my cord was being compressed because if he did all four levels there was a much higher chance that not all of them would fuse. The surgeon used two Titanium CeSpace implants. He didn’t used a plate or screws and didn’t use bone graft and I didn’t wear a collar. He explained to me that he had used this method for the last 10 years and it did work. He said that he would rough up the vertebrae to make it bleed and that my own bone would then grow through the hole in the spacers to fuse my vertebrae together. He said that the spacers had ‘teeth’ in them that would hold them in place while I fused.
Most of my symptoms remained after surgery, but the surgeon had warned me that it might not help them and that he was doing the surgery to get the compression off the cord to stop the damage that was happening. He did say that I might need another surgery from the back later. When he last reviewed my neck about 3 years ago, he said that he didn’t need to do another surgery on my neck because there was still just enough room for the spinal fluid to flow around the cord. He did mention surgery on my thoracic and lumbar spine and emphasised that they would be very invasive. His follow up letter didn’t mention anything about surgery and it didn’t sound like there was much wrong with them. I wondered why he had talked about surgery during our appointment. After this, my GP felt that we should get another opinion. which we did.
So I was very surprised to have another neurosurgeon tell me that he thought my cervical spine wasn’t fused. I am in the UK where we have to wait for a long time to see specialists. I had to wait until the beginning of February this year to get the results of the scan and x-rays to find out if I was fused or not. I was very disappointed to be told at that appointment that the registrar wasn’t sure if I was fused or not but it looked ok to her. She wanted to view the scans with the Consultant, but he was on leave, and she would write to me when she had done that.
Today I received her letter. She mentioned that C2/3 had slight movement on the extension x-ray. I knew about that and there is a degernative grade 1 spondylolisthese there, but I don’t think that is a problem at the moment. She mentioned that the MRi of the whole spine showed degenerative changes throughout, but I knew that. There is just one sentence specifically related to my neck. I quote ‘Complete fusion has not yet taken place in the cervical spine’. Now this could sound like there is still time for my neck to fuse, but I feel doubtful that it will happen now, 7 and a half years after the surgery. My neck is becoming progressively more painful and the level of pain in both arms and especially the hands is also getting worse, and both neck and hand pain are significantly worse that before the ACDF. Back in August, the Consultant neurosurgeon pointed out the stenotic foramen to me. I hoped that if I needed a revision cervical fusion surgery, that he would be able to deal with that at the same time.
In the letter today, no mention has been made of another surgery, just that they will continue to follow up in the outpatient clinic. I now have an appointment in August this year. I don’t think that this registrar neurosurgeon knows how long ago my surgery was. At the start of our appointment a few weeks ago, she was under the impression that my ACDF had been done at that hospital 6 months previously, and clearly hadn’t read any of my notes. Ideally, I would hope that when she viewed my scans with the Consultant, they would have read the notes and seen how long ago the surgery was done, but I know that he is a very busy man, very much in demand and overwhelmed with the number of patients he overseas. She does say that they do not advise any particular restriction to my mobility.
So, my questions are,
* is my neck likely to fuse itself now after over 7 years?
* Is it ok to just leave it unfused? I do think that NHS patients are often left for much longer before surgery than in the US because of the waiting lists.I am feeling very grateful to you for the opportunity to come to your forum and ask my questions.
#32113Topic: Cervical MRI in forum READING X-RAY, MRI & CT SCAN |I am a 36 year old woman. About five weeks ago I started experiencing weakness in my hands, specially my left, it progressed to the point that I have trouble holding the utensils while eating, or typing in the computer, it has also started affecting my legs, specially my left leg. I went to my primary doctor and after an initial assessment he noted a significant difference between both sides, with extreme weakness in my left side and hypersensitivity, ordered a cervical MRI and referred me to neurology. I am waiting on the neurology consult but I have received the results of the MRI, and it reads:
At C2-C3, there is no significant disc herniation, spinal canal stenosis, or neuroforaminal stenosis bilaterally.
At C3-C4, there is a minimal disc bulge which closely abuts the ventral cord with minimal flattening. There is no significant neuroforaminal stenosis bilaterally.
At C4-C5, there is a mild disc bulge causing mild spinal canal stenosis and mild indentation of the ventral cord. There is no cord signal abnormality. There is no significant neural foraminal stenosis bilaterally.
At C5-C6, there is a mild central disc bulge causing partial effacement of the ventral thecal sac, and mild flattening of the ventral cord. There is no significant neural foraminal stenosis bilaterally. There is minimal spinal canal stenosis.
IMPRESSION:
Reversal the cervical lordosis. At C3-C4, minimal disc bulge which closely abuts the ventral cord with minimal flattening. At C4-C5, moderate spinal canal stenosis with mild indentation of the ventral cord. At C5-C6, minimal spinal canal stenosis with mild flattening of the ventral cord.What should I expect? What is going on? Is something that could be solved with physical therapy or surgery might be needed?
Thanks for the help,
#32086 In reply to: Help with MRI results |Update for MRI results. The original lumbar spine MRI was a result of severe hip, and calf pain that happened after carrying a large suitcase down a flight of stairs. It started with a cramp in my hip and started traveled into the side of my calf a few days later. After a week it became difficult to sit for any period of time. I did not have any back pain. I would get a shock like jolt when I would stand up or turn at the waist. I developed weakness in the right leg along with drop foot and it became more difficult to walk. I thought I was having a problem with my hip and had no idea it was my back causing the problems. The pain level was about an 8. I went to the chiropractor to get an adjustment. I explained my symptoms to the chiropractor and he tried to adjust me. As soon as he positioned me a had the electric shock pain shooting down the right side. I decided it was time to visit the orthopedic for further evaluation. The Dr. immediately recognized the symptoms and referred me for a MRI and neurologist follow up. 2 weeks later none of the symptoms changed and I went to my neurologist appointment and was immediately scheduled for surgery. I had nerve compression at L3/L4 that was causing the problems. After surgery I had instant relief of the pain and symptoms. that was August 2018.
December 2018 my back felt better that it had in years. I was on a forklift at work moving some pallets and had stopped to let another forklift pull out of an aisle when I was struck from behind by another forklift. I immediately felt pain from my neck down to my tailbone. I was taken to the hospital for evaluation and a CT scan. The CT scan did not show any major trauma. For the next 2 weeks I was in a considerable amount of cervical and lumbar pain 8-10 when walking around and a 5-6 at rest. I started to lose sensation in my hands and had numbness in my fingers and thumb. The pain in the neck was dull aching pain with some shock pain when turning my head. I made an appointment with my surgeon for evaluation. I had some hyperflexia and tested positive for Hoffmans sign. I went for the 2nd MRI. After going over the results my surgeon said there was nothing that needed immediate surgical repair. I had several bulging disc without cord impingement. I was referred to PT and chiropractic care. I did the 8 weeks of PT and several months of Chiro care. The pain and numbness slowly got better but i never recovered completely. I still had numbness in my hands and electric shocks that ran down my arms. I was having stiff neck and mid back spasms daily. The pain was mainly dull and achy with some sharp pains 6-8. Over the past 3 months the intensity has increased and the duration has also increased. I noticed that I would drop thing from my left hand and my fingers were numb mainly in the pointer finger and thumb. It started to become difficult to sit at my desk and work and driving made me uncomfortable. The pain is a 6-8 and I would get relief when I would lay down. I went back to my surgeon for evaluation. I showed the same symptoms as before, hyperflexia and positive Hoffmans left and right. I have had the 2nd cervical MRI and am waiting to follow up with the surgeon March 3rd. As I am sitting here typing this my hands are becoming more numb and my thoracic spins is starting to ache more along with my neck.
Please let me know if you need any more information to assist you with evaluation. I need to find somewhere to get horizontal for a few minutes. Thank you very much for your time and expertise. I greatly appreciate anything you can do to help me.
Let’s start from the beginning. Why did you have the extensive surgery? What were your symptoms in the beginning? What were the dates of the initial and then removal surgery? Why was the hardware removed? What were the results after removal? Have you had a CT scan to confirm or refute fusion status?
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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