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Hi Doctor Corenman,

Two additional question please. You have said facet pain can mimic the nerve (c2-3, c3-4). Aside from pain, can a degenerated facet via the medial branch nerve cause all of the other possible nerve symptoms such as irritation, burning, radiating and numbness???

You mentioned facet capsule tear. If this is the case is pain management the treatment (radiofrequency) or does this become a surgical issue???

Thanks Doc

Hello Dr Corenman
Sorry for the length. My symptoms are diffuse (c2-3 – t1-2), from a variety of trauma. There is both facet and nerve pain. Left side neck pain is the dominant, diffuse symptom, especially above the base of the neck, but downward and in the arm as well. There is no cord involvement or symptoms I am aware of. The traumatized c2-3 facet is a particular nightmare. The mri is normal, the area tender, with trigger points and what feels like some atrophy. You have suggested the inflammation or a severely degenerated facet may affect the nerve.

Originally (1 year ago) I went to a Beckers list/Castle Connally (like our Vail, Colorado hero) pain management doctor. After receiving a thorough examination and questioning by the physicians assistant (who might have been too young to vote), she took the mri report and left to present the case to the doctor. The doctor soon arrived, coffee container in hand, only visible from the waist up as he leaned in the doorway. (He was not going to do any doctoring…today). His recommendation was to medial branch block the entire side. I was somewhat taken aback as they advertise the meticulous search for the pain generator. I asked how he would know which nerves to radiofrequency if the block successfully produced pain relief. He responded, “I burn ’em all, they’re all involved” and vanished. He was including c1-2 and possibly even c0-1 (not sure).

I went elsewhere to a pm doc with identical credentials who did the procedure in-office, sparing surgical center, anesthesiologist and even procedure expense (just co-pay) . The radiofrequency was c3-t1. A couple of months later I forced him to do c2-3. All results were minimal.

The odd part is this doctor started with only c3-4 (the opposite of the burn ‘em all doc). The short acting, 30 minute block weirdly produced 3 days of wonderful relief. Encouraged he next did a 4 hour marcane block adding c4-5 to the c3-4. No relief at all. Zero! Zilch! This morphed into the c3-t1 radiofrequency. Months later I convinced him to do c2-3. He first did a marcane block and there was 4 hours of great relief. Again the radiofrequency results were minimal. (there was an epidural in the middle which did little for pain but did reduce irritation, burning, tingling type symptoms for a couple of months. You have replied about out of position nerves, anesthetic spread vs needle width and capsule tear (although these were medial branch)

I am going to try pm again and am seriously contemplating the burn ‘em all doc this time for simplicity sake and his credentials.

Questions:
1-Do you approve of any radiofrequency at c1-2 (headaches are not a symptom)????

2-Because this facet is surely enflamed, would it make sense for the block to be into the facet with anesthetic and cortisone vs medial branch (at least once). The injury and symptoms are years old????

3-In my case c2-3 and c4-5 must be done together this time and I would approve adding c4-5. Is there any downside to including all the way to t-1 as he seems to routinely do????

4-The common denominator to the relief I got twice on blocks seems to be c-3. Again the mri at c2-3 is normal but the facet is bad news. There are posterior discs (mild) with lateral extension also producing left foraminal stenosis at c3-4 and (c4-5) termed moderate but look and feel worse than that to me. C5 nerve root was +1 fib ans psw on nerve test -no weakness-but certainly sensory symptoms. Any idea why these blocks are so successful????

Thank you for everything Dr Corenman ( I read the forum daily and frequently re-read parts)

Hello admired Dr and Person

I am wondering about your statement “The C3 nerve can be affected by inflammation of the C2-3 facet” which is my case is surely traumatically damaged. The mri looks and says normal. I do believe the nerve is “affected”. Besides pain I feel sensation in the ear when turning or pressing painful, swollen trigger points that seem to deflate and also nerve endings (?). It is a bumpy, atrophied(?) area. Sometimes I think the capsule is busted out (guessing). It is painful to turn in that direction…feeling blocked.

Medial branch blocks worked, but the radiofrequency minimally. I think the anesthetic dripped onto something. I realize now that cortisone and anesthetic was never injected into the facet, the doctor had said not for this condition, and went right to the medial branch, with radiofrequency in mind. The nerve was never considered at the time. I’m thinking that even though the medial branch is deadened successfully the inflammation remains. This inflammation then still affects nerves that affect the ear, ear area, side of face/head etc that do not transmit their symptoms through the medial branch but through the nerve and thus strong symptoms still remain (even with the medial branch muted).

Is that last statement correct?

What do you mean by the nerve affected?

Is it different than compressed and might it clear up if the inflammation is treated?

Should this facet have been treated with the facet being injected vs the medial branch and is this what you would recommend in the soon to be repeated pain management arena?

Thanks for what you are doing.