geckogirl

Hi Dr. Corenman,

Thank you for your previous response.

I did undergo Radiofrequency Ablation and have experienced significant improvement. My question now is in regard to tremors. I have previously been diagnosed with benign essential tremor in my hands and jaw. I am now experiencing pill-rolling tremor primarily in my left hand and additional tremor in my left arm below the elbow. I will be having a repeat cervical MRI to determine if the previously noted canal stenosis has worsened. While I realize the pill-rolling tremor is primarily related to Parkinsons and other neurologic disorders, have you found tremor to be a symptom of cervical central canal stenosis?

Thank you.

Thank you for reply. Hopefully the following information answers your questions.

Did you have deep tendon reflex changes (DTR) on exam? Reflexes: Right/left biceps, brachioradialis, triceps absent/absent, patellar and Achilles 2/2.
Did you have sensory changes in your arms? Light touch intact bilaterally C5-T1.
Did you have any weakness of muscle groups upon examination? Right/left shoulder abduction, elbow flexion, extension, wrist extension, finger abduction and thumb opposition 5/5.
Did you have long tract signs (hyperreflexia, clonus, Hoffman’s sign) present? No

WHen you note levels for injections, are these medial branch blocks (MBB), facet injections, selective nerve root blocks or epidural injections.
Diagnostic C2,3,4 medial branch block, Left – Only 25% relief
Therapeutic C7-T1 interlaminar epidural steroid injection #1, Midline – good relief for 6 days
Therapeutic C7-T1 interlaminar epidural steroid injection #2, Midline– moderate relief for 4 weeks
Diagnostic #1 C4 and C5 and C6 medial branch blockade Left– 95% relief
Diagnostic #2 C4 and C5 and C6 medial branch blockade Left– 95% relief

When you developed “Arm pain – I do occasionally have upper arm pain but this is minimal. My arms are quick to fatigue which has prevented PT progression beyond basic arm exercises. I also have tingling in the forearm and into the hand as well as a decrease in grip strength”, what sides? Tingling in forearm/hand is on the left side. Upper arm fatigue occurs in both arms but worse on the left side.

I did have an EMG which indicated mild carpal tunnel.
There is a left, mild in degree median neuropathy at the wrist that may be associated with carpal tunnel syndrome. There is no electrophysiologic evidence for right or left cervical radiculopathies, brachial plexopathies or other evidence for neuromuscular disease.

The neurologist and 2 spine specialists did not feel the canal stenosis noted on MRI was significant enough to cause my symptoms.

Since the 2nd C4,5,6 MBB was successful I will be scheduling RFA. Do you feel this is the best approach and would you think surgery might be required in the future?

Thank you for reply. Hopefully the following information answers your questions.

Did you have deep tendon reflex changes (DTR) on exam? Reflexes: Right/left biceps, brachioradialis, triceps absent/absent, patellar and Achilles 2/2.
Did you have sensory changes in your arms? Light touch intact bilaterally C5-T1.
Did you have any weakness of muscle groups upon examination? Right/left shoulder abduction, elbow flexion, extension, wrist extension, finger abduction and thumb opposition 5/5.
Did you have long tract signs (hyperreflexia, clonus, Hoffman’s sign) present? No

WHen you note levels for injections, are these medial branch blocks (MBB), facet injections, selective nerve root blocks or epidural injections.
Diagnostic C2,3,4 medial branch block – Only 25% relief
Therapeutic C7-T1 interlaminar epidural steroid injection #1 – good relief for 6 days
Therapeutic C7-T1 interlaminar epidural steroid injection #2 – moderate relief for 4 weeks
Diagnostic C4 and C5 and C6 medial branch blockade – 95% relief – 2nd injection will be this week.

When you developed “Arm pain – I do occasionally have upper arm pain but this is minimal. My arms are quick to fatigue which has prevented PT progression beyond basic arm exercises. I also have tingling in the forearm and into the hand as well as a decrease in grip strength”, what sides? Tingling in forearm/hand is on the left side. Upper arm fatigue occurs in both arms but worse on the left side.

I did have an EMG which indicated mild carpal tunnel.
There is a left, mild in degree median neuropathy at the wrist that may be associated with carpal tunnel syndrome. There is no electrophysiologic evidence for right or left cervical radiculopathies, brachial plexopathies or other evidence for neuromuscular disease.

The neurologist and 2 spine specialists did not feel the canal stenosis noted on MRI was significant enough to cause my symptoms.