Msamatas

Symptoms
• Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles? I have pain in my neck and at the base of my skull. It is always there. Either dull or more prominent ache which gets to a point of causing nausea. It spreads up the back of my head and on the sides of my ears. I feel pressure as though someone is strangling me. I get a strange sensation in my neck when I swallow – not pain but feels a little constricted.
• Does the quality of pain change with activity? The pain gets worse as the day goes on regardless of what I am doing. Sitting and standing make it progress faster.
• Is the skin hypersensitive to touch? no
• Are there associated skin changes like thickening, color change or nail changes? This is important in the shoulder, arm and hand. no
Percentage of Pain by Location
• What is the percentage of pain in the neck vs. shoulder and arm? 60% neck 30% base of skull and 20% from the inside of the elbow down to the wrist. My wrists become painful when I hold things and they are weaker than they used to be. For example, I cant take a baking pan out of the oven with one hand anymore. Its very painful and my wrist strength won’t support it.

Intensity of Pain
• Pain started at a zero in January and progressively got worse over the last few months. It ranges from a 1 usually in the morning to a 5 in the evening every day. Only once I had a pain that went to an 8, it was a about a month ago. The pressure in my head was so severe I debated going to the hospital. The pain in my lower arms and wrists is only when I use them and it’s a 3.
Weakness
• Is there weakness associated with the pain? The weakness occurs only in my wrists and forearms. I get a numbness down my left leg into my pinky toe occasionally. I’m not sure what triggers it.
• Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is weak because the signal from the brain is interrupted due to a pinched nerve)? I don’t feel like any muscles are weak. It seems like its neuropathic weakness. I am extremely clumsy with my hands also.
• Is there now an inability to lift the arm due to pain or to weakness? no
• Are certain activities more problematic like pushing away or throwing (due to weakness and not pain- such as a weak triceps muscle) or lifting due to a weak deltoid or biceps muscle? Just my forearms have limited strength with pain.

MRI OF THE CERVICAL SPINE
Axial and sagittal images were done according to the usual protocol.
Overall, alignment is normal.
There is congenital fusion between the C2 and C3 vertebrae both for the vertebral bodies and posterior elements.
There is mild multilevel degenerative disc disease including the upper thoracic segments.
There is no bone marrow edema or Modic type changes.
Spinal cord signal is normal. The craniocervical junction is clear.
Axial images were done from C1 to T2.
Mild degenerative changes are noted at C1-C2.
At C2-C3, no significant abnormality noted.
At C3-C4, there is a small posterocentral disc protrusion. No foraminal or central stenosis.
At C4-CS, there is diffuse disc bulging. No significant central or foraminal stenosis.
At C5-C6, there is significant bilateral foraminal stenosis due to diffuse disc bulging and congenitally short pedicles. Both the right and left C6 nerve roots could potentially be affected.
There is also a disc protrusion at the right posterolateral and inferior aspect of the disc measuring 8 mm in the transverse diameter × 3 mm in the AP diameter. This could also potentially affect the right C7 nerve root. In addition, there is mild central stenosis with the canal measuring 9.6 mm in the AP axis.
At C6-C7, there is diffuse disc bulging, more prominent left of the midline. There is mild to moderate bilateral foraminal stenosis worse on the right side. Both C7 nerve roots could be affected but particularly the right one. There is no central stenosis.
The C7-TI segment is normal.
The TI-T2 segment is normal.
We even covered T2-T3 and we see a right foraminal hernia at that level. The T2 nerve root could potentially be affected.
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There is mild to moderate diffuse facet OA.
The rest of the study is unremarkable.
Impression:
Multilevel degenerative disc disease with facet OA.
Congenital fusion of the C2 and C3 vertebrae.
Presence of a few disc protrusions as described above. On their own, they could cause focal or locally referred pain. Some of them however may also cause associated radiculopathy. This is the case of the CS-C6 disc protrusion right of the midline which could potentially affect the right C7 nerve root. We also saw a small hernia at the right T2-T3 foramen which could potentially affect the right T2 nerve root. Clinical correlation is recommended.
The patient has multiple foraminal stenoses of variable severity. The most significant are seen CS-C6 and C6-C7 particularly on the right side. Therefore, the right C6 and C7 nerve roots could be affected.
Mild central stenosis at C5-C6.
Other findings, as described in the body of the report.
Thank you for referring this patient.