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Neurology (Expert Forum)
Chronic Neck Pain
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Chronic Neck Pain
by rod, Sep 28, 1999 12:00AM
I am a 33 year old male who had a tennis injury 7 years ago. A popping or cracking noise was heard while reaching and twisting my head at the same time. Very little movement was possible the next day and I was put into a cervical collar. X-rays did not show any damage. Everything was fine except that I put up with many years of slight discomfort in that I couldn't tilt my head back without pain. After a re-injury on a trampoline 16 months ago, I finally got it checked out. Yes, silly me.
My doctor referred me to a physiotherapist and after 6 visits with no results, she recommended that I see a chiropractor. After seeing the chiropractor for almost 30 visits over 10 months, results were disappointing. My range of motion improved, but still the restricted aft head tilt with pain. About 9 months ago, I noticed tingling a slight numbness in my left hand.
Meanwhile, with consultations with my doctor, he ordered more cervical X-rays, which showed "mild spur formation at C5-6 and bilateral cervical ribs at C7".
I was then referred to an orthopaedic surgeon. He ordered a bone scan and it "shows normal appearances in the cervical spine". He concluded that the problem is a "diffuse soft tissue and joint sprain and this would be capable of treatment with continued chiropractic manipulation". I had asked for a recommendation for a MRI and he disagreed, saying, "I did not believe that this would in any way alter treatment."
Anyway, I went to a private clinic for a cervical MRI. This was done 7 months ago and the results are: "The cervical lordosis is normal. No abnormalities of the bone marrow are seen. The signal intensity of the spinal cord appears normal. The C2-3, C3-4, C6-7, and C7-T1 intervertebral discs appear normal in signal intensity and morphology. Minimal degenerative signal loss is evident at the C4-5 disc level, but the morphology of this disc appears normal. The C5-6 intervertebral disc is narrowed and demonstrates diminished signal intensity. A small broad-based disc protrusion is evident at this level and is associated with uncinate process hypertrophy, resulting in minimal foraminal stenosis bilaterally, but worse on the left. Minimal canal stenosis is present at the C5-6 level resulting in mild cord compression. Conclusions: Degenerative changes and small disc protrusion at the C5-6 level with minimal foraminal stenosis, especially worse on the left."
I took this to my doctor and he then referred me to a neurologist. He gave me a quick examination and the only thing he noticed was "Tinel's test at both elbows was positive, but either ulnar nerve at the elbow subluxed." His conclusion was that he agreed with the orthopaedic surgeon "that I think he has a chronic soft tissue problem with his neck and I don't think we will be able to pin it down to any particular structure. I don't think any form of surgical therapy is indicated here, and after seven years it is probable that the patient will continue to have neck symptoms which should be treated conservatively."
Since all of this, my symptoms are getting worse as the neck pain has worsened and my left hand tingling is constant. I haven't had any chiropractic manipulations since last April. So where do I go from here? Can this be "pinned down". Help!
Otherwise, I am in excellent health with only post varicose vein surgery 9 years ago.
My doctor referred me to a physiotherapist and after 6 visits with no results, she recommended that I see a chiropractor. After seeing the chiropractor for almost 30 visits over 10 months, results were disappointing. My range of motion improved, but still the restricted aft head tilt with pain. About 9 months ago, I noticed tingling a slight numbness in my left hand.
Meanwhile, with consultations with my doctor, he ordered more cervical X-rays, which showed "mild spur formation at C5-6 and bilateral cervical ribs at C7".
I was then referred to an orthopaedic surgeon. He ordered a bone scan and it "shows normal appearances in the cervical spine". He concluded that the problem is a "diffuse soft tissue and joint sprain and this would be capable of treatment with continued chiropractic manipulation". I had asked for a recommendation for a MRI and he disagreed, saying, "I did not believe that this would in any way alter treatment."
Anyway, I went to a private clinic for a cervical MRI. This was done 7 months ago and the results are: "The cervical lordosis is normal. No abnormalities of the bone marrow are seen. The signal intensity of the spinal cord appears normal. The C2-3, C3-4, C6-7, and C7-T1 intervertebral discs appear normal in signal intensity and morphology. Minimal degenerative signal loss is evident at the C4-5 disc level, but the morphology of this disc appears normal. The C5-6 intervertebral disc is narrowed and demonstrates diminished signal intensity. A small broad-based disc protrusion is evident at this level and is associated with uncinate process hypertrophy, resulting in minimal foraminal stenosis bilaterally, but worse on the left. Minimal canal stenosis is present at the C5-6 level resulting in mild cord compression. Conclusions: Degenerative changes and small disc protrusion at the C5-6 level with minimal foraminal stenosis, especially worse on the left."
I took this to my doctor and he then referred me to a neurologist. He gave me a quick examination and the only thing he noticed was "Tinel's test at both elbows was positive, but either ulnar nerve at the elbow subluxed." His conclusion was that he agreed with the orthopaedic surgeon "that I think he has a chronic soft tissue problem with his neck and I don't think we will be able to pin it down to any particular structure. I don't think any form of surgical therapy is indicated here, and after seven years it is probable that the patient will continue to have neck symptoms which should be treated conservatively."
Since all of this, my symptoms are getting worse as the neck pain has worsened and my left hand tingling is constant. I haven't had any chiropractic manipulations since last April. So where do I go from here? Can this be "pinned down". Help!
Otherwise, I am in excellent health with only post varicose vein surgery 9 years ago.
Doctor's Answer
by CCF neuro MD MM, Sep 28, 1999 12:00AM
I think it is possible that you will not be a suitable candidate for surgery. For a surgery to be successful there need to be an obvious clear cut problem which need to be corrected and which is obviously causing your symptoms.
If the surgeon feels that the disc protrusion is not impressive enough on the scan it is unlikely that a surgical procedure will work.
The main factor which would decide if surgery is necesary would be if it can be demonsrated that there are diagnostic findings in the territory of the nerve root which enmerges at the left C5-C6 level. The best way to do this would be by means of an EMG, if the EMG supports this then there is some evidence that a surgery would be useful, if not then the soft tissuue theory is probably correst. I understand your frustration in this whole scenario, but nobody wants to put you through an unnecessary surgical procedure with out a realistic chance that it will make a difference. I would recommend an EMG as your next step.
If the surgeon feels that the disc protrusion is not impressive enough on the scan it is unlikely that a surgical procedure will work.
The main factor which would decide if surgery is necesary would be if it can be demonsrated that there are diagnostic findings in the territory of the nerve root which enmerges at the left C5-C6 level. The best way to do this would be by means of an EMG, if the EMG supports this then there is some evidence that a surgery would be useful, if not then the soft tissuue theory is probably correst. I understand your frustration in this whole scenario, but nobody wants to put you through an unnecessary surgical procedure with out a realistic chance that it will make a difference. I would recommend an EMG as your next step.
There are neck exercises that can help reduce cervical disc protrusion that a good physiotherapist will be able to demonstrate. Neural tension in your upper quadrant has probably developed over this time and I find many of my clients benefit from these stretches.
I would say don't despair Rod, I'm sure there is a good physiotherapist who could improve your symptyoms.
I have seen my internal doctor and she has placed me on an anti-inflammatory and a muscle relaxant, I have been to an orthopedist and he performed x-rays and an MRI that shows nothing. He tells me that he is stumped and does not understand the reason for the pain, and suggests that I have a bone scan done only to rule out the possibility of anything else that could be occurring.