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Neurology (Expert Forum)
Arm Radiculopathy and C5-6, C7-8 bulging and foraminal stenosis per MRI
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Arm Radiculopathy and C5-6, C7-8 bulging and foraminal stenosis per MRI
by kimmie, Nov 17, 2006 12:00AM
I am an RN with an orthopedic and neuro background but now I am the patient. I was involved in 2 separate car accidents 16 years ago and have had neck, bilateral shoulder and left arm pain, pinching and occasional numbness since then but never had any imaging studies except x-rays. I had bronchitis 8 weeks ago and was coughing hard for 2-3 days and started having significant right shoulder pain with numbness and aching down the back of my arm to my fingers. I am also having constant aching in my clavicles and front ribs, which is new. I have had one steroid dosepack and 2 injections of solumedrol IM which have helped the pain some. I had an MRI last week which shows multilevel DDD and disc bulging at C5-6 and C7-8 wild mild spinal cord compression and some foraminal stenosis. My orthopedist says my pain does not correlate with my MRI scan and ordered Physical Therapy and EMG and nerve conduction studies. He said I might need epidural steroid injections. I saw the PA not the ortho and he did not look at the CD of my MRI I gave him, only the radiologist report.
Questions:
1. Is my PA/ortho doc on the right track? He is NOT a spine surgeon, just a general ortho.
2. This pain is BAD. I can barely function or use my arms and am unable to sleep more than 2-3 hours at a time. I need some relief. Typically, rest and anti-inflammatories relieve this type of injury within a few weeks (my experiences w/patients).It has been 2 months and I am getting worse. Should I see a neurosurgeon after my EMG is done? Do I need a myelogram?
Any advice appreciated.
Kim
Questions:
1. Is my PA/ortho doc on the right track? He is NOT a spine surgeon, just a general ortho.
2. This pain is BAD. I can barely function or use my arms and am unable to sleep more than 2-3 hours at a time. I need some relief. Typically, rest and anti-inflammatories relieve this type of injury within a few weeks (my experiences w/patients).It has been 2 months and I am getting worse. Should I see a neurosurgeon after my EMG is done? Do I need a myelogram?
Any advice appreciated.
Kim
Doctor's Answer
by CCF-Neuro-M.D.-SH, Dec 07, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms that you describe are non-specific, and may or may not be related to your back pathology. Patients with spinal cord compression and bulging disc are more susceptible to injuries. Minor trauma can cause damage and chronic pain. However this is not typically after coughing. Further, shoulder pain after pneumonia can be referred pain from diaphragmatic irritation related to your lung infection. The EMG will be helpful in determining if there is nerve root compression etc, from the disc bulges in your back. I would also recommend that you have a SSEP (somato-sensory evoked potential) to assess if the spinal cord compression may be playing a role in your symptoms. I do not think you need to see a neurosurgeon at his point, but a neurologist can direct your care to determine the cause of your pain. If your pain will be helped by surgery your neurologist will be able to refer you to a surgeon with a specific plan and diagnosis.
I hope this has been helpful.
The symptoms that you describe are non-specific, and may or may not be related to your back pathology. Patients with spinal cord compression and bulging disc are more susceptible to injuries. Minor trauma can cause damage and chronic pain. However this is not typically after coughing. Further, shoulder pain after pneumonia can be referred pain from diaphragmatic irritation related to your lung infection. The EMG will be helpful in determining if there is nerve root compression etc, from the disc bulges in your back. I would also recommend that you have a SSEP (somato-sensory evoked potential) to assess if the spinal cord compression may be playing a role in your symptoms. I do not think you need to see a neurosurgeon at his point, but a neurologist can direct your care to determine the cause of your pain. If your pain will be helped by surgery your neurologist will be able to refer you to a surgeon with a specific plan and diagnosis.
I hope this has been helpful.
I went to see the leading neurosurgon in my state for bulging discs. He said I was NOT bad enough for surgery but under NO CIRCUMSTANCES was I ever to take any Epidural or invasive injections in the neck. The chance of infection out weighs the benefits he said. He said that the Drs that don't see the end results don't understand how hard that is to recover from.I have two online pals that concur...they had horrible problems and became disabled because of injections. It's absolutely awful that we must argue with a family pratice Dr over this. Stand firm....try something else.
Good luck to you.