Arm Radiculopathy and C5-6, C7-8 bulging and foraminal stenosis per MRI

[kimmie]

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

[CCF-Neuro-M.D.-SH]

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.

[mike1105]

the rib/clavicle pain in my exerience is telling. you should research Thoracic Outlet Syndrome/scalene syndrome, and upper crossed syndrome. The scalenes attach from your vertebrae to the inside of your first rib/clavicle. if they are tight and short, they pinch parts of the brachial plexus (causing arm symptoms) and they cause pain in the upper chest area by the clavicle/fierst rib becasuse they are attached there . "Disk bulging" and "mild stenosis" in my experience do not seem to be the cause your symptoms. These findings are common and not usually symptomatic.. I've been there. Do a search for Vladimir Janda, read erik dalton's website.

[cheeps]

If you have been coughing from your bronchtis or have inflammation in the muscles from coughing, well, I think you've strained/sprained some of your chest muscles.

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.

[Jewel529]

I found your post almost comforting! I have had similar symptoms for 2 1/2 yrs. Neck, shoulder, arm pain, pain under the shoulder blade in the upper back and in the front below my collarbone and chest wall and into my armpit. The worst pain is under my scapula. It is excrutiating at times. I was involved in 2 hit from behind car accidents, exactly one yr apart. That was 2003 and 2004. My symptoms became very apparent in the summer of 2004. I started seeking help in fall 2004. I have had 2 cervical MRIs, shoulder xray and MRI, chest xray, 2 emgs, abdominal US, several mammograms and US, 3 rounds of PT (did not help), and most recently had an injection in my shoulder joint(did not help). Over the counter pain meds do not help at all! Out of all of those tests, not much has been found. I DO have a mild bulge at C5-6 with no impingement, degeneration at C5-6 and C6-7, but the doc does not think this is causing my probs.I guess everyone has some degree of degenerative disc disease at my age-48. The emg showed mild carpal tunnel. The shoulder MRI showed a tiny cyst in the socket and some tendonitis, but again, nothing major. I am also in a substantial amount of pain, not constantly, but a good part of the time and my sleep is interrupted.I am a healthy person, in good shape and I have never had many medical issues. This has about done me in, if you know what I mean. Thoracic Outlet Syndrome and Pectoralis Minor Syndrome have been mentioned to me several times. I do have classic symptoms for TOS, but I have been told it is hard to diagnose and hard to treat. I was referred to a trigger point massage therapist who is VERY knowledgeable about the body, muscles, nerves, etc. Just listening to him to talk about it all while I am getting the treatment helps so much. I would go to him twice a week if I could, but insurance will not cover it. My doc did say that once you have a syndrome like this that the longer it persists, then it is unlikely you will ever be able to completely 'fix' the problem. Such happy news, huh? I don't think I will ever be pain free, hopefully it will become tolerable though. My ortho doc has also mentioned epidural injections and other steroid injections, but I am going to give the massage therapist time first.
Good luck to you.

[mike1105]

jewel-- hopefully i did not wait too long to post this and you will still read it. your symptoms are like mine WERE..... 2 1/2 years of agony in the same areas you describe. i did all the tests, had  a few unnecessary surgeries. Muscle imbalance syndromes like Upper crossed and TOS/Scalene syndrome are tough but can be fixed. I dont have the pain anymore. I worked UNREWARDED for 4 months 45min per session 3 sessions per day on stretching my "font" and strengthening my "back". Finally, in month 5, i began to feel better. I learned to sit and stand correctly. You've got to "undo" what you've done to your posture/muscles for decades. It's tough to do, but how tough are you? You cannot rely on a massage therapist. You'll feel better for a few hours, maybe, and you'll feel like he's addressing the right areas, but if you dont fix yourself you'll be posting on this forum forever. Muscles have memory and they go back to where you've trained them to go. do your research: Erik Dalton, Vladimir Janda, Jolie Bookspan. Fix yourself- no one else will. I'm happy to help you as I have helped a few others thru this website. but you must be prepared to work. you can email me at ***@****.

[gurlnurs]

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[april11]

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