C5 RADICULOPATHY

  HI!!! I have finally gotten diagnosed with SOMETHING. A brief history, 25 years old female 130 lbs...I have had a problem in my shoulder (right) for over 8 years that has consisted of numbness tingeling  and PAIN....Was involved in an automobile accident 2 months ago in which the pain increased 100%....Had an MRI and the results were read by a Radiologist who said that everything was within the "Normal Limits".... My regualr MD sent me for and EMG and these were the results, "There is an Electrophysiological evidence of mild C5 radiculopathy with a paraspinal muscle spasm on the right side. No evidence of Ulnar Neuropathy or carpel tunnel syndrome at this time." SO, that was the reult, now my MD says that it is a pinched nerve and he has me in Physical Therapy 3x's a week in which all therapist is doing is putting ultrasound on it.I'm not getting better the pain is the same and I just want it GONE.....Any ideas what is causing the nerve to be "pinched" if my MRI has come back normal???? I have an Orthopaedic Surgeon looking at my records next month but maybe I need a Neurologist????? I just want to feel better =(  Thanks Ahead !!!!
  Kim
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Thanks for your question.  The EMG and the MRI scan are quite different
methods of looking at the same problem.  With an imaging study, such as
a MRI scan of your neck, a (neuro)radiologist looks at position of the
cervical spinal cord within the canal space, the dimensions of the foraminal
spaces (i.e., the spaces through which the nerve roots exit the vertebral
column), the surrounding tissues (fat pads, muscles, etc.), the nerve
roots themselves, and so forth.  Because it is a "static picture" of your
neck, it can certainly miss the interaction between the different parts
when your neck region is in motion.  Furthermore, the different "cuts"
of the imaging through your neck region can potentially miss a very small
and focal lesion.
On the other hand, the EMG test relies on the electric behavior of peripheral
nerves and muscles to diagnose a lesion to the nervous system.  For instance,
a compression at a nerve segment can result in a blockage of transmission
of the electric impulse either by means of "blockage" (because of disruption
of the delicate fatty covering, myelin, of nerve fibers), or by means of
actual loss of the nerve fibers themselves.  Each one of those lesions
will manifest as different phenomena in the Nerve Conduction Study (the
part of the EMG exam where the electric stimulation is used) and in the
Needle Electric Exam (where a small pin is used to study the electric
activity of some of your muscles).  Furthermore, because the nerve fibers
take very elaborate/intricate routes between the exit points from the spinal
cord and their final muscle targets, one can frequently pin-point the
site of possible nerve lesion by testing different combinations of nerves
and muscles.  That was how the physician who performed the EMG was able
to "localize" the problem to the C5 nerve roots, and eliminate the alternative
hypotheses of lesions to the Ulnar Nerve (a peripheral nerve), or of Carpal
Tunnel Syndrome (a lesion to the Median Nerve).
If you would prefer to have a second opinion, I would recommend seeking
a neurologist who specializes in the Peripheral Nervous System and in
Electrodiagnosis/EMG.  If you live in the Cleveland area, the Department of
Neurology at the Cleveland Clinic has a group of neurologists involved in
this specialty (Drs. Levin, Mitsumoto, Pioro, and Shields).
If you wish an appointment at the Department of Neurology at the Cleveland
Clinic, please call 1-800-CCF-CARE, or 1-216-444-5559.
I hope this information is helpful.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.