Chronic Neck Pain

[rod]

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.

[CCF neuro MD MM]

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.

[Valerie]

Sounds similar to some of my symtoms.  I have cervical dystonia.  Severe pain and neck tilted to the left.  There are several sites on the web about dystonia.  Try a search for more clinical info.

[Karin Underwood - Physiotherapist]

I am an Australian physiotherapist and after reading your post Rod, I tended to agree with the orthopaedic surgeon too.

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.

[Susan Logue]

Rod, I've had anterior cervical fusion surgery and surgery will not cure your pain. I would stop the chiropractor too. I was in your spot in 1993 when I only had a bulging disc at C4-5, 5-6, and 6-7. The more "treatments" I had the worse it got. I'd been careful, stopped working, and took care of myself until, wow, 3 years later it's now a ruptured disc. I think that high velocity neck cracking by the chiropractor ruptured it! The doc who responded is right about the EMG and everything else. I ended up having all the stuff on my test results and probably did need the surgery, but I still can't work and I still have pain. I think you sound like you have really good, contientious docs treating you. Good luck and cool it with the trampoline! Susan

[Debbie Ramos]

Rod,Only consider surgery as your last resort! I had disc herniation at 3 levels. I tried many alternative forms of treatment-P.T.,traction,exercises and various meds. I was under the care of an excellant spine specialist-one of the best in the north east. Surgery was done only after everything else failed. The bone fusion took well but 1 year after surgery I am still in much pain. Spinal surgery is very unpredictable even with the best doctor. I am currently under the care of a pain management clinicand will never be able to return to work. Please be sure to try every alternative before you consider surgery. I can sympathize with your pain and wish you the best in your search for relief.    Debbie

[Charlotte]

I am 37 years old and have had pain and stiffness in mostly the right side of my neck for as long as I can remember. Over the last 6-7 months, I have been experiencing a stabbing pain in my right shoulder (more spefically, behind the right shoulder blade) that has gotten progressively worse. Laying or resting on the right side makes the pain more severe. I had played a lot of softball while I was in high school and college, and at one point, had what appeared to be a bone spur or bursitis in the right shoulder, I was unable to move the shoulder for several days without severe pain.

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. cancer?

I thought was that it was skeletal because motion does not seem to aggravate it or make it better. Is it possible that this is not skeletal, but rather musclar or neurological? I am unsure where to turn next. The anti-inflammatory seems to help, but the nagging pain is always there and the neck pain/stiffness is always present.

[catherine o keeffe]

i am a 22 yr old female and underdstand exaxtly what u are going through well at least some of it anyway.

last year i work from a deep sleep and heard a click in my neck got out of a bed and fell to the floor crimpled.

my left hand went dead and i couldn't move. i was sent to physio which helped a little but didn't recifiy much either, as i am sure u understand

i returned to work after 2 mths and tried to start living a normal life and yet again 7 mths later the problem recurred. worse this time though, so this time i decided to take the chiropractor approach and i now have a back problem aswell as a neck problem, my neck feels heavy at all times and pain only on the left side sometimes my left side of my face is numb aswell. my hand isn't dead but i still feel a difference. i have spasms of pain most of the time from my lower back all up the left side also and nobody knows whats next. i have now been referred to a neurologist so hopefully he will be able to help!

so if u have any advise as to what way to treat what i have please write a little help and advice would be great!

catherine

c.***@****

[catherine o keeffe]

i am a 22 yr old female and underdstand exaxtly what u are going through well at least some of it anyway.

last year i work from a deep sleep and heard a click in my neck got out of a bed and fell to the floor crimpled.

my left hand went dead and i couldn't move. i was sent to physio which helped a little but didn't recifiy much either, as i am sure u understand

i returned to work after 2 mths and tried to start living a normal life and yet again 7 mths later the problem recurred. worse this time though, so this time i decided to take the chiropractor approach and i now have a back problem aswell as a neck problem, my neck feels heavy at all times and pain only on the left side sometimes my left side of my face is numb aswell. my hand isn't dead but i still feel a difference. i have spasms of pain most of the time from my lower back all up the left side also and nobody knows whats next. i have now been referred to a neurologist so hopefully he will be able to help!

so if u have any advise as to what way to treat what i have please write a little help and advice would be great!

catherine

c.***@****

[Sam]

Dear Rod,
I am a practicing Physical Therapist and I enjoyed reading your question. It seems like your pain is probably coming from the c5-6 level. There are many structures that can be compressed and cause pain when you look up. The most likely, given your description sounds like either the capsule surrounding the facet joint at that level,or perhaps the facet or uncinate process. The disc degeneration may be the cause of this, as the vertebrae are sitting closer together now, so more compression between the facets will occur In the unfortunate scenario that you do not find a Physical Therapist that can help you with this, you might consider a facet block or rhizotomy at that level, so you can see if that is the source. Sometimes facet rhizotomy ( radio current to block the pain signal) at that level is helpful and a fairful low risk procedure from the research I've read. I would recommend consulting either a neurologist experienced in this or a pain clinic. I would disagree with the Australian Physiotherapist that exercise can reduce a protrusion. The protrusion is more indicative of a degenerative disc, and protrusions are extremely common and more often than not an incidental finding. There is no current evidence that exercise can reduce a disc protrusion. The most effective treatment for your problem would be to mobilize the stiff joints in your neck and stabilise that disc level with exercise, so that it hurts less.
Hope you find a solution.
Sam B

[Maggie Smith]

Im a 30yr old  who been diagnosed with c3/4,5/6,6/7 bulging disc
pain and numbness and weakness in my neck and arms..
when should i consider surgical treatment..i ben thru all conservative treatments and nothing helps

[Mike Oct 25, 2000]

I am a 44 year old male.On September the 6th I was working down in a manhole bent over at the waste with my head turned to the left.When my Co worker kicked our explosive gas and oxygen sencor down into the manhole opproximately 8 feet and it struck me in the back of the neck. I remember that I fell to my knees and was completly stund for a few minutes. I was then able to stand and noticed that I had a bulge from the muscles in my neck on the right side. I tried to shake it off, but no go. I then had a urgent need to use the bathroom. I told my Co worker that something was wrong with my neck and that I had to use the bath room. I then drove my work truck back to our garage. While driving the movement of the truck caused a great amount of pain in the middle of my neck. I used the bathroom #2 and told my boss what had happened and asked him to take me to the hospital. The pain got even worse on the way. At the ER they promptly put me in a cervical collar and placed me on a back board and took me to X-RAY. The X-rays were negitive. The ER Doctor then removed the cervical collar and felt down my neck. When He touched the contact point in the middle left side of my neck I felt an extreme amount of pain and became very nauseous. He then gave me a pain shot,replaced the cervical collar, gave me a prescription for Percocet and told me and my boss that I would be able to return to work with no retrictions after two days off of work. My boss then took me over to my family Doctor. She informed me that my pain was do to the swelling and also gave me a prescription for cyclobenzaprine and relafen a muscle relaxer and anti inflamitory and said I should feel better in a couple of weeks. She then referred me over to my Chiropractor to be my primary doctor and handle my care. The first two weeks my Chriopractor treated me with ice packs and then with hot packs along with ultrasound to get the swelling down. IN the third week my Chiropractor tried to manipulate my neck using a activator to the right side of my neck on C-3 and C-4 which were out of alignment. This stund me and caused me to become dizzy.nauseous and blurred my vision. My chiropractor became very concerned and odered a CAT scan on my cervical spine  focusing on my C-1 for a posible hairline fracture. I had the CAT scan and it to came back negitive. My Chriopractor then put me back on the treatment of hot packs ultrasound and now was going to use muscle stimulation. At this time I noticed that I had lost feeling in my skin from the center and left side of my neck down to the top of my shoulder including the upper half of my shoulder blade, and when pressure was placed on the impact point of the left side of my neck a wave of fire would roll down my left arm and turn into extreme pain and roll back up and go away. Also after the muscle stimulation the pain in my neck intensified dramaticly for days. Frustrated, my Chriopractor referred me to a specialist who evaluated me and ordered a bone scan with spec. The bone scan also came back negitive except for a posible problem with my shoulder. I then met with the specialist again and he put me on a graduating dose of prednisone for a week. While on the prednisone my face,arms and hands swelled up, I could not sleep, was irritable, and worst of all were the cramps in my legs. Also the prednisone did not change my condition except for some gain in my range of motion in my neck. The specialist has stop me from taking the prednisone and has now ordered an MRI. I am hoping that the MRI will finally get to the bottom of my pain. These are my symptoms today after 7 weeks.  
       1. contant pain in the middle of the left side of my neck
       2. a catch when I move my head from right to left
       3. realy painful if I lift My head up and to left
       4. pain in the bottom of my left ear.
       5. can't sleep except for on my back with my head tilted slightly to the left.
       6. driving increases the pain especially sudden stops and left turns.
       7. loss of feeling from the middle of my neck on the left side down to the top of my left shoulder and half of my left shoulder blade.
       8. Pain down my left arm when pressure is placed on the impact point in my neck.
       9. tension builds up in the neck when I read or look at the computer or watch TV.

        I will respond latter with the results of my MRI. In the mean time, if any one has any suggestions that will help me, please reply.  Thanks, Mike