trembling

I have had neck pain and headache several months now. Saw an ENT twice, a neurologist twice, had MRI and CT scan. Now seeing a chiropractor who says I just have a bad kink in my neck. It helps pain when I see him but I have this trembling feeling in my left shoulder area that sometimes goes down my side. Not much pain now just a lot of trembling. Is this trembling normal?

[Joanna Fong, MD]

Hi treetimedad,

Your sensation that radiates down your left shoulder and side can possibly be several things:

1)  Radiculopathy related to cervical spine pathology.  With cervical (neck) nerve irritation, injuries, or compression, you can have pain, sensory deficits (numbness, tingling sensation), and weakness where the affected nerve innervates.  Cervical nerve supplies the shoulders, arms, hands, upper chest/neck.  However, nerve impingement or compression can be detected by imaging techniques such as MRI.  Make sure that you have a good radiologist to read the film as they can pick up small, not so obvious abnormalities.

2)  Muscle fatigue - Your trembling sensation can be related to muscle fatigue.  

3)  Although less likely, multiple sclerosis or other spine abnormalities can present with isolated sensory loss.  To diagnose those problems, MRI brain and spine with and without contrast is a good start.  MRI brain can also detect stroke.

Regarding your neck pain and headache for several months -
1)  This can be chronic daily headache, tension headache type.  One of the common causes of chronic daily tension headache is neck pain.  I would recommend you to see a neurologist specializing in headache.  Physical therapy is also essential in treating this headache.

2)  Chronic daily headache can also have migraine type.  Migraine headache typically presents with throbbing, sharp pain, one-sided; it associates with photophobia (sensitive to light) and phonophobia (sensitive to sound).  

3)  Bleeding - some type of bleeding in the brain can present with headache.  It can be caused by ruptured aneurysms, trauma, or some vascular malformations.  MRI brain and CT brain can easily detect hemorrhage (bleeding).  Aneursyms can be detected from arterial imaging, such as CTA or MRA.  Although the gold standard to diagnosis aneurysms is angiogram.  However, angiogram is invasive.  Therefore, unless there is strong suspicion for aneurysms, physicians typically rely first on clinical examination findings, histories, and noninvasive imaging studies listed above.

Good luck.

THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY.  PLEASE CONTACT YOUR PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITIONS.