All help is greatly appreciated.

[Trying To Cope]

Hello, I am a 35 year old male who was in a mva about 6 years ago and have been suffering from pain and numbness since. I have pain in my left shoulder with streaks of pain that go from my spine into my shoulder blade area. also numbness in my left leg and arm. Numbness is like a dull ache which is very much unbearable at times.

I went to the Emergency room within several hours of the accident because I had a severe headache which upon a ct scan showed no abnormalities. However within the first few weeks of the accident I started having the back pain and numbness and returned to the ER but x-rays showed nothing. I went for chiropractic care and begin having treatment 2x a week that helped slightly but the pain would continue to return.then a neurologist who sent me to have an . mri on my thoracic and lumbar spine. The Lumbar spine showed no evidence of abnormalities but the thoracic conclusions where no evidence of disc herniation or spinal stenosis but there was a mild disc desiccation and mildly prominent scmorls nodes within the mid thoracic spine,  This was done on 2/28/ 03 the mva was in 8/02

I had physical therapy which was ineffective and have lost mobiltiy in my left shoulder. I was sent for trigger point injections which were also ineffective, the physician that administered the trigger points sent me to have another Mri of the t-spine.
1. 3-4 mm central and left paracentral disc protrusion t7-8. Effacement of the ventral and left lateral margin of the thoracic cord. No evidence of neural foraminal   narrowing.

2. Multilevel Schmorls node formation T7, T8, T9,and T10. Date of Mri was 9/22/05

My question is why is this mri so very different than the first? And what are effective treatments that could help me to be more functional? Also is there any surgical procedures that would benefit me?  Also is the 3-4 mm is that considered mild or moderate?

Thank you for any answers and information.

Trying To cope.

[paindoc38]

if your pain is in fact the worst in the are medial to your scapula and lateral to your spine (ie between the 2) then I would ask
1) does the pain get worse and worse throughout the day? Ie get worse the more you use your left arm outstretched in form of you ( eg typing) If so you likely have injured one of the nerves to the muscles that control your scapula (spinal accesory nerve, dorsal scapular nerve (DSN) or long thoracic nerve (ltn). the ltn and dsn can be injured with violent head motion as they leave the cervical spine and pass through the middle scalene muscle. (also can be injred if you broke any ribs onthe same side at the time of the injury.  If so you cannot repair the nerve at this point but direct electrical muscular stimulation of the denervated muscle can be very helpful.


A very good emg/ncv study by an experiecned person can tell you if one of these nerves is injured.--most docs dont do this well as they are afraid if they put the needle too deep they will go through the muscles and get into lung.

when the scapula is not held in place correctly you have abnormal pull to the nerves passing through the muscles in this area to get to the skin (dorsal medial cutaneous branches) causing a neuropathic type pain.

alternatively with you the disk may be pressing on the exiting dosal primary ramus.  the way to test if it is really one of these two causes of nerve impingment is to have a friend touch you with a piece of ice in the spot where your pain is the worst and then on the opposite side.  I predict you will find in the area of your pain that you have some sensory loss that will manifest as it not feeling as cold in that area.  

either of these two things (disk vs scapular dysfunction) result in abnormal firing of the nerve casing pain and paraspinal muscle spasm.  some of these muscles insert on the first and second rib puling those ribs inferiorlly and increasing the tone and stretch of the scalene muscles that are supposed to elavae the ribs.  the corresponding scalene muscle hypertrophy impinge on the traversing nerve root of the brachial plexus to the arm.  this can be verified by MR neurography of the brachial plexus looking for edema and other abnormalities in the brachial plexus at the level of the scalenes.

One other way to help sort this out is to have your local pain doc do a selecive nerve root block at the level of your disk.  If the disk is the cause of the problem your pain should get much better for the first few hours after the injection. If your emg is normal and this injection helps go see a surgeon to see aobut having the disk operated on.

if the emg is abnormal do the muscles stimulating thing.  treat the back pain and the arm pain may magically get better  over time .  the association of mid back pain and arm pain has been termed "the t4 syndrome" which has noted the association of the finding that thoracic disk disease often surprisingly is associated with this kind of arm numbness and pain.

good luck

[paindoc38]

1) does the pain get worse and worse throughout the day? Ie get worse the more you use your left arm outstretched in front of you ( eg typing)

2. the sensory disturbance is compelling for you having a problem with the nerve innervating the skin in this area. it could be either at the level of the known disk protrusion or it could be due to the nerve being stretched if the scapula is oriented abnormally due to LTN or DSN injury.  IF it is due to the disk using your arms shouldnt affect it. Ie painting a wall shouldnt make a difference. if it is due to LTN or DSN dysfunction painting a wall should drive you crazy.

happy to help
oh yeah and it may get a lot better with the standard treatments for neuropathic pain.. I'll be posting some things this month on how to treat neuropathic pain better for physicians with less experience.

Ill check back in a couple of weeks
ian

[Trying To Cope]

Thank you for the information. My wife tried the ice test and I did notice a marked loss of feeling in the coldness over the area I have the most pain compared to the opposite side. I am scheduled to follow up with my neurologist in the next couple of weeks and will try to see if he will refer me to have some of the other tests run.  I appreciate your help greatly! What are your thoughts concerning  the disc protrusion and the schmorl's nodes?
Thanks again.
TTC

[Trying To Cope]

Please read this and post some information. Thank You

[Trying To Cope]

I was not driving, I was in the passenger seat. It was an impact on the drivers side door area that almost flipped the van. I flew in the air and into the window, cracking the window with the back of my head. My back and shoulder  continue to cause increasing pain with time. The above MRI results are a few years old and I feel I may need a new mri. Is it common for spinal injuries to worsen over a period of years? Also, as a trained expert, reading the above mri results, what would that suggest  to you?
Thanks again.

[isthiscp]

Were you driving? Were you holding on to the wheel? If so you could have a rotator cuff tear. This would explain the loss of power and pain in the arm that the mri would not.

[Katijanae]

Schmorls nodes are caused by trauma to the back.  The reason that MRI results are different is because the situation with you thorasic spine has changed with time.  This often happens in spinal injury.  When the spine is compromised in some way, and treatment via chiropractic, physical therapy and injections are not effective, surgery may be your only option.  Not all spinal injuries can be improved with surgery though.  I would arrange to be seen by a Neurosurgeon and an Orthopedic surgeon.  Both look at the spine from a different perspective.   Because of the problems scar tissue can cause, surgery isn't always the best choice.  That's why I suggest that both perspectives be involved before going forward.  
Hopefully my answer will be of some help to you.  Without viewing the films, I doubt the doctors here could be of much help as to whether or not surgery is a good choice for you.  If your shoulder is still no mobile, it would be worth it to be seen by a surgeon soon, imo.
Best of wishes from a vet of back surgery,
Katijanae

[Trying To Cope]

Please answer my questions. Thank you.

[Trying To Cope]

What causes Schmorls nodes? Thanks again.