Pain - is it a pinched nerve

[su]

Hi,

I fell down the stairs and am having constant pain after that.
The doctor said nothing was broken and prescribed ibuprofen for the pain.

I can only walk very slowly and sitting down or getting uo causes a pinching/grinding pain in my left side.

I am also using ice and heat which relieves the symptoms for a
few seconds but then it comes back. The ibuprofen helped initially, but is not helping much anymore.

I need to get back to work - what do I have and how long will it last?

Thanks,
Su

[Patti]

Thanks for your advice.  I did get the MRI and it shows "moderate amt. of asymmetric spurring at c5/6 on rt. side of midline which encroaches to some degree upon intervertebral neural foramen and encroaches significantly on anterior/posterior dimensions of rt. side of cervical spinal canal and, as a result, cervical spinal cord is displaced posteriorly somewhat at this leve l; also some slightly asymmetric bulging of the annulus at c6/7; all else normal (cerebellar tonsils lie above the foremen magnum.  .  Earlier this week had 1st of a series of 3 epidurals, which so far has not helped at all.  Both my neurologist and anesthesiologist mentioned possibility of surgery if epidurals don't work.  My questions at this point are:  Can me continuing pt cause more damage if done improperly since my pain perceptions are dulled considerably due to Neurontin?   Should I be seeing a Neurosurgeon rather than a Neurologist at this point?  Is my MRI consistent with recommendation of surgery if epidurals fail?  Do these types of problems ever do into remission on their own or do I have to do something (other than just treat the pain) to prevent further damage?   Thanks again.

[CCF Neuro[P] MD, RPS]

Dear Patti:

Tennis elbow is subluxation of the radial head and not due to a C-spine lesion, so your tennis elbow is due to minor long term trauma of your elbow and not your back.  That needs to be treated separately and will not be resolved until you do something about the elbow.  The neurontin level your on is small and pain relief might be better with higher doses.  But we are only talking about symptomatic relief.  The issue is your spine and some of the symptoms you describe are related to that area.  I would see if your neurologist would do a MRI and look at whether you might have a radiculopathy from a herniation or foraminal problem.  The sooner scerenio would be better than waiting.  Likely, things are not going to improve unless the lesion is found and rehab can begin.

Sincerely,

CCF Neuro MD

[Patti]

Since 3/99, have had almost constant pain in my mid-cervical (c-5 or 6, I think) spine area and down my right arm, with tingling in several fingers of right hand, particularly thumb and ring finger.  Pain in arm eventually resulted in tennis elbow, for which I was treated first with pt, then steriod shot, which resolved the acute elbow pain.  The neck pain never not better, as a matter of fact has gotten worse, and arm pain is still there also, as well as finger problems.  Also have had migraines most of my life, but not very often.  The mirgriaines recently progressed to 1/2 a week.  Was on nortryptiline plus various pain/nsaids meds+ chiropractic for most of last year to to avail.  Have been seeing neurologist/doing pt/taking neuronitn 300 mg 3x/dy for almost 3 mos. and have had one occipital nerve injection plus one injection in the large muscles at the top of the back which were supposed to loosen things up (as I'm supposed to be very tight).  Am now in the twilight of the pt, and have more flexibility in upper neck, but have not seen any improvement in my primary symptoms, except the migraines, which are less frequent.  Med seems to mask neck/arm pain, but when it wears off,  pain/tingling always returns...sharp, shooting down my right arm into my forearm and fingers and involuntary intermittent jerking or fingers plus sometimes wierd worm like sensations in forearm area previously affected with tennis elbow.   No MRI has been done, but xrays of cervical and lumbar spine showed degeneration in those areas.  Pain is/has been disabling.  Are my symptoms indicative of anything and how long should I tough it out before getting second opinion?

[CCF Neuro[P] MD, RPS]

Dear Kay Buffington:

Not being able to see the test results I cannot really make a comment.  Get a second opinion from another neurosurgeon or neurologist.

Sincerely,

CCF Neuro MD

[kay Buffington]

Since March 1998 I have had constant pain down my left leg and into my foot.  It hurts to sit, walk and stand.  I have had a myelogram, cat scan, EMG and specta-scan.  The specta-scan shows that I have arthritis L3-4 and the doctor says that he can do a bone fusion. All other tests are normal.  Of course , I don't want back surgery! My Chiropractor says that I could have a muscle that is squeezing the nerve somewhere along the line.

Do you have any suggestions?

***@****

[CCF Neuro[P] MD, RPS]

Dear azappone@:

Your symptoms certainly sound like you have a radiculopathy from your disc problem.  I would see a neurologist who is familar with disc problems.  As you have probably read, surgery is the last resort and can be, depending on the degree of the problem, either beneficial or have no effect at all.  Get a second opinion also from a rehab specialist.  See what your options based on your individual problems and what is out there.  Usually, we recommend a good trial of PT, rehab, and change of lifestyle as the initial therapy (but this is dependent on the lesion).

CCF Neuro MD