What's my next step to see a Dr?

[obry]

My husband had a bike accident on Sunday landing on his head (helmet) & shoulder.  No Insurance.  Went to ER.  After several xrays, yes he's got a broken collar bone on right side but excrutiating pain in left shoulder.  Finally got a CT and confirmed small linear defect present at C7 involving C6 & C7 joint with a small non-displaced fracture.  Disk space narrowing at C5-6, C6-7 with marginal posterior spurring.  Moderate post bulging at C5-6, and minimal post bulging at C3-4.  ER suggests neuro-surg.  After attempts to get him into a NS, and paying $480, seeing 2 Drs that never even touched him, the first didn't even look at xrays or CT I brought with me.  He was given a skelaxin muscle relaxer Rx and told to come back in 6  weeks.  He keeps having excrutiating pain in upper left shoulder/spine connection, feels like a knot, and has not been able to sleep much.  Cannot get another appt with anyone else.  We have $ but are being treated as indigents.  HELP!

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine your husband and obtain a history I can not comment on exactly what the next step for him should be but I will try to provide you with some information.

It sounds like he has a non-displaced C7 fracture. From the description of his imaging that you provide, the fracture is non-displaced, meaning the bone fragments have not moved and are not pressing on the spinal cord; it sounds like there is not spinal cord compromise, which is reassuring. The pain in your husbands may be a radiculopathy. As the nerves form from the spinal cord, they then exit through areas between the bones called foramina, then exit the spinal column to provide innervation to the skin and muscles of the body. A radiculopathy is a pinching of the nerve, or pressure on the nerve, as it exits the spinal cord. This may be due to some swelling (edema) in the area of injury or may be related to prior arthritis, etc. A radiculopathy is best diagnosed by physical examination and a test called EMG/NCS, which tests how electricity is conducted along nerves and how muscles respond. You may benefit from evaluation by a neurologist for this purpose. His pain may also be muscular.

I can not comment on whether or not your husband needs surgery, but in general many injuries similar to your husbands resolve with time (2-3 months), muscle relaxants/pain medications, and importantly physical therapy. It is important, after clearance by your husband's neurosurgeon, to have physical therapy, so that he does not start getting pain because of lack of movement of his arm due to the pain itself. Follow-up at your 6 week appointment is essential, and further discussion of your concerns with your husband's physicians is important.

Thank you for using the forum, I hope you find this information useful good luck.

[obry]

Wow!  Dr. Chahine I think you may have hit the nail on the head.  He keeps thinking he is getting better.  He'll have a good day with no feeling of crushing of the arm and extreme pain behind the shoulder, but then he'll wake up like today and the extreme pain is back.  We keep alternating ice packs with heating pad.  He is nearly out of Vicadin, but has plenty of Skelaxin, and using Advil.  He's also upped his Vit C, water, glucosamin condroitin, and I keep a constant supply of bananas, yogurt and fresh pineapple, and he regularly takes his vitamins.  The more natural he can go, the happier we are.  He has started back to work.  He is a Mad Scientist and does 1 hour classes, and is not picking anything up.  I am his driver and personal assistant, getting him dressed and tying his shoes.  He keeps the spinal collar on and arm immobilizer for the collar bone.  He feels the collar bone and ribs are healing.  I have printed your reply and will get it to him when he wakes.  He, like I, will feel much better knowing WHY we are waiting 6 wks.  Thank you so much!  Very useful info!