neck, left shoulder and arm pain

[Rhonda]

I've been having alot of neck, shoulder and arm pain.  My doctor ordered an MRI and the report showed bulging annulus c6-c7 but no focal disc protrusions, mild posterior lateral spurring on the right at c5-c6 with a slight thecal sac encroachment.  What does this mean?  Will this get better on it's own?  I have severe pain that travels down my left arm so bad I can't even use my arm.  It's worse when I first get out of bed in the mornings.  Is this going to require surgery?  If it will get better on it's own, how long will it take before the pain is tollerable?  Thankyou, Rhonda

[CCF Neuro[P] MD, RPS]

Dear Rhonda:

Sorry about your pain.  I am not sure what to tell you.  Most of the time slight disc buldging has no effect.  The spurring, which can cause problems but yours is on the side of your body that gives you no problems.  So the question remains why the pain.  Did your neurologist indicate that your neurological exam was completely normal?  Do you have diabetes, vasculities, vitamin B12 or folate deficiency, drink alot of alcohol, osteoarthritis, etc?  Does the pain come and go, or is it the same every day?  Are there specific areas in your shoulder and arm that hurt more than others?  Where in your hand, which fingers hurt?  How did the pain start?  What is your age?  Any medical problems other than your pain?

Pain medication might help but you need to find the etiology of the pain.  If you haven't seen a neurologist then I would make an appointment to see one.

Let me know the answers to my questions and I will get back to you.

[Jo-ANN]

Dear Rhonda,

I also had c 5-6 herniation and a couple of large pieces of disc
which had broken off and were hitting the spinal cord, this was
2 years ago.  I ended up, because the pain was so severe,
being operated on in Sept of 97 which helped that particular problem but i still have several herniations and many bone spurs,
arthritis and degenerative disc disease.  The doctors had to be
convinced of my pain...see a couple of doctors neurosurgeons etc
and ask many questions.  I still have much pain -but if i knew
then what i know now..maybe i would have made other choices.
Feel free honey to e me at ***@**** if you need someone
to talk to..and in the meantime offer up the pain for the conversion of sinners.

jo-ann

[CCF Neuro[P] MD, RPS]

Thanks for your comments.

CCF Neuro MD

[randa]

I am having somewhat the same symptoms.  My Dr. said that it was a C5 protrusion and that a lot of times this goes away by itself.  My left thumb is numb and there are days that I can not lift or use my left arm.  Some days the pain is too much to bear too.  And it is always more painful when I lay down and when I wake up in the morning.  I am going to try doing some arm and neck exercises since I don't know what else to do at this point.  I will let you know if this helps and if you find something that helps, please let me know. ***@**** Thank you!

[CCF Neuro[P] MD, RPS]

Dear Randa:

Sorry about your pain.  I am assuming that you had a MRI and that showed disc protrusion.  Was there thecal sac compromise, neural foramen changes, cord compression????  Depending on the etiology, such as arthritis, collagen vascular diseases, etc the treatment might vary depending on the MRI and neurological exam findings.  I would speak to your neurologist and see what your options are depending on the MRI findings and your medical history.  You may only need life style changes and rehab with a little medication to help you through the pain while rehabing.  Sincerely,

CCF Neuro MD

[Susan Logue]

Dear Rhonda,
I am 40 years old and I was kind of in your spot in 1993. The more doctors I saw, the worse things got. I ended up with 2 carpel tunnel surgeries, one of which became infected during surgery with fecal matter bacteria, then I was diagnosed with a rare bone disease in my right arm called keinbock's disease which required 2 surgeries and a year in a cast, then I was diagnosed with myofacial pain, then finally a ruptured disk at c4-5 which I had anterior cervical fusion surgery where now instead of a disk I have a bone with a metal plate and 4 screws. Oh, I forgot about the fibromyalgia diagnosis.
What my point is, is that sometimes the cure is worse than the problem. I still suffer debilitating pain and am unable to work.IF you have degeneratative disk disease, there's no stopping it other than lifestyle changes. Don't lift ANYTHING over 30 pounds and be really careful with any kind of sports or impact activities. Unless you can't move, I wouldn't suggest any disk fusion surgeries because the remaining disks just wear out faster. Just be careful and forget about some doctor or some surgery making you feel like you did before. Sorry to be so negative but think really hard before you submit to surgery. Good luck.  Susan

[CCF Neuro[P] MD, RPS]

Thanks for your comments.

CCF Neuro MD

[Linda McDonald]

I have been experiencing severe pain in my left shoulder, scapula, elbow, wrist and numbness in my left thumb.  Sometimes I feel pain in my neck and lower back.  The bursea below my shoulder and elbow are quite inflamed. I believe this started when I was digging a hole to plant a shrub.  I have been under some stress lately and feel this has contributed to the problem.
I have been treated several times by a chiropractor and also a massage therapist. I did get some relief but there are times when the pain flares up and is almost intolerable.  I have been trying ibuprofen, tylenol pm, and a generic form of flexoral but nothing seems to give much relief.  I haven't been able to sleep for longer than 2 hours at a time before the pain has me pacing the floor again. I have a problem with taking strong medication such as morphine or demoral.  My real concern is, will there be permanent damage to my tissue because of the numbness?  I assume there is a ischemic condition. Also, how long does it ususlly take for the nerve to heal after being constricted?  This problem has been going on for about 3 weeks now.  I am currently attending school for massage therapy and wonder if this will affect my ability to be a massage therapist.  Any information you can give me will be greatly appreciated.  Thank You

[CCF Neuro[P] MD, RPS]

Dear Linda:

I would see a neurologist and have things looked at.  It may be that you have a spinal problem.  But, this will be unknown unless a thorough exam is initially done.

I hope you find out the source of your problems.

CCF Neuro MD

[[email protected]]

I am a nurse that has had a injury to neck & shoulder have pain in neck r side which goes down my R arm,  i have periods of dizzy feeling and at time feel that i need to hold on to somethings. Its wakes me up out of a sleep, it come into my dreams & wakes me
its not getting any better have seen nurologious X3 they think I depress but i know I'm not this has only happen since my injury
nearly 6 months ago . Pain is the main problem with the dizzness
hope you can help  with some suggestions

[CCF Neuro[P] MD, RPS]

Dear "toctoole"

It is rather difficult to tell you what you may have as I have not examined you or seen your workup.  I am assuming that the MRI of your C-spine was normal.  The neurological exam must also be perfectly normal with no weakness or sensory level.  The radiating pain suggest some sort of radiculopathy.  I assume that your trauma was minor and that you had no head trauma or lost consciousness.  Since your EMG must of have been normal, there is likely not a brachial plexus injury, no cervical spinal damage, no neuropathy, etc.  Sorry, but I am at a loss to suggest anything else.  If the dizziness is vertigo and there is a negative Hillpike-Dix then the problem is central but a positive sign would be peripheral and suggest some inner ear problem.  The normal MRI and EMG however, would suggest that the etiology of your pain is something other than peripheral or central.  This might suggest that your pain might be functional.  However, until you rule out all other causes I would not jump to that conclusion.  You may want a second (in your case fourth)opinion and have all the films, EMG, blood work etc gone over by fresh eyes.

Sincerely,

CCF Neuro MD

[jeffco]

I am told that there is an improved MRI exam available which is especially designed to locate nerve damage, compression,etc. If so, where would this machine be found?

[CCF Neuro[P] MD, RPS]

Dear Jeffco:

If you find a new type of MRI that defines nerve compression or damage let us know.  The only refinements are in selecting the spin times, time to echo, relaxation times and tensla power.  There are things that have been around a few years to note metabolic features of cells but this is old technology.  

CCF Neuro MD

[to linda mcdonald, 9/30/99]

Linda,
Sounds like you might have a rotator cuff tear or other injury to that area.  My suggestion would be to see and Orthopedic Suregeon that specializes in shoulder injury.
Often a person can have "referred pain", meaning the pain is being directed to other areas of you body.

Especially, since you were digging at the time, I would have the shoulder checked out.

[CCF Neuro[P] MD,RPS]

thanks for the comment.

CCF Neuro MD

[Robert]

I have a question in regards to mild twitching(1-5) per minute in the legs(various locations),  buttocks,  tricep area , cheek bone area and sometimes in the small of the back.  I also have what seems to be a muscular type pulling sensation in my hands(palms), feet(bottom near tendon to big toe area and around ball of big toe) and back of legs. Twitching seems to occur mostly while sitting or laying. Twitches are quick in nature sometimes length of tendon in thigh and sometimes very small area & not always visible to the eye.  What can be causing all of this and should I be worried? I am currently very stressed over the whole ordeal and feel something is terribly wrong.  An emg is scheduled,  although the nuero surgeon says there is nothing to worry about.   What can an emg determine?  I am 30yrs. old fairly muscular and have a degenerative back.  Is there need to worry about als?

[Eva Rodriguez]

I have a feeling of tightness in my left arm, when I get stressed it hurts worse.  I often feel a pain that radiates from my pinky to my neck and my arm gets real cold.  After the pain it feels  cold and tingly. After I excercise I also get this problem where my left arm gets real cold.  I have been having heart palpatations and  lots of dizzy spells,shakiness in both hands and legs, nausea,headaches,fatigue, and a pain in my mid upper back.

I have talked to my doctor but he tells me I am too young for any heart problems. My brother had a heart attack when he was 31,   My father too has a history of heart problems as well as diabetes.  I had a stress test 12 years ago that showed Mitral Valve prolapse, along with an abnormal EKG's.  Now my EKG's are normal therefore my doctor refuses to refer me anywhere or do additional testing.  Could this be a normal feeling or should I try and get more testing done???  

I am 35 years of age.

[CCF Neuro[P] MD, RPS]

Dear Eva:

I would think that some simple tests such as a sedimentation rate, CBC, etc might halp in clarification of your problem.  It is very unusual for parasthesias to travel up the arm, the vast majority of peripheral nerve problems that induce parasthesia travel down the arm.  I would just sit down with your family physician and see what he/she thinks.

CCF Neuro MD

[Carolyn]

I recently had X-Rays of my neck and spine and an MRI of my back due to neck and back pain.  The results were disturbing:
1)Osteoporosis  2) straightening of the cervical and lumbar spine, and  3) degenerative arthritis and degnerative disc disease with prominent bone spurs. I cannot understand why I have osteoporosis because I have been on estrogen therapy for over ten years, exercise moderately,drink plenty of milk and take a daily multi-vitamin supplement.  Additionally, I had a bone density test in June of '98 and was told that I had "the bones of a thirty-year-old."  I teach and have to lug heavy books around all day.  Plus I must strain my neck by looking down to grade papers for hours on end.  Needless to say, I am in constant pain, but do not want to have to take addicting painkillers.  What can I do?My small-town doctor has chosen to treat me with large doses of steriod/cortisone shots (which will make my "already remarkable" cataracts mature earlier than had been expected) and pain management (i.e. sedatives and Tylox #3).  Should I seek the advice of a larger-town specialist, and if so, what kind--a neurologist, orthopaedist, or rheumatologist?  I need help and quickly!

[Carolyn]

I recently had X-Rays of my neck and spine and an MRI of my back due to neck and back pain.  The results were disturbing:
1)Osteoporosis  2) straightening of the cervical and lumbar spine, and  3) degenerative arthritis and degnerative disc disease with prominent bone spurs. I cannot understand why I have osteoporosis because I have been on estrogen therapy for over ten years, exercise moderately,drink plenty of milk and take a daily multi-vitamin supplement.  Additionally, I had a bone density test in June of '98 and was told that I had "the bones of a thirty-year-old."  I teach and have to lug heavy books around all day.  Plus I must strain my neck by looking down to grade papers for hours on end.  Needless to say, I am in constant pain, but do not want to have to take addicting painkillers.  What can I do?My small-town doctor has chosen to treat me with large doses of steriod/cortisone shots (which will make my "already remarkable" cataracts mature earlier than had been expected) and pain management (i.e. sedatives and Tylox #3).  Should I seek the advice of a larger-town specialist, and if so, what kind--a neurologist, orthopaedist, or rheumatologist?  I need help and quickly!

[CCF Neuro[P] MD, RPS]

Dear Carolyn:

Sorry to hear about your pain.  Most of our bone density, if not all of it, occurs in our formative years, childhood through our teen-age years.  After this time we are just trying to maintain our bone density.  The fact that you have been doing so much that last ten years is great, but it was after the fact.  Using pain medications does not treat the etiology.  You are doing your best, and that is very good.  I think I would seek better rehab for your condition.  There are things that you can do, such as exercises, learning better techniques for lifting, etc.  Second, if you have lost bone density in other bones, then maybe medications for osteoporosis and arthritis might be helpful. I would seek both of these.  See a neurologist and rehab specialist.

Sincerely,

CCF Neuro MD

[Judy C]

I was recently in a bad auto accident and as a result have a badly bulging disc at C6-7, torn rotator cuff and damaged ulnar nerve both in my right arm. Ihave numbness and tingling in the last fingers of my right hand, burning snesations inthe elbow and have already lost some mobility in the shoulder. I am also having difficulty is grasping small objects with right hand. Ihave had an MRI and an EMG but showing significant damages. My neurologist has sugggested delaying cervical surgery for a while to see if the bulge will receed on its own. He is extremely concerned about the ulnar nerve and shoulder. I have been put on Neurontin and am now in week 3 of the medication. So far it seems to be having an impact on the headaches and the elbow pain but nothing on the shoulder. I recentlyread inthis column that Neurontin is a psychiatric medication with the odd properties of having significant impact on neurologic injuies. My question is this...could the Neurontin have any effect on my PTSD (post traumatic stress disorder) whose source is domestic abuse?

[CCF Neuro[P] MD,RPS]

Dear Judy:

Neurontin is not a psychiatric medication.  It is an epilepsy medication that also had effects on neuropathic pain.  It has been used as a pain medication for headache.  There may be other uses but these are only small studies and haven't been proven in large blinded studies.  I would not think there is much data for neurontin for post traumatic syndrome.  However, I do not treat post traumatic syndrome and small studies would not be known to me.

CCF Neuro MD

[Marji]

Dear Doctor,
For approximately 3 years now I have been suffering from chronic upper back pain with headaches, neck pain and left arm tingling.  The upper back pain being the worst of it.  It took pulling teeth but an MRI was finally done on my lumbar, thoracic, and cervical spine.  Pre MRI xrays were done as well.  The findings showed mild C5-6 and C6-7 neural foraminal stenosis possibly secondary to mild bony overgrowth of the associated uncovertebral joints.  Lumbar rotoscoliosis, spondylosis, degenerative disk disease, posterior herniation of disc at L1-2 with mild central canal stenosis and effacement of the ventral aspect of the thecal sac.  Thoracic degenerative disc disease and spondylosis with wedging of T7-10, prominent posterolateral left herniation of disc material at T6-9 with effacement of the ventral lateral left aspect of the spinal cord.  I was also told I have Lhermitte's phenomenon per my neurosurgeon.
   My symptoms include mild pain in the mid thoracic region which increases to severe and intolerable after sitting for periods of time over 1-2 hours.  This includes muscle spasms in the left scapular area radiating up into the left side of neck, jaw and face, then down the left arm and into my little finger and ring finger.  In these areas I also have sensations of burning, coldness, tingling, sharp piercing shocks, and sensations of needles. I also have weakness in my left arm when I try to lift objects such as a book or coffee cup.  The symptoms range in severity and come and go depending on what I'm doing.  There is loss of range of motion in the cervical, thoracic and lumbar regions.  Driving and sitting greatly increase the pain, laying down alleviates the pain.  I was also told that I have straightening of the lumbar lordosis and kyphosis of the thoracic spine.  
   I have been through numerous physical therapy treatments, use of the TENS unit, 3 steroid epidural injections (without lasting relief), muscle relaxors, pain medication and paxil and prozac.  At this point I have found no "cure" for my back pain.  It has resulted in the loss of my job and has reduced the quality of my life.  The pain wakes me up at night and I now take Ambien to help me sleep.  Sometimes the pain is bad enough that it feels like I have a tight band around my chest and taking a breath of air causes shooting pain clear to my middle back.  It all starts in about a fist-sized area in the middle of the spine in the thoracic spine.  None of my physicians have been able to offer me any help for pain relief involving the thoracic spine.  It seems as though this is an area that is lacking in information.  They are more than willing to look at the herniated disc in the lumbar area-but it doesn't bother me!  The solution has been just to exercise and learn to live with the pain.  I do not agree.  Is there any approaches to finding help on this that I have not already done?  With surgery being a last resort effort, would it help?  As my posture has become terrible with leaning forward, slumped forward rotating shoulders, and neck held forward.  I attempted to practice good posture but the more I sit up straight the worse the pain and burning in the back becomes.  I respect my physicians but they tell me there just simply is nothing that can be done for problems of the thoracic spine.  I have to believe that that is not the case and if I do enough digging I will find something.  As evident by this web site there is more than just me who has thoracic spine problems.  I also remember hearing about a device that can be implanted in the back that delivers morphine to a pin-point site and does not have the usual side effects or dependancy.  Have you heard of this?  If so where would one find out more information on the subject?  I have had to make drastic changes to my lifestyle to cope with the pain.  I desparetly need a job but I know that I cannot do the work I spent so much time and money on educating myself in.  Not in this condition.  Not with living with chronic pain day in and day out.  I am increasingly becoming more fatigued but refuse to give up the fight to find relief.  I know there are physicians who specialize in thoracic spine disorders-just don't try to find one in Colorado!
Do you think a CT myelogram would show anything that might be being missed?  I am currently off all the meds except an occasional pain pill and the Ambien to help me sleep.  I have been told that I am not a surgical candidate because I am overweight and I smoke (I'm working on both these issues). Any information you can provide would be greatly appreciated.  Hope is a wonderfully powerful tool.  God Bless You