Current symptoms: Since 2011, escalating daily neck pain (5/10 to 8/10) ranging from aching to stabbing pain in back of the neck that frequently results in pressure headaches, more often on the right side than the left, including stabbing pain in the right eye. Since 2012, increasingly frequent electrical shocking sensation that radiates down right and left arms (not concurrently) to the thumbs (usually coincident with shock sensation in jaw on same side), involuntary arm muscle (forearm, sometimes tricep) and thumb “twitches” that are visible, and occasional numbness in the forearms. Conservative measures aren’t effective, symptoms are worsening, and recent physical therapy isometric tests indicate loss of right arm strength. Aching neck pain is typically worse at the end of the day. Nerve pain is totally random.
1980s – diagnosed with Ankylosing Spondylitis.
1990s – total hip replacement due to AS.
Early 2000’s – began Remicade therapy (continues to present) – reduced inflammation per ESR from 60-80 pre-Remicade to less than 10 since. No indications of current systemic inflammation.
2008 – diagnosed w/ osteoporosis, lost ~2” of height, began 2 years of Forteo injections.
May 2012 – Radiologist report of MRI of cervical spine noted posterior osteophyte complex with moderate to severe canal narrowing and bilateral neuroforaminal narrowing at C4-C5, small posterior disc osteophyte complex and lateral uncovertebral degenerative changes. (majority of spine is fused from AS).
May - June 2012 – EMG and nerve conduction testing indicate normal readings – Physiatrist). Report states “severe degenerative changes noted with near fusion at C2/C3 and C4/C5. Neural foraminal narrow is noted as well as spurs noted at C5-C6 on the left. On the right, there is much more narrowed neural foramen at C4-5, C5-6, and C6-7.”
June 2012 – X-rays show advanced neural foraminal stenosis at bilateral C4-C5 and right C5-C6 – Orthopedic Spine surgeon (doctor sees bilateral and central stenosis at C5/C6 in MRI as well). Minor reflex abnormalities are noted in doctor’s report. Doctor refers patient to pain doctor to consider RF ablation/facet rhizotomy. Doctor notes to patient that future fusion surgery may be needed if symptoms progress with conservative measures.
July 2012 – began pain management treatment, medial branch block, facet block, topical and oral pain medication . Medial branch block was inconclusive (attempted at a time of low pain so hard for patient to judge).
December 2012 – patient begins experiencing “electric shock” nerve pain radiating to thumbs bilaterally though independently, as well as involuntary muscle twitches and acute numbness bilaterally. Neck pain continues to progressively worsen despite increasing conservative measures (orthopedic office chair, braces, etc.). Level of pain and frequency of nerve type pain increase over time to present (September 2013).
June 2013 –Radiologist exam of MRI didn’t indicate significant change relative to 2012 MRI though symptoms have progressed (Surgeon and Physiatrist noted C5/C6 foraminal stenosis on X-rays and MRI that Radiologist didn’t note). Facet joint block by Pain Doc provided only short term pain relief (actually about 6 hours).
August 2013 – Physical therapy assessment indicates neurological deficits - right arm 20 - 60% weaker than left (Patient is right handed and per PT Doc, patient’s right arm should be 10% stronger than left). PT Doc suggests right arm weakness may be caused by pinched nerves at C5/C6. Physiatrist repeated test with same result.
Conservative treatments attempted: Physical therapy (neck ROM causes electric shock pain to occur so stopped per physiatrist’s orders), heat (sometimes makes it worse), ice (sometimes helps), 4 different neck braces, neck traction (inflatable collar), TENS (doesn’t help), massage (sometime helps but can make it worse), oral steroids (provides 1-2 weeks of benefit), pain pills (usually taken only at night – does usually help), medial branch and facet blocks (short term improvement), Indocin (did nothing), and Cymbalta (did nothing).