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Diagnosing an Intermittent issue?

LumpyLLumpy Posts: 103
edited 06/11/2012 - 8:40 AM in Neck Pain: Cervical
Hello All! Its been a while since I posted. I originally had Neck pain and nerve pain down both arms daily. I went through 1 month of PT and have been in WC limbo ever since. Currently I have a new NS and am to start ESI injections in C6C7 and another round of PT soon. My acute pain is subsided. Now I have what I can possition dependant pain. If I read a book, for instance, I get deep neck pain (not muscle pain) and then get the radiating "nerve" pain and tingling down one or both arms. The pain will last for hours, or even a day after I aggrevated it. I can go a few days or even a week pain free and then something else will start the cycle.

I have had 2 MRIs, both looked about the same to me and to my original NS, but one report says medium bulge at C6C7 and the other says mild. Neither indicate enough pressure on the nerves to cause my symptoms.

My question is this: For those of you who had experience like this, how was the problem finally pinpointed? I'm getting pretty frustraited with the whole process.

Thanks Guys!


  • How do you know that isn't enough to cause your symptoms? For one thing how was your mri done?Was it laying down or standing? You must be putting yourself into positions that are allowing the bulges in your neck to aggravate the nerves.It really ticks me off when doctors see bulges and they think that it can't cause problems.If nothing else is showing on the mri and its the same symptoms that can be caused by a large herniation or moderate one then why can't things that you do being causing those symptoms.They put you in a relax position ,flat on your back show you what it looks like then and then assume once your standing and bending your neck that everything is going to be exactly the same.Your head is a very heavy object that your neck is holding up and it puts a lot of pressure on those joints all by itself.I wouldn't rule out those bulges if i were you.
  • I couldn't agree more. The cervical spine is a highly mobile joint ( several joints ) as we know. The cervical spine ( as does the entire spine) acts as a shock absorber, when we walk,bend, dress, move, you get my point.

    Some Doctors are lacking in the common sense area and lack the ability to think about how a certain area works and what that areas intention was.

    I would ask GOD why he placed spinal fluid ( the thecal sac) around a spinal cord, but I already know the answer ( as should they) The thecal sac, spinal FLUID is there to protect that all important spinal cord, it is fluid filled so that it also acts as a cushion and protects the spinal cord ( same thing as amniotic fluid that surrounds a fetus! HELLO its there to protect the baby!

    IF a disc or bulge is extruding, touching the spinal cord what do they think, as you said happens when this mobile joint moves around and the discs that act as shock absorbers when the vertebrae move as they must and squeeze and put pressure on the disc, well obviously the disc that are shock absorbers are going to bulge out worse!

    Its just absurd really the thinking sometimes or shall I say lack of when it comes to this area!
  • Thanks for your posts. You both capture my frustration exactly. My MRIs were both laying down. I have heard of people having sitting MRIs while in the possition that most aggrevates their issue, but I really doubt WC would foot the bill for that. It is my thinking that it will take something like that or maybe there is some other test or evaluation. I have had EMGs, BTW.

    In defense of my latest NS, I have only seen him once and he is the one pushing to get me started with the ESI shots. I think this is a logical step, but not necessarily a long term cure, especially since my occupation will require me to be physically fit and not just "comfortable". I really sympathize with those of you who have gone through this for years. I have 5 months invested in it and I am already beyond frustrated.

    Are there many who have had the sitting MRI? Is so, what was your experience?
  • I've had several. They are good because they show you in the position you are in pain. The down side is the quality. Many doctors will not even look at them which isn't fair. I was lucky to have an amazing radiologist who spotted the problem immediately. Too bad I then went to a surgeon who was a complete ass.

    I've been doing this for 8 months now and I am so ready to be done. Keep your fingers crossed for me.
  • Kris, Best wishes with the upcoming surgery!
  • Lumpy said:
    Thanks for your posts. You both capture my frustration exactly. My MRIs were both laying down. I have heard of people having sitting MRIs while in the possition that most aggrevates their issue, but I really doubt WC would foot the bill for that. It is my thinking that it will take something like that or maybe there is some other test or evaluation. I have had EMGs, BTW.

    Are there many who have had the sitting MRI? Is so, what was your experience?
    Howdy Lumpy!

    First off the cost of a recumbent vs. a positional MRI are basically the same. :-) I've had 2 and as was posted before me, there is a LOT that won't show until they take the MRI in the position that puts your spine under load. Under load can equal "actual bulge" and its relationship to your spine or nerve roots.

    To give you an idea. Due to years of helicopter flying, and flying with night vision goggles, I had a complete loss of lordosis in my neck, and due to that, I have a lot of forces "not normal" on my cervical and lumbar spine. A recumbent MRI after my C6/7 went showed no problems at that level! I was hurting, weak and numb and demanded a stand up (positional) MRI. On the "straight" sitting and forward extension, the hernia and its relationship to my right side nerve root were plainly evident! Surgery was scheduled 5 weeks later. I hope that is of help.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • dilaurodilauro ConnecticutPosts: 9,865
    are always the hardest come diagnose.
    When the stranded tests come back without a positive problem, the doctors need to use their medical skills in attempts to identify the problem.

    Its almost like when you have a car problem. Some times your car doesnt start. But it doesnt happen all the time. You bring it into a mechanic and they cant find the problem.

    You know there is a problem, but unless someone sees it when it happens, it becomes so difficult to diagnose
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Dilauo,

    You are exactly right about intermittent issues. That is my specialty at work. I'm the technician that is called to find the problems others miss. I train our guys to realize customers/companies don't take time out of their day and pay big money just for fun. If they complain, there is a problem.

    I am amazed that the medical community seems so reluctant (read lazy) to go after problems like this and use their big brains to help people out. I know there are difficult issues that can't be fully undertood, but I don't think mine is really that difficult.
  • I hate that some people feel that they need to generalize all the medical community together as too lazy to get to the root of our spinal problems. Lumpy, I'm not pointing this to you specifically or anybody else - it's a very common problem and I can certainly understand how it can seem true to a lot of people trying to find answers.

    I personally have found a spine team that all work together to find out exactly what's happening with me, work together to decide what treatment they feel is needed and then proceed, with my approval, of course. I'm very active in my care in conjunction with my spine team. Every time they suggest a procedure, they give me a detailed account of exactly what they want to do, why they want to do it, and what they hope the results to be. Then we go over the results at length, was it worth it, did it accomplish what we wanted it to, and what's next, if anything.

    I know it's not always easy to doctor shop when you're not getting a diagnosis quickly or your doc seems to hemhaw, scratching their heads trying figure out what's wrong. In fact, I find that downright scary. Some spine problems are indeed very difficult to pinpoint, but there are docs out there that will crawl under every rock, lift every leaf, and keep on doing it until they've come to a reasonable conclusion and thus what they will consider a reasonable ractive treatment. It's mutual trust that must be established so you and your doctors aren't battling each other, you're both working together to battle your spine problem(s).

    I guess I'm just wanting spineys to be proactive in their care enough to find that doctor that you believe in, that you know will do everything (no matter how trivial or complicated) they can to work with you and treat you as effectively as possible. Many times it takes a team of docs, not just one surgeon, and that's why I'm always touting finding a fellowship-trained spine surgeon (who generally are surrounded with a team of others). Those are the docs that have a passion for the spine and thus their patients with spine problems, and their goal with each and every patient is to find satisfactory outcomes.

    This is my opinion only, of course, but I truly believe that once you find that doc or team that you can fully trust, you're able to focus more on what you need to do personally for yourself than focusing on if the doctor is really trying his/her hardest to help you.

  • Hi Cath,

    I understand what you are saying and agree with it. But my ability to doctor shop is very limited due to the WC system. I believe it is due to frustration with the WC system that doctors tend to be a little more dismissive or, at the least, less attentive. The system is nothing but a frustration to all involved. The doctors have to deal with paper pushers who demand conference calls with very busy doctors to verify the most basic treatments. No wonder they sigh loudly when they find out it is a WC case...Rant ended.

    I really didn't mean my generalization as a slight against the profession. Rather, I meant it to capture the sentiment of all of us frustrated souls who know our problems are real and need real treatment but go month-upon-month without progress or answers. To the point that we spend countless hours trying to self-diagnose and lead our doctors, rather than the other way around. That, of course, leads to its own set of serious issues. What a circle!


    Thanks for your post about the positional MRI. I believe my issue would show on this also. But chances are WC would never approve it... X( I believe I will have to wait for my NS to go through whatever process of elimination or differential diagnostics he has to do and hope he comes up with a solution.

  • Lumpy, you're 100% correct and I apologize for forgetting that there are many more problems to deal with when having to work within most government systems. I don't have any experience at all with WC, but I have a friend who does and from talking with her, I know that the frustration, hypocracy, politics, etc. can be an enormous mountain to climb.

    So I'll just hope that what I said about finding the right doc helps someone who's lucky enough to be working within the private sector but too new to be able to effectively navigate that situation and it's own puzzles.

    I never took your comments as a slight against the profession and you very effectively communicate the frustration that you and tens of thousands of others are facing on a daily basis.

    Please except my apologies for my ignorant post. You could bet your life that if I were in the WC system, I wouldn't have made the statements that I made.

  • Cath, No need to apologize. I take your comments in the constructive spirit you wrote them. It is a good conversation to have. I appreciate it. The people I want to apologize don’t frequent this board… ;)
  • Greetings Lumpy!

    I don't know if this helps or not? The prescription (as I get from my NS) is for an MRI - whether it is positional or recumbent is my choice. Even under WC that would apply. Now that being said of course, if you had a recent MRI, then yeah, sadly WC will put a fuss up about that!

    As a supervisor in the federal govt. WC can be a challenge not only for me as the sup, but what my employees have to go through. When I first started having "nerve" issues, it was due directly to a work related injury, and due to what I saw my employees go through, I opted to use my insurance. I did not want to jump through their hoops at all! I don't know your insurance status, but that is what I ended up doing.

    I have one employee who has had his shoulder operated on 3 times, and now it is giving him problems again (2 years post op if memory serves). WC is giving him major grief and delaying many of his appointments. Due to risk of permanent damage, his "patience factor" is now zero with them, and he too is switching to his insurance. Thanks to their delays, he may now be looking at disability retirement! Wonderful huh? - NOT!!!

    I hope things go better for you Lumpy. *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • LOL - I know what you mean. :-)
  • Lumpy - did anyone do flexion/extension X-rays or only the MRI?
  • Yes, I had the flex/extend x-rays when this first occured, but I don't think is revealed anything.

    Aviatrix, I probably can't get another MRI for a while. I checked my personal insurance. They have to approve MRIs and it has to be at an authorized facility. According to their website, they don't cover upright MRIs. They call it "experimental" because of lack of published studies showing their clinical value compaired to the stronger recumbents. Bottom line: I am SOL on that.

    A little progress today, though. I did go in for a consult with a PM doc. He was very thorough with the history and actually took the time to document all the details. Probably I will be getting an ESI soon. Of course it isn't a cure, but it is progress...
  • Sorry to hear that Lumpy! For me anymore, if it is for any part of my spine, I will only go with the positional. The images on the machine I go to are really no difference than that of the recumbent MRI I use to go to. My surgeon has gotten (especially after the big difference on mine from recumbent vs. positional = herniated disk) to where he too now prefers them.

    So sorry that you are in the "SOL" status. ESI's didn't do anything for me. If they work for you, that is great! I will keep you in my thoughts Lumpy!!! *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I have the same issues with my neck. I have heavy cranial/facial involvement as well. SS251 said it
    very well - about the thecal sac protecting the cord. I believe that every time I move, I create soft tissue damage with symptoms that are very much like "whiplash" (only much worse). I *think* the doctors are calling this "Fibromyalgia". Which is both scarey and laughable (to me). (What-Ever ! !)

    The surgeon I saw...actually told me that my neck was better than HIS. omg! I've got complete reversal of the lordosis - I can see on my MRI how the spinal fluid is lacking on one side of my cord..and actually BULGING on the other side. OF COURSE this would be the reason for my cranial symptoms - and the surgeon I saw is full of caca.

    Don't let them shove you around. I've been letting them shove me around...and it's going to STOP.

  • Yes the PROBLEM IS the workers comp system. While it is difficult in itself to find a Doctor to take time with a patient these days ( I am in the field and see it all day long) But when you must consult with a workers comp Doctor, unless THEY find you one ( many states don't allow you any choice at all) So unless they find you one that is afraid of malpractice or has a conscience you are up against a horrific system.

    I have C5-C6 central posterior herniated disc with tear abutment of spinal cord, the tear and disc material sit right on the spinal cord, you can not see a smidgett of spinal fluid ( that fluid that protects the spinal cord)

    ( I have other issues too) But save that for now.

    The workers comp Doctor actually after viewing films and report came back to room and said he saw no reason for me to be having pain. I said you looked at my films , he said yeah he said well you have a disc bulge, so what, it not causing any problem.

    I said disc bulge, I said lets go look at films together ( he has no idea I read these)

    I said can you point out where you see ANY spinal fluid between the disc herniation and the spinal cord itself? His answer was ( WELL its not pushing the spinal cord down!) I said so its normal to have a herniation that sits right on the spinal cord? I then said what is that pointing to the obvious tear, I said you don't see the tear ... and he said thats just wear and tear.

    I just had to smile at him in disbelief.

    He said there was nothing I needed to do, cause I had no problem and the nurse manager with workers comp later told me she begged him to try physical therapy and he approved PT for 2 weeks.......?

    I am through with the system, trust me through.
  • I hope you your nuro will get his brain engaged and think about what he is saying to you. My nuro is out to lunch as well and my primary is now the one sending me for ESI in my lower back and also for my neck some test that can observe my loss of felling in my arms for my neck injury. I had the lay down MRI that showed large fragment inpinging my cervical cord, thus only primary is involved with this and awaiting my return to nuro in feb 1st for this neck problem. I wish you the best. I think for kicks when i go to my nuro im going to bring a copy of some of these post like the one SS251 I had to laugh. It makes so much sense to me have stand or sitting one would show how in acctuall position of the disc not laying on your back with no stress or pressure exzerted. best of luck...Shawn
  • Yes, I can relate to all of that. I had two MRI’s. One was through my regular Neurologist and one was through the worker’s comp doctors and their choice of imaging center. I looked at both of them and read both reports. They were about 3 weeks apart. Aside from the WC images being a little grainy, the images were almost identical. Here is an example of the two reports. I will call the MRI my doctor ordered “Original” and the Worker’s Comp one WC. My PM looked at all this, shook his head and said something like “Its amaze to see how different these can be at times.” He basically discounted the differences and did a complete eval.


    ORIGINAL: …Dessication of this disc is identified. Mild diffuse annular bulge with small right foraminal protrusion is identified of this disc indenting the thecal sac and impinging on the right neural foramen…

    WC: …There is no significant disc bulge or disc protrusion….


    ORIGINAL: …Dessication of this disc is identified. Mild diffuse annular bulge is identified of this disc indenting the thecal sac…

    WC: …There is no focal disc protrusion. The cord is not compressed or deformed. Minimal uncinate arthropathy is present…


    ORIGINAL: …Dessication of this disc is identified. Medium sized broad based central protrusion with associated posterior osteophytes of this disc is identified partially obliterating anterior subarachnoid space…

    WC: …There is no focal disc protrusion. The cord is not compressed or deformed. There is no significant central or foraminal stenosis.


    Original 1. Mild diffuse annular bulge with small right foraminal protrusion of C3-C4 disc indenting the thecal sac and impinging on the right neural foramen. 2. Mild diffuse annular bulge of C5-C6 disc indenting the thecal sac. 3. Medium sized broad based central protrusion with associated posterior osteophytes of C6-C7 disc partially obliterating anterior subarachnoid space.

    WC: …1. There is mild disc dehydration at C5-C6 & C6-C7. There is minimal posterior disc bulging at these levels without cord compression or cord deformity. 2. No significant disc bulge or protrusion at the remaining levels. 3. No intrinsic cord abnormality.

  • There needs to be laws preventing medical personnel from being able to see what kind of medical coverage a patient has. Medicare, Medicaid, Workers' Comp. is the "Lazy" label when nothing could be further from the truth.

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