Question
QUESTION: I was in a car wreck march 2 2009 I broke my c2 i wore neck brace no surgery couldnt go back to Dr didnt have no ins. I have never been able to go back to work. I cant do nothing if and when i do I cant move at all for three or four days.I got ins and went had a mri and it states this There is a deformity of the c2 vertebra at the base of the dens which has the appear of chronic posttraumatic changes with associtated bony hypertrophy and slight anglar deformity all resulting in the bony hypertrophy flattening the anterior aspect of the cord . The atlannoccipital and atlantoaxial articulations are otherwise normal.The c2c3 level shows a central disc herniation indenting the anterior aspect of the thecal sac.The neural foramina are patent. c3456 shows spinal stenosis c67shows concentric bulging of the disc. The c7-t1 are normal What can i do I have ins went to my Dr that worked on me back in 2009 went in nurse said a guy would come in and ask me about what was going on and then Dr would be in I told guy about the pain in neck how i couldnt do anything he said you need to lose weight and you have arthritas he left. Nurse came in said you are done Dr never came in My question is will this ever get better what can i do for it and will i ever be able to work? I picked up 25 pound bag of dog food hurt my shoulder went to a dr for that he said frozen shoulder been going to physical therpy 2 a week but it just kills my neck and all i can do is sit in chair i take mobic and a musle relaxer but this helps nothing do you thank neck has something to do with shoulder and should i sighn up for disability?

ANSWER: Hi James,

Sorry to hear about this problem.

Well, it depends on your symptoms. If you have symptoms of myelopathy (pressure on the spinal cord), decompressive surgery may be indicated. This would depend on a neurological examination that would correlate with your symptoms and the findings in the MRI. So, your primary doctor should be able to refer you to a neurologist or an orthopedist that can help make this determination. If there are no indications for surgery, perhaps injections would help to provide some relief. There is no reason to have a doctor that is not going to spend the time to help you. A second opinion may be necessary should you experience a doctor that will not answer your questions or indicate that nothing can be done.

Loosing weight is always helpful, however, this needs to be done carefully and any help with the pain can make a difference. Arthritis is certainly present and there are other medications that might be considered to provide more relief.

It does not sound like the shoulder is a direct result of the neck. It is possible that areas of the neck can refer pain into the shoulder and weak neck muscles can lead to less support for the shoulder, however, it sounds like it could be a shoulder problem like a rotator cuff tear or bursitis. The neck and shoulder muscles are connected, so shoulder problems can also cause neck pain. An injection in the shoulder might provide some relief, considering physical therapy is problematic at this point.

As far as disability, that determination would need to be made by your doctor. So, if you are not happy with your doctor, get a second opinion. Hopefully, finding a more caring medical environment would offer additional options to get you on the road towards improvement and a better quality of life.

You can learn more about myelopathy and see if you have any of the symptoms at http://www.necksolutions.com/myelopathy.html

Wishing you all the best.

Dr. Steve
www.necksolutions.com

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QUESTION: Thank you Dr Steve I did get another appointment with a different Dr. My question now is I am a diabetic also I am taken metformin 1000 mg twice a day glipizide 10 mg twice a day My family dr said he didnt no about them shots because of me being a diabetic and that i need to ask the orthopedist dr about that What is your opinion on that. I just had my A1c checked and it is 6.5 If i would have to take them shots do you thank that will help me enough to go back to work? I am a welder by trade and how long of a process would this be? I have to wait until Feb 5 to see specialist. Thank you for your time and answers

ANSWER: Hi James,

I hope the new doctor will provide more options. Regarding diabetes, it is up to the prescribing doctor. In my experience, as long as the diabetes is under control, there should not be a problem. Usually a short monitoring period after the injection. The doctor may decide to use an anesthetic instead of steroids at first to see if injections will help. This would be more of a diagnostic injection. If the injections will help, it is possible you could return to work, depending on your symptoms and the level of relief any injections would provide. A diagnostic injection would not take long to see results. Relief from injections are usually within a day or two, but successful management may include other or additional methods of examination and treatment.

Regards,

Dr. Steve

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QUESTION: to bother you Dr but I am scared the other night walking up my steps i had the sharpest pain run from my neck to my right arm down my right leg i had to stop for a second I then went on up stairs and noticed i had pee on myself and my fingers and toes where tingling so i go to Er the dr ran a cat scan and said nothing broken i told him i have a apointment to see specialist on Feb 5 the soonest date i could get into them The er dr said no thats not soon enough this is serious something wrong and could paralyze you follow up with family dr and see if he can get another date they said the was the earlist they could see me. I am scared to walk upstairs afraid of something bad will happen the tingling is still in fingers and toes what should i do and what do you thank happened to me can it paralyze me I am So Sorry to keep asking you question but it seems like you are the only one will listen to me

Answer
Hi James,

Well, first thing is to try and keep calm. I assume the CT scan was of your neck, considering the history. If this was not a traumatic injury, I would also assume nothing was broken and would want to see an MRI. I think it is tough to have to wait for an appointment. Seems like that is just the way things are. I see this all the time, even in my personal medical care.

I think an approach might be to call your primary and ask for a referral to a neurologist. I can't imagine your family doctor being able to perform a thorough neurological exam. This might save some time, because he will probably do a referral anyway. That is not to say you won't have to wait for a neurologist, but you symptoms should prompt a speedier appointment.

I am not a neurologist, so I am a bit out of my field, but I know how frustrating it can be. Diabetes can sometimes cause neurological problems. Perhaps it is related to your diabetes, I would assume they did a full work-up on this at the ER and ruled this out, thus the CT scan. It sounds like it may be related to the spinal cord at the base of your skull. Since you do have a history of trauma in that area, I might try to keep from moving the head to extremes of motion. Again, not sure that this is the problem, but considering your history, perhaps this would be simple advice. Of course, should you experience any worsening, I would go to the emergency room again.

I'm just curious as to why the ER doctor, who said this could paralyze you, would not have done something more there or admitted you for further testing. So, could this paralyze you? I am sorry to say I don't know.

As we have discussed previous, it may be related to myelopathy. I would think you might try to remember what position your head was as you were going up the steps; did you look up all the way? Was your head down all the way looking at the steps? Did you turn your head to look at something or talk or were surprised?

In any event, I wish I could be of more help with this. I think an MRI would be good, but this may require a dynamic MRI, to see if different head positions result in cord pressure. It could be instability of the ligaments. Prolotherapy claims to be able to tighten ligaments with injections.

Anyway, getting too far ahead and making too many assumptions, but try to relax; call to see if you can get a referral, if not a neurologist, maybe an orthopedist. Try to monitor your head positioning in relation to any symptoms, and go to the ER should symptoms get worse.

Take care!