Question
I am a 44 year old mother of 4, several years ago  I fell down a flight of stairs but nothing was found wrong when I was treated in the ER. Now I am suffering from daily headaches, upper back pain (feels almost like a Charlie horse) and neck. On a daily basis I have numbness and pain going down both arms to my fingers with my index and middle finger going numb.
I had a MRI of the cervical spine without contrast done however the doctor I saw only told me to take naproxen or Motrin and loose weight (I'm 5' 11" and 191 lbs).
The finding of the MRI:
The included cerebellum, brainstem, and cervical spinal cord are normal in signal. The vertebral body heights and intervertebral disk space heights are well maintained. The facets are well aligned. The spinous processes are normal. Normal vertebral body bone marrow and prevertebral soft tissues.
Neural Foraminal Narrowing: C5-6 mild bilaterally. C6-7 moderate right.
Spinal canal stenosis: none
Disc Spaces: Broad-based disc bulges at C5-6 and C6-7. Additionally, C6-7 has a far right protrusion that enters the lateral recess. This would affect the exiting C7 nerve root and may affect the traversing right C8 nerve root.
IMPRESSION:
1. Neural foraminal narrowing at C6-7 moderate right
2. Broad-based disc buldges at C5-6 and C6-7
3. C6-7 also has a far right lateral disc protrusion that enters the lateral recess. This may affect the exiting right C7 nerve root and the traversing right C8 nerve root.

I do not know what all this means all I do know is that I am in allot of pain on a daily basis sometimes to the point I cant get out of bed without assistance.
Do I need to get a second opinion? Is there something more I can do for relief?

Answer
Hi Deborah,

I am sorry to hear about your fall and how you are suffering.

First, do not be overwhelmed by these findings. They do not necessarily have to coincide with your fall. These findings can also be found in people who do not have any pain. So, the main thing is not to get too worried about what is found on the MRI. It does indicate problems, however, they can be addressed.

Mainly, there is no canal stenosis, indicating no pressure on the spinal cord. That is good. Most of the findings indicate problems on the right side. The foraminal narrowing - this is where the nerve exits from the spinal cord and the disc protrusion is on the right side. The protrusion is a part of the disc that pushes out of its place and places pressure on the nerve.

Understanding the terminology can be difficult. Basically, if you think of the disc as a jelly doughnut, the jelly inside is pushing on the outside of the doughnut. A broad based bulge would be the jelly pushing the outside of the doughnut outwards along the back half of the doughnut, whereas the protrusion would be a smaller area that is pushed out further than a bulge. There is no indication that there is a free fragment herniation, which would be the jelly part pushing completely through the outside of the doughnut.

So, the findings of nerve pressure can explain the symptoms into the right arm. A broad based bulge can cause neck pain. Again, this does not mean everything is from what is outlined on the MRI, there can be strain (tearing of muscles) and/or sprain (tearing of ligaments). Unless very bad, this is not going to show on the MRI. This could also explain some of the symptoms in your left arm.

If you have been receiving therapy which is not effective or there is no improvement, then you may require a second opinion. It is possible, if basic therapeutic measure were not followed, that there is a good deal of scar tissue built up. In general, I would expect a doctor to initially prescibe some anti-inflammatory and analgesic medications. This may also include muscle relaxants if there is general muscle soreness or muscle guarding. Ice should be used, not heat, for the first week or so. Referral for physical therapy, which would consist of measures like ice packs, electrical stimulation, pulsed ultrasound... Topical analgesics can also be helpful.

This would progress over the weeks to more active measures like specific exercises and heat in the form of hot packs, continuous ultrasound, diathermy, and therapies like massage and, if nerve pressure is indicated, traction.

If this type of treatment does not produce the desired results within a few months, changing methods of therapy or referral would be indicated. If this were me, I would use medications in the begining, however, I would go to a Chiropractor. Depending on the doctor, similar therapeutic measures as physical therapy would be used, however, there would be a focus on any misalignments of the vertebrae (spinal bones). This would relate to the nerve pressure indicated on MRI.

So, please try to relax and perhaps use this as a guide. The more you can relax, the less tension you will have in the muscles and the less pressure they will place on the nerves. I know, easier said than done! If you have not been to a Chiropractor, you might find one in your area to consult. If you have, all doctors are not the same, and you may want a second Chiropractic opinion. If there has been scar tissue built up from improper healing, relating to what I described above, a good idea might be to find a certified active release practitioner, usually a Chiropractor or Physical therapist who specializes in the muscles and nerves. You may also look into fibromyalgia as a diagnosis and there are specific areas of pain associated with this which is illustrated at the link. As far as just taking Motrin and loosing weight....... I would try a second opinion.

I hope you get better soon. All the best to you and your family.

Kind Regards,

Dr. Steve