Question
In 1999 I was in a car accident and fractured C5/C6 vertebrae. The medical notes state the following?br>
Non displaced fractures of the left lamina of C5. The left pedicle of C5 and an undisplaced sagittal fracture of the body of C6 extending through both anterior and posterior aspects of the vertebral body are noted. No soft tissue oedema is identified within the spinal canal and no soft tissue oedema in the prevertebral space. Slight widening of the left C5/C6 facet joint but no subluxation or dislocation.Slight widening of a facet joint ligamentous, no subluxation/ dislocationI was 17 at the time of the accident.

In 2003, I was in another MVA where I sprained my thorasic area, neck and lumber sparin. I received Xray抯 for this, nothing showed up.

In 2004, I sprained my thorasic back when I was lifting and twisting a tray of dishes from a dishwasher and again sprained my back in 2006 and 2008 while sliding open a heavy door.

In 2009, I was involved in another MVA and I sprained my neck and thorasic area. This accident aggravated my neck and it hurt when I laughed.

In 2010, while carrying out an alpine crossing I injured my thorasic area again but this time the symptoms have not settled. It is only now that I am investigating a treatment for this latest injury have I realised the reoccurring injury to my thorasic area. I have had an MRI carried out but nothing is mentioned about the T6 area that was affected. Before the tramping accident I would get pain in my thoracic spine that would develop as the day went on and settle after a nights rest however after this accident I had sharp pain in the T6 area and the pain remained contstant, i.e. it did not go away after a night抯 rest. My whole back also inflamed and went into spasm. The pain seemed to radiate into surrounding joints. I was taking a course of anti-inflammatories, they helped but did not remove the pain.

The pain increased especially when I sat down. The pain is no longer constant however I still get pain when I sit for short periods of time and I also still get sharp localised pain for no reason at all. When I carry out simple day to day activities like going for short walks or cooking my back still gets inflamed.

It is now 8 months since the accident and I am still aggravating my back after only sitting for short period of time and walking..

I have done a lot of research online but cannot diagnose what I抳e done and the best way to treat it, can you please give me a theory on what you think I have done to my back and the best way to go about treating it. Initially after the accident I tried oesteopath, physio and chiropractor. The pain was no longer constant however it was still present. After about 5 months my doctor suggested a cortizone injection but after speaking to the administer he said not to go ahead with it because my symptoms had improved he said to leave it and not have any intervention such as physio, oesteopth etc.

I feel like doing nothing isn抰 the right answer either?



Findings from the MRI include:

In the cervical spine, alignment is satisfactory. There is loss of T2 signal and mild loss of disk height at C4/5 and C5/6 with loss of signal but preservation of disk height at C3/4. The remaining cervical disks return normal signal. The spinal canal is of normal calibre and the cord returns normal signal.

On the transverse scans:

At C7/T1 there is a mild disk/osteophyte centrally but the nerve root exit satisfactorily.
At C6/7 the exit foraminae are patent.
At C5/6 there is mild disc osteophyte but the exit foraminae appear normal.
At C4/5 the exit foraminae appear satisfactory. In the thoracic spine there is mild loss of disc height in the upper levels but no significant disc lesion and the cord returns normal signal.
On the transverse scans, allowing for some mild artefact appearances are satisfactory at all levels.

Comment: Minor spondylotic changes in the cervical spine most marked at C5/6 but no significant foraminal narrowing at any level.


Since the accident in 1999, mobility in my neck never came back and has been restricted. The neck was not particularly painful, initially it was just the mussels around the neck, however several years later after I finished university and started working at a desk job my thoracic area would get quite saw and I would get localised pain in my neck over the fracture site. I noticed the neck pain and restriction getting worse. I do exercises everyday for my neck however I still get quite a lot of pain from the area from time to time.

In the last couple of years the physio noted that I had weak scapulas and I attempted to strengthen them through swimming and stretches. More recently they tested my long thorasic nerve to see if that was damaged but it wasn抰. The physio said that I have also developed a holding pattern where I hunch my shoulders up to protect my neck area.

I am at a loss to know which direction to head now, pain and discomfort have taken over my life but I抦 determined not to give up. I am starting to investigate surgical options for my neck to see if there are any solutions that could help with the pain and I am also wondering what I can do to help my back recover. My back is causing me the most concern at the moment, as I can抰 carry out simple day to day activities with out it getting a feeling of my back being pressurised.


Thank you for taking time to consider a diagnosis and any treatment options?

Regards,

Julia from New Zealand

Answer
Julia,

  Wow, that is a lot of trauma to your upper back area over the last couple of years.  After reading through everything you put down, one of the biggest issues that I am noticing is that your are probably tight in your chest muscles.  You have been told that you are weak in your scapula muscles, but nothing is wrong with the long thoracic nerve.  Swimming, depending on the stroke can exacerbate tightness in your pecs.   If you have ever seen the swimmers in the Olympics standing at the podium, most of them have rounded shoulders with a forward head lean because of tightness in their pecs/chest muscles.  The other reason why I think this is problem because when you sit for short periods your pain increases.  If you don't have the strength in your rhomboids and lower traps your pecs will tighten with time and your head will fall forward causing an increase strain to the thoracic spine.  #1 try to stretch your pecs, place both arms in a doorway with your elbows bent at a 90 degree angle.  Step forward and you will get a stretch in your chest.  Hold a light to medium stretch for 40-50 seconds.  #2 is to strengthen your rhomboids and lower traps.  Lying face down on your bed, with your arms out in front of you with your elbows straight, try lifting your arms up into the sky.  Your arms will make a "Y" looking symbol.  Try and do 3 sets of 5-7 reps.  Let me know if this helps.


Martin