Question
Good Morning DR,I recently suffered a work injury back in late march this year. in July i had an MRI scan of the Cervical Spine and the report was..C4/5 small posterocentral disc herniation is seen..C5/C6 Posterocentral disc herniation also indenting the anterior subarachdoid space but not resulting in any signnificant neural compressions..C6/C7 Broad posterocentral disc herniation is seen also mildly indenting the spinal cord. No major neural foraminal encroachment identified at this site.I can say this that i experience extreme pain around the neck & shoulder region. My right arm is NUMB with pins & needles in certain fingers.I was receiving workers compensation but that ceased a week ago as they said the problem should have eased by now, Ive had 1 bout of physio and seemed to have increased the pain and suffered headaches for 3 days. Could you please enlighten me on this as i seem to get no answers about my condition. And now my work wants me to return to normal duties (home care}.Kindest Regards Michelle

Answer
Dear Michelle,

You are not alone in this...workers compensation is one of the worst systems around and does a very poor job in handling injuries.  Workers compensation doctors are notorious for being poor diagnosticians, poor clinicians, and at limiting what they report finding with the patients.  They will often say there is nothing to substantiate your injuries because this is how they make their living...it is a very corrupt system.  Amazingly enough, even if you get a good work comp doc, the workers comp system will often go against the doctors recommendations when they say you need more care or have a permanent injury or disability.  I personally know 2 previous work comp docs who were pushed out of the system for documenting injuries correctly and recommending continued care.

You have a paresthesia into the right arm which can definitely be caused by the finding on the MRI.  Just because there is "no major neural foraminal encroachment" doesn't mean that there is no problem.  I am always amazed by these reports...most of the docs opining on them don't understand pain transmission very well and don't know what referred pain or sclerotogenous pain, because they are looking at everything from a neurogenic pain model.  However, referred pain patterns have been well documented in the clinical literature since the 1940's.  irritation of the spinal cord can produce pain, numbness, tingling etc...down the arm, not to mention that a stretch of the brachial plexus (nerve bundle from the neck that supplies information down the arm) can cause these symptoms.  The funniest thing here is that your symptoms perfectly match the pain patterns I would expect from the MRI findings!!

The first thing I would suggest you do is get a better doctor...one outside of the work comp arena.  I would suggest that you consider a chiropractic physician who will actually address the spine and one who will perform a functional orthopedic and neurological examination.  I would further suggest that you try some axial traction which is pulling upward of the head to take pressure off the disks in the neck...often patients get significant relief from this very simple tactic and a home unit can be utilized safely.  Lastly you may want to consider the use of a Posture Pump which you can purchase online.  They help to decompress the spine by approximating the normal curvature which takes pressure off the cord while creating fluid exchange from the vertebral bone marrow to the disk.  

Also please research Sclerotogenous pain on my Allexperts responses and you will find a complete explanation of referred pain with the clinical references.  Unfortunately, I am having some computer problems and cannot attach it at this time.

Good Luck, I hope this helps Michelle.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoastehalthcare.net