Question
Dir Sir,

I am a 28 yr old female suffering from extreme and widely dispersed muscle spasms, nerve  pain in the upper extremities, and loss of strength in my right arm.  I am currently working oversees in a very remote area and must travel internationally in order to obtain diagnostic and specialist treatment, I will not have the assistance of a referring physician to coordinate my care.  Any advice you can give me for treatment options and or types of practitioners I should see would be greatly appreciated.  

Background:

In 1997, I had complete MRI, CT Scans and X-rays preformed on my trunk neck and head .  No skeletal abnormalities were noted at that time. (Final diagnosis 1 year later was Stroke).

In 2003, I was manipulated by a chiropractor and immediately lost sensation in the face, neck mobility, and the use of my right arm.  These acute symptoms lasted approx 3 weeks
I sought referrals (3) to specialists and was told it was most likely muscle tear.  I was prescribed pain medication and muscle relaxers and was unable to find any physician who would perform any additional diagnostic tests.  I underwent PT for some time, however the therapist expressed concern at my lack of improvement and advised against further PT as it seemed to be aggravating my symptoms.   I finally received a Cervical MRI in 2006.  Findings were 揅3-4:  揗ild disk bulge? otherwise the rest was normal.  Final Impression was Cervical spondylosis.  Continuous Spasms were reported to be present during the test and the Cervical spondylosis was reported to likely be caused by spasms.  At that time I was experiencing stiffness and generalized pain in the neck, shoulder and arm, but otherwise did not notice the spasms.  I was prescribed intermittent muscle relaxers and stretching and told the spasms were in the deep tissue and would likely not respond to medication.

Since 2006 my symptoms have progressed to radiating neuropathic pain and loss of strength in my right arm.  I have limited range of motion in the neck and shoulder and experience localized pain when turning my neck and raising my arm, this is also audible.  I experience constant and often intense muscle spasms in the neck, face, chest, shoulders, right arm and often times down into the sides of my trunk and buttock.  Spasms are visible as I am very thin and have little fat tissue.   I have bulbous muscle swelling along my thoracic and cervical spine and across my shoulder.  During periods of increased pain I also experience numbness in the top of my hand and in some digits.  I have a visible lump around C3/C4 and when pressed loose sensation in my arm (seems like a large muscle knot) Recent X-rays show marked abnormal curvature of the thoracic and cervical spine.

Initially I believed the nerve irritation and numbness was due to strangulation by the irritated and spasming muscles which may not have properly healed.  However I receive some relief from radiating nerve pain when leaning my head down and am concerned that is may not be the case.  I have started having headaches which may be related to my neck or side effects of the medications.

The Local physicians are helping to the best of their abilities, however resources and capacity is extremely limited here.  The physicians have placed me on lidocaine injections but are uncomfortable with addressing the cervical area. I was taking valium (the only Rx we have here as I cannot take most pain medication) until recently receiving special ordered medication. I was placed on Celebrex, baclofen, Esperisone (from PI) and neurotin.  Since starting the neurotin and Celebrex I have experienced some relief. However with a history of Stroke, I am concerned about taking them all together, these drugs a relatively foreign to the local physicians.

I need to understand which type of physicians I should see as I will only have two weeks away to address diagnosis and establish a treatment plan; complicated treatments must wait until after January of this year.  I will be a self paying patient and not limited by HMO/PPO referral requirements but need to schedule my appointments in advance.

Thank you for any advice you can give me on setting up my appointments.  

Answer
Dear Brianne,

I believe I can help you.

The general array of symptoms and the presence of the palpable "lump" at C3-C4 suggest spasm of the muscles of the neck and trunk (upper thoracic area), with impingement of the facial nerve and of the brachial plexus, the nerve center which goes to the arm and through which sensory signals from the hand pass.  If you were my client, I would examine you to determine if that is the case and seek information on your history of injury, before proceeding on that premise.  So should your doctor(s).

Drugs can't correct muscular spasticity, and neither can surgery or manipulation of muscles or bones, as (apart from momentary reflexes) muscular function is regulated by brain-level, conditioned postural reflexes and high-level brain control, neither of which can be modified in any lasting, beneficial way by drugs or surgery.  

The correction can most directly be accomplished through sensory-motor training, and I recommend Hanna Somatic Education as the most effective approach of which I know (and of which I am a practitioner).  This kind of training quiets overactive postural reflexes and improves voluntary muscular control of the type used in ordinary movement.  Spastic muscles relax.  With relaxation, muscular pain and strangulation of nearby nerves ends.  Symptoms typically abate quickly, sometimes instantly.

If you can't get to a Hanna somatic educator, a practitioner of the Feldenkrais method can help, though that process can be quite a bit slower to produce stable results than the Hanna method.  Recorded self-help programs are also available; consult with me for that option.  Write:  [email protected]

Spastic muscles don't "heal", as they are not injured, but overactive as a result of neurological activity.  Sudden stretching of spastic muscles, including stretching induced by sudden chiropractic adjustments, can exacerbate muscular spasticity, which could account for the sudden loss of facial sensation, whether or not you have had a stroke.

For more information, see somatics.com.

Lawrence Gold