Question
QUESTION: Hello, I am a forty five year old male. I suffered a fall three and a half years ago, landed in an awkward position, hit my head, twisted my neck and blacked out. When I came to I had no movement in my left arm, this quickly returned after about a minute, but I had restricted movement in the arm for several months. (Difficulty lifting it above my head). I saw a neurologist, had an MRI scan, and an occluded right vertebral artery was found. Once my arm returned to normal I had no other symptoms, I felt good and was playing badminton 3 times a week. Six months later, during a game of badminton I suffered a real bad neck pain, accompanied by severe dizziness and nausea, numbness down both arms, across the head, tingling sensations at the back of the head and blurred vision. For the last three years I have had ongoing similarvproblems. Physiotherapy sessions have helped to relieve the symptoms for short times, but I continue to suffer lengthy bouts of severe dizziness, usually accompanied by nausea and extreme thirst, gritty, painful eyes and some blurring of vision, my neck and shoulder muscles periodically lock up, I constantly have chronic fatigue, a numb right hand, numb right side of head, bouts of excruciating headaches across the front of the head, and a really painful right heel. I constantly have chronically tight shoulder muscles. I have a crunching sound from my neck when move my head around.I have had two episodes when I found it difficult to walk due to a feeling of loss of movement in my thighs.I have recently been diagnosed with a herniated cervical disk and cervical spondylosis. I am again being referred to physiotherapy but am really despairing at the length of time I have been ill. Out of the last three years I have probably only been without symptoms for around four months. I have had several lengthy absences from work and cannot afford any more time off, I have to force myself in to work as I feel so bad. My symptoms are not always simultaneously present and can be a combination of those mentioned. Some days I have the full works! I constantly have a general feeling of illness and severe fatigue. At times it is difficult to climb a flight of stairs. I have tried osteopathy, massage, chiropracty, physiotherapy, acupuncture, heat therapy, cold therapy, traction, all kinds of vitamins, anti inflammatories, enzymes, all to very little avail. I am told my symptoms are not severe enough for surgery, but I am at the end of my tether and feeling very low with what has become a severely challenged quality of life. Can you offer any insight into what may be happening in my neck and if there is any treatment which may relieve these uncomfortable symptoms? Is there any hope of a cure, or am I now faced with spending the rest of my life with these difficult symptoms?

ANSWER: Dear Henryk,

The problem with this is that you have seemingly been to every medical professional known and gotten absolutely no results on this matter.  Unfortunately, doing physical therapy, osteopathy, chiropractic, acupuncture, and traction does not give me any information on what was actually performed in these sessions.  All disciplines have various forms of treatment protocols in their respective fields, and without the notes, I cannot begin to guess what may have transpired with the doctors and therapists.  Not to mention some doctors are really good and others aren't...the same goes for PT's and acupuncturists.

The disc bulge you have mentioned could easily be the cause of the symptoms you have described.  Especially if it is centrally located and places pressure on the nerve roots and spinal cord.  However, bulges such as this are usually candidates for surgery (diskectomy).  If you are not a candidate, then I must assume that there is no or little pressure on the cord.

Syrinx formation is another diagnostic idea.  Although they are much less frequent than a disk bulge/herniation, they are often caused by trauma, and it should be ruled out.  This is a fluid filled cyst in the spinal cord and results in bilateral problems in the neck and arms, and can affect the musculature of the legs as well (this is called a long track sign).  This is usually found on an MRI scan though.  If you haven't had a recent MRI, you may want to get another one to see if the bulge has increased or if a syrinx can be visualized.

In the short term, I think you may be interested in looking into a product I use in my office with patients who have disk bulges and arthritic changes (spondylosis) in the neck who are not surgical candidates.  It is called the posture pump.  The device works to restore the normal curvature of the neck while increasing fluid concentrations to the disk and relieve disk pressure.  It has been proven to actually reduce the disk bulge on MRI and can be quite effective in reducing pain and symptoms.  You can read more about the device on the Internet at www.posturepro.com.  You can also buy the device for home use and it is not cost prohibitive...under $200.00.  I think you should give it a look.

Good Luck Henryk.

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

---------- FOLLOW-UP ----------

QUESTION: Thank you for the advice. The doctors I have seen (I am in Scotland) do not seem that interested in MRIs, I had the herniated disk detected in Poland. They seem to base the decision of whether to operate or not, (not in my case) on the strength in my arms, and whether I have severe pain in my arms. (I don't, one arm is weak, but I can still function with it OK) I recently heard about Upper Cervical Chiropractic (we don't have this in the UK), and am interested in this, I feel that perhaps I am suffering from a sublaxation, do you think this could be causing  such symptoms? On close examination, I do have a high left shoulder, high right hip, bit of a twist to the spine, and my head does lie to one side a bit in what is (to me) a neutral position. I was considering flying to the US for treatment for this, would appreciate your thoughts. Thanks also for the advice on the pressure pump, have ordered one.

Answer
Dear Henryk,

Any form of Chiropractic care will likely help reduce your symptoms, not just upper cervical work.  When the spine becomes fixated, it actually increases the pressure on the disk and reduces the local blood flow to the disk.  This reduces the oxygen and fluid content of the disk resulting in poor nutrition and degeneration.  Not to mention that inflammation increases which further irritates the disk fibers as well as the surrounding nerve roots that supply the arms.

Most chiropractors are trained very well in the manipulation of the upper cervical spine as well as the radiological assessment.  Upper cervical chiropractor may have additional training to focus on that area, however, some of them do not address the remainder of the spine.

I would suggest that you try to find a local chiropractor first or one in the U.K. and get started there before making travel plans to the U.S.  If you have any additional concerns with the chiropractic physicians you consult with or treat with, please feel free to write me back.

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