Question
QUESTION: In Nov 2010 I was struck in midback at work by a large box on a unloading line. At the time of impact, according to several coworkers I fell to the floor, catching most of my weight on my hands/wrists and possibly smacking my skull on the concrete floor ( I do not remember how I got to the floor) When I got up my right hand was tingling and sore but I though it would pass. After over an hour it was getting worse not better and I was told I was "spacing out", so I went home where after less than an hour my wife took me to an immediate care center that told me they did not have testing equipment for the kind of injury but figured it was a pinched nerve in my wrist. I went to a Dr of work's choice the next afternoon who suggested I go to an ER for a CT scan. From there I saw my primary who sent me to a neurologist who has since sent me to a neurosurgeon. But none of them can tell me what is wrong much less how to make the pain stop and me be able to have a "normal" life.

The symptoms I am having that nobody can explain is a hot sharp pain in my neck, especially the right side; numb tingly feeling down the right arm and hand; my grip comes and goes but even at best is less than half what it had been. When the pain hits the hardest I can hardly stand from how overwhelming it gets. I also have pain through the back into the ribs and most terrifyingly a "pasty" feeling in my face as if it were numb or not attached to me. At its' worst moments the facial feeling gets so bad that it affects my speech. I suffer headaches at times and when I have one I can not focus or concentrate. My vision had been doubled and blurry but that has begun to ease recently.
They have me on ibuprofen, naproxen, tramadol and flexeril and with all of them I can just barely function at all on my bad days. I want to be able to play with my daughter and hold my wife again without pain or needing to be wary of how they touch me

ANSWER: Tom,
You need further workup. We all know Worker Comp doctors and/or cases are difficult to navigate, and I am no expert. However, it does sound as if you have more than just a pinched nerve in your hand or wrist. From the symptoms you describe it sounds as if you could POSSIBLY have a small herniation of a disk in your upper back/lower neck area. You need an MRI and possibly a nerve conduction study. A good neurologist could perform those tests. I don't know what you need to do to get the attention of someone, but please do so ASAP. Ask your primary doc for a referral. Of course, it will eventually be paid for by WC, but right now we just need to make sure there is not a herniation, and if so, to what extent. They are more painful than they are dangerous, but if they're large enough they can lead to loss of sensation of a limb. That's why you are having the numbness, tingling, pain, etc. If you need further help let me know. I hope this helps.

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

QUESTION: The MRI the dr ordered showed mild bulging of a disc in my upper cervical spine but according to the doctors the bulge would not affect me at all, much less what I am dealing with. So I am at a loss on what comes next. They sent me to a neurosurgeon last week who basically implied he thinks there is nothing wrong with me at all  and that if there is it is purely psychosematic

Answer
Tom,
Thanks for contacting me again. I had thought of your problems, and wondered how your situation was going.

It is true that some small herniations can cause little to no pain or problems. However, you are having this searing, burning pain and numbness down your arm which is a classic textbook case of herniation in the cervical spine. However small it is your neurologist should take it seriously and at least treat your pain. It is possible, also, to have an epidural injection which is something that might help you a great deal. My son had one for a very small herniation. It helped. The procedure is not painful at all, in case you are worried. I assure you; they numb the area first, and it is completely painless.

IF the neurologist is not reasonable about at least treating your pain, you are still under Worker Comp and (unless I'm wrong) you can consult with any doctor. Consider a pain management specialist. They are the ones who would have to do the epidurals anyway. They are usually anesthesiologists who practice to help treat patients' pain and keep it manageable.

It is entirely understandable that the dr would consider a small herniation to be nonsurgical. He should at least try some physical therapy, water therapy, some mild ultrasound treatments for pain, and, as I said above epidural injections if the pain is too intense.

It may become necessary for you to consult someone to help you navigate this Worker Comp universe. Sometimes doctors work "for" WC and treat these problems very, very conservatively, not taking the patient's interest to heart.

Also, if it is a small herniation you could seek treatment from a chiropractor. They work wonders in cases like these, and they file WC.

Please use the above suggestions Tom, and see where that gets you.

Best,
Patricia RN