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calypso12 08-21-2012 01:15 PM

Help understanding neck x-ray & MRI
I was hoping you could give me some input regarding my x-ray and mri of neck.
Iíve had severe chronic pain for more than 3 years. Much of that time, itís been constant and incapacitating. Iíve seen many specialists and had a gazillion tests. I did get a dx of fibro which it may or may not be. Iíve tried dozens of intervention and medications to treat the pain. currently on 75 mcg Fentanyl + breathru.

Severe constant pain inside my neck. cramping, gnawing sometimes burning.
Pain in back or side of neck that affects mobility
Severe headaches starts with pain in back of neck, pain extends to back of head
Pain in shoulders and arms. (x-ray shoulders was fine). I have very little use of arms. Pain is exacerbated with simple movements, reaching and turning arms. Sometimes simple movements result in blood curdling screams. Pain is in lower and upper arms. Itís worse in bicep area. Painful muscle spasms in upper arm. Sometimes movement of arm that results in tremendous pain makes arm unusable for hours. Itís limp, hold arm against body and canít open hand. Many times, I canít use/extend upper arms. Iím like a penguin hold arms against body. Deep muscle pain in arm and sometimes zapping fleeting pain.
Pain in lower legs, deep muscle pain. sometimes cramp in calf.
Sometimes, I have trouble walking due to cramp in leg or difficulty lifting feet or I drag one leg. Most of the time walking is ok except that I may get pain in a leg while walking.

Hyperreflexia and clonus in leg. No clonus ankle. Sometimes I canít stand on heels or tap foot. This is intermittent. Most of the time I can. (Iíve had mri of back which is fine).

The rheumatologist I see says unequivocally that the pain in my arm/shoulder neck is due to cervical ddd and cervical radiculopathy.

While this makes sense based on my symptoms Iím not sure the imaging supports that.

X-Ray Cervical Spine, 4/2012
Severe degenerative disk disease at C5-6 with the space narrowing and anterior ossified formation. Some neural foraminal impingement on the left at C5-6.

MRI, 5/2012
Study is limited by extensive motion artifact. The technologist reported that the patient was unable to hold still.
There is cervical spondylosis with degenerative disk changes greatest at C5-6 and C6-7.
At the levels of C1 through C4 no significant canal stenosis is seen. Spinal cord detail is poorly defined but there is no evidence of significant cord impingement.
At C5-6 there is decreased height of the disk space with the small posterior disk-osteophyte complex. There is slight effacement of the anterior thecal sac and again no significant cord compression. The neuroforamen are not satisfactorily defined on this exam however, correlation with plain film study from 4/12/2012) revealed at least mild bony left-sided neuroforaminal narrowing at C5-6 level.
At C6-7 there is mild disk desiccation with slight decrease height of the disk space. No significant stenois or cord impingement is seen.

Degenerative disk changes predominately at the levels of C5-6 and C6-7.
Examination is severely limited due to extensive motion artifact.

I did move during exam as I was in pain. Was exhaling thru mouth.

Do I have pinched nerve? My understanding is that x-ray reveals yes but mri no?
It seems like imaging results are not that significant??

The pain in my neck, shoulders and arms is severe and debilitating. Itís extremely painful to use my arms reach for something, open a door etc.

Your input would be greatly appreciated.
Thanks very much.

WebDozer 08-21-2012 06:15 PM

Re: Help understanding neck x-ray & MRI
When you reach, where do you feel the pain? Neck or arms? Both sides or just one (which)?

Really seems like you need another MRI, and maybe another radiologist.

Why does the rheumatologist think it's radiculopathy?

calypso12 08-21-2012 06:52 PM

Re: Help understanding neck x-ray & MRI
thanks for reply webdozer.
when i reach the pain is upper arm, bicep. it can be excruciating.
while i have pain in lower arm. this pain is not made worse with movement.
when i use hands fingers sometimes that brings on pain in upper arms.
for example, it's painful in upper arms to turn steering wheel. i can use my finger such as press a button, use remote and it causes pain in upper arm.
i'm assuming rheumatologist believes pain in (arms/neck/shoulders) is due to ddd and pinched nerve because of how pain presents and imaging.
i thought "neural forminal impingement at C5-6 means pinched nerve?

WebDozer 08-22-2012 06:39 AM

Re: Help understanding neck x-ray & MRI
The neuroforamen is the opening that the nerve passes through. I suppose it's possible for that opening to be impinged upon without the nerve itself being affected. Apparently the doc(s) who looked at the MRI's (other than the rheumatologist) thought so.

Let's say that the nerve is being affected, though. For one thing, the symptoms would be LEFT SIDE only. If that is, in fact, the case, it would seem like a strong argument for radiculopathy and against fibro. Conversely, if you have RIGHT arm symptoms, how could they result from LEFT side radiculopathy?

BTW, the C6 nerve goes down to the thumb and index finger, but not the three other fingers, if that tells you anything.

From my own experience... I have had many cervical spinal problems, and many symptoms stemming from those problems, but PAIN was never one of them. When I did suffer pain, it was post-op, and was centered around reaching, which is when the neck muscles have to be used to hold up the arms. I don't think, in my case, that this was a NERVE problem, but more due to muscle damage/inflammation as the result of the operation. For this reason, I wonder if your neck pain (when reaching) does not originate more in the muscles than the nerves.

Anyway, back to the need for a new MRI. I take it that the radiologist COULD NOT READ the C5-6 level, and was resorting to the X-ray to make his determination of impingement? Is that the "plain film study" he referenced? If so, I don't think you should settle for this. There's a reason MRI's are used for cervical spinal diagnosis and not just X-rays, which are too blunt a tool.

Please keep in mind that all of my pronouncements are no more than the opinions of a self-educated amateur....

calypso12 08-22-2012 05:34 PM

Re: Help understanding neck x-ray & MRI
Thanks again webdozer.
Youíre incredibly knowledgeable & helpful!
I have no pain in thumb or index finger.
I have pain in both arms which would rule out left sided nerve compression.
I wish doc that ordered this mri had explained so simply and clearly.
Also, interesting to hear your experience with cervical spine issues in that pain was not issue (except post op).
You wrote, ďI wonder if your neck pain (when reaching) does not originate more in muscles than nerves. you may have intended to write arm rather than neck as I have pain in my arm when reaching. But you may be right pain very well may originate in muscles not nerves.
Youíve been an enormous help.

WebDozer 08-22-2012 06:26 PM

Re: Help understanding neck x-ray & MRI
You're welcome, but I'm not sure I did any more than confirm the mystery. I don't, of course, mean to say that you don't have radiculopathy. I'm just pointing out why it might be a logical conclusion that you don't, or at least that there may be something else also.

It's be nice if you could show the MRI to the rheumatologist and ask him to justify his radiculopathy dx. He'd probably defend himself by saying that the MRI is unclear, which is hard to dispute. You really need a new one, imo. That MRI tech should not have let you get away with moving...

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